Researchers are from Venus, policy makers

from Mars

Professor Wendy J Graham

Wellcome Trust International Public Engagement Workshop: 3-5 December 2008, Africa Centre, UKZN

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Researchers are from Venus.

Policy makers are from Mars.

Different worlds, different “communities”

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The University of Aberdeen established the First Chair of Medicine in the English-speaking world, in 1497.

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DR ALEXANDER GORDON (1752-1799)

A Treatise on the Epidemic Puerperal Fever of Aberdeen:

1795

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~99.2% of maternal deaths

occur in developing countries

~0.8% of maternal deaths

occur in developedcountries

Estimated 536,000 maternal deaths each year:98% preventable

“Maternal deaths: deaths during pregnancy, delivery, or up to 6 weeks after the end of pregnancy or delivery”

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Millennium Development Goal 5 is off-track

MDG 5 Target

MDG5: 75% reduction in maternal mortality between 1990-2015

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“The role of the scientist is to use research to ascertain the effectiveness of innovative policies

and programs.

This is in contrast to {their} role as advisor in which the scientist can indulge in over-advocacy ...”.

Donald T Campbell 1988 The experimenting society.

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Immpact is the international research

Initiative for Maternal Mortality Programme

Assessment

Purpose: to improve the evidence-base for policy-makers through comprehensive evaluations of safe motherhood

intervention strategies

www.immpact-international.org

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Immpact in brief

• Sept 1st 2002 – Aug 31st 2008

• Funded by DFID, EC, Gates Foundation, UNFPA, USAID, & WHO

• 7 partner research institutions in North and South (University of Aberdeen is co-ordinating centre)

OUTPUT 2New knowledge to

design & implement strategies

OUTPUT 3Stronger capacity for

evidence-based decision-making and outcome evaluation

OUTPUT 1Enhanced methods

for evaluating strategies

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Burkina FasoGhana

IndonesiaNepal

NicaraguaSenegalUganda

Zimbabwe

• Developed & tested measurement “tools” • Synthesized existing evidence• Undertook major evaluations in 3 countries (Burkina Faso, Ghana & Indonesia), plus 5 other collaborations• Strengthened research teams in partner institutions

Immpact activities

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Immpact “closing the loop”

Assessing policy-makers’ priorities for evidence

Gathering & synthesizing

evidence

Translating & communicating evidence for decision-making

Using evidence to inform the

design, implementation & evaluation of

enhanced strategies

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Crucial translation step

Research priority-setting

Knowledge-generation & dissemination

Evidence filtering & amplification

Policy-making processes

Adapted from: Alliance for Health Policy and Systems Research. 2007.

“Translation {evidence filtering & amplification} is the conversion of findings from basic, clinical or epidemiological research into information, resources or tools that can be used to improve health.”

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“One of the big changes in the research-policy interface is the shift from the two community approach to what might be called the network approach”.

Source: Alliance for Health Policy and Systems Research. 2007. Sound Choices: Enhancing capacity for evidence-informed health policy. WHO: Geneva. p25.

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Media

Advocates, civil society, NGOs, parliamentarians

Research institutions

Think tanks

Funding bodies

Government bodies

Demand for evidence is now more diverse

Researchers “need” to work with and for a broader constituency – not just the Ministry of Health

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Networks also bring opportunities

..policy-makers are more likely to use evidence in political systems that call them to account through strong networks and an active media.”

Source: Alliance for Health Policy and Systems Research. 2007.

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Creating an enabling environment for translation

• Start from the perspective of decision-makers

• Ensure continuity of linkages and exchange

• Promote multiple pathways to translation & form strategic alliances

• Capitalise on personal contacts, trust & credibility

• Timely findings (planning or budget cycles; reforms)

• Communicate effectively (filtered/amplified evidence; tailored messaging)

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Researchers are from Venus.

Policy-makers are from Mars.

Communicators are from Pluto.

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0

100

200

300

400

500

600

700

Mat

erna

l dea

ths

per 1

0000

0 liv

e bi

rths

Sri Lanka Thailand MalaysiaHonduras Egypt Matlab, BangladeshBangladesh MM Survey 2001 China India

“Tell us the good news”

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There is no magic bullet – or “shot in the arm” - for maternal mortality reduction

“Tell us the certainties – not the complexities”

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Serang and Pandeglang (2004-2006)

Wealth quartile

Poorest

Low middle

Upper middle

Richest

* based on enumeration of all deaths (n= 474) and expected number of births in each village

Relationship between maternal mortality & skilled attendant: Indonesia

Proportion attended by skilled

attendant

Maternal deaths per 100,000 live births* (95% CI)

Yes 10% 2303 (1487-3292)No 90% 541 (420-684)

Yes 17% 1218 (773-1830)No 83% 278 (201-373)Yes 33% 778 (541-1076)

No 67% 280 (195-388)Yes 71% 257 (181-351)No 29% 202 (107-334)

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“Four births and a funeral”(or children sitting

on their mother’s grave)

WHO, 2004

“We need powerful messages and imagery”

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• Tackling the burden in the poorest women will achieve the greatest reduction in maternal mortality overall.

2. Financing mechanisms can be used to facilitate universal access to skilled care at delivery, including emergency care.

“Give us evidence to support our policies”

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Who should do translation of research evidence?

Knowledge brokers work at the interface between research organizations and their target audiences.

http://www.research-transfer.org

Knowledge brokers aim to provide evidence that is accessible, timely, credible and trusted, and packaged in user-friendly format, relevant to the local context.

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Researchers are from Venus.

Policy-makers are from Mars.

Communicators are from Pluto.

Knowledge brokers are from……..?

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QUESTIONS FOR DISCUSSION?

Not a matter of why do engagement, but…

How “best” to do it?Who “best” to do it? How to show it “works”

What are the roles & responsibilities of different stakeholders in answering these questions?