Rhona Mijumbi, MD, PhD (c)
KT workshop, Ministério da Saúde, Brasília, Brasil 27 August 2014
Part I
Part I (3hrs) ◦ Rapid Response Methodologies (RRM)
◦ An overview of rapid response mechanisms using Uganda (Africa) as a case study
Model and establishment and spread
Part II (2hrs) ◦ Running (day to day)
Overview and resources
Practical bits (clarification, developing a search strategy, searching, appraising evidence, summarizing
Other issues – user testing (usability testing,
discussion (1hr)
What are RRMs
Why and when RRMs
Features of an RRM
RRMs using The REACH-SURE Model ◦ Establishment
◦ Development/set up
◦ Successes/Challenges/Issues
A form of KT strategy set up to avail already
synthesized research evidence to facilitate
decision makers in passing quick and/or urgent
decisions of policy relevance.
Avails timely and relevant research evidence ◦ Best available evidence (quality, quantity)
◦ At the time it is needed
◦ In direct response to an urgent need (individual,
institutional)
◦ Contextualized
◦ Accessible – package, language, size
Urgent needs for evidence may arise ◦ In daily context of parliament, media, meetings ◦ In real or perceived crises ◦ As spurts that are part of longer decision making
processes
** Urgent is relative (in this case it is defined by the evidence-user). ◦ However a service will provide its working definition
of what it considers as urgent
Lavis et al, 2006
Timeliness
Relevance
Interaction
Direct and tailored to one’s need
◦ contributing to the processes within the longer more
complex process of policy and guideline formulation
◦ potential impacts on decisions that are made urgently
when there is a real or perceived need to respond
◦ potential impacts on attitudes and the general climate
in which policy is developed
◦ developing a better understanding of policymakers’
needs for research evidence in their daily work
Questions
Organizations or Agencies with some form of rapid response mechanism.docx
Features ◦ Hired staff (researchers, knowledge brokers)
◦ Decision makers
◦ Link (Physical or ICT)
◦ Research (or access to)
◦
REACH-SURE model
Health systems queries
• Financing, Governance
• Organization arrangements
• Implementation strategies
• HTAs
Time within - 28days
• Search strategy drawn
and compared amongst
team
• Search is done for the
best available research
evidence
• Evidence appraised,
contextualized and
summarized
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1. Identifying literature and provide links to the policy maker
2. Appraise the literature and give summary of the evidence (evidence summaries)
3. Full document (evidence brief for policy) of appraised and contextualized evidence
4. Full document of appraised and contextualized evidence, reviewed by content experts
5. Full document of appraised and contextualized evidence, reviewed by content experts and involved in a policy dialogue
Questions
The establishment of a RRM
Case study : REACH-SURE RRS
Lavis et al. 2006
Country-level efforts to link research to action
i. The general climate
ii. The production of research
iii. A mix of four clusters of activities used to link research to action.
a. Push efforts b. Efforts to facilitate "user pull"
("one-stop shopping" and rapid-response units)
c. “User pull" efforts undertaken by those who use research
d. Exchange efforts
iv. Approaches to evaluation
Healy et al. 2007
RRMs ◦ not feasible, not
appropriate, not necessary
Because ◦ Evidence - requires careful
assessment and planning, within different contexts and highly political environments
◦ Information has to be context specific
◦ provision of information often depends on external information providers
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Healy et al.’s arguments in fact highlight three crucial issues the lack of experience with organized efforts to meet
policymakers’ needs for rapid and urgent responses
the importance of a rapid response service being based within a country or region
the important challenges that must be met by a rapid response service
REACH – PI RRM
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Continued input from •Advisory group •Inter-country network of SURE-EVIPNet partners
Item Comment
Personnel (salary and allowances) What is spent here would depend on the personnel;
these may be few but with all the skills needed or a
number of them with a skill mix.
Office space with amenities This may be part of space already present at the host
institution otherwise space may have to be hired and
amenities like water, electricity and cleaning services
paid for.
Equipment
Furniture (Desks, chairs, filing cabinets)
Computers and Printers
Stationary (paper, office equipment like staplers
etc)
Communication
Internet connection (initial and monthly
deposits)
Telephone connection
For reliability especially because of the nature of the
work and the fact that time may be a constraint many
times, more than one internet connection or provider
may be needed.
Item Comment
Transport (enable meeting policymakers and
attending meetings whenever necessary)
This may be provided when it is needed or may
be paid out as part of allowances
Subscription or access to peer reviewed
journals
If the service is a part of an institution this may
be easier as they would have access to these as
part of the institution.
Sensitization and advertisement Depends on the method chosen, choices
include brochures, flyers, sensitization
meetings, sensitization letters among others
Training in research and research methods ◦ ability to critique research objectively
Training in Health Policy (analysis) ◦ Policy and decision analysis and contextualizing, for
relevant information to be relayed and not just everything found in the research
Skills that are of advantage: ◦ Search skills ◦ Writing skills ◦ Communication skills ◦ Time management
Questions
Establishment vs Setting up
(Long term vs short term)
Timeline of events in establishment of REACH RRS
Important elements in the establishment of RRMs
Governance and organization of a RRS
Sustainability
Capacity / Capacity building
Governance of KT
Political
Leadership
•Create the environment that allows or hinders KT and
strategies for KT. They are also instrumental HR users of
the strategy
Technical
Leadership
•Give direction and mentorship to the technical personnel
• Give direction to the political leadership
Technical
Capacity
•Carry out the real KT work
Champions
This varies and each place may have advantages and disadvantages. Research is still ongoing about this for LIC.
In high income countries most of these supportive think-tanks or similar services have been based in academic institutions
Options ◦ Academic institutions ◦ Ministries or Departments of Health, Government
institutions ◦ Independent private institution
Host Institution Advantages Disadvantages
Academic institution e.g REACH-SURE RRS Uganda
•Easy access to research through institutional subscriptions •Support from other researchers e.g. for research location, reviews of briefs, etc •Neutral/unbiased view of the policy questions
• May be looked upon with suspicion by the end-users (policymakers) of the research •Do not have continued easy access to the on-going decisions in the policymaking world
Ministry/Department of Health e.g EVIPNet-SURE Burkina Faso
•Easy access to policy making process and therefore contextualizing queries •Viewed in a more acceptable and friendlier manner than a service based at a research institute •Easy to push their products of research evidence as seen to be legitimate part of the policymaking body
• Access to research may be limited and not easy • More prone to influence from within the ministry on given positions (may not be entirely neutral)
Private institution (Semi-autonomous) CDBPS – Cameroon ZAMFOHR - Zambia
• Neutral/unbiased view of the policy questions •Resources may be more than those seen in the other public institutions e.g. better internet connections, better personnel remuneration, etc
• Usually profit-making organization that might be prone to bias •Access to research may be limited by how much organization is willing to invest in resources •Support from researchers may be limited by level of interaction/networking
Consider your country and its context and discuss where the best place would be for a Rapid Response Service to be set, giving reasons why.
What challenges do you foresee in setting such a service up?
How would you overcome these?
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