Governments across the globe are progressively realizing the significance of research synthesis in health policy and systems decision-making processes. Research evidence is required to inform routine policy decision-making but sometimes these policy decisions have to be made in emergency situations as well. In such contexts, rapid reviews provide an efficient solution to inform health policy and systems decision-making as they provide robust high-quality evidence in a timely and cost-effective way. The Agency for Health Care Research & Quality (AHCRQ) defines rapid reviews as a form of evidence synthesis that may provide more timely information for decision-making compared with standard systematic reviews.1 This direction towards institutionalising rapid response mechanisms where researchers respond to queries from policy-makers or health systems managers through rapid evidence products provides a big opportunity to facilitate evidence-informed policy-making more sustainably.
Embedding Rapid Reviews in Health Systems Decision Making in Zimbabwe (ERAZ)
Ronald Munatsi, from the Zimbabwe Evidence Network (ZeipNET) had an interview with Mr. Banda, the Zimbabwe Ministry of Health and Child Care (MoHCC) Director of Policy Planning to share the ministry’s experience with rapid evidence synthesis. MoHCC is working to institutionalize a rapid evidence synthesis platform in the ministry under the ‘Embedding RApid Reviews in Health Systems Decision Making’ (ERA) project supported by the World Health Organisation Alliance for Health Policy & Systems Research (AHPSR). The project will ensure:
That an ERAZ platform is developed embedded and sustained within the MoHCC.
That the MoHCC acquires the current skills and knowledge levels in conducting rapid reviews and produce evidence synthesis products like, policy briefs and other evidence summaries that are friendly and easy to use for policy and decision makers.
That a wider ecosystem or institutional landscape exists with networks to facilitate production, synthesis and use of research evidence in health policy and practice.
The development of a continuously updated online knowledge repository of policy relevant evidence to support informed policy and decision-making
Streamlined, Focused Evidence Generation and Stakeholder Engagement
According to the Director, the ERAZ project aims at ensuring that the best quality evidence gathered in the shortest possible time is used to back policy decisions. Previously it used to take the ministry a long time to gather and synthesise evidence as they relied on commissioned research studies that were carried out over lengthy periods. Effectively linking research and policy cycles has always been a challenge for the ministry but the ERAZ project has changed that. The policy and planning department is now able to swiftly respond to direct evidence needs on specific health policy or health system issues. The ERAZ project has also resulted in improved stakeholder engagement in generating evidence to inform the policy process. Before the ERAZ project there was not much being done to engage stakeholders as a means of gathering evidence. Extensive stakeholder engagement is now being done and this is creating the necessary consensus for policy change. Sharing and exchanging information with various communities of practice and other stakeholders has proved to be very helpful in prioritizing needs and identifying policy options and barriers to implementation. The project has also resulted in building institutional support for evidence informed policymaking and the development of individual skills to find, assess and communicate evidence for policy.
Good Fit With Broader Ministry Strategies
The ERAZ project not only came at a very opportune time but fits really well with broader ministry strategies. The National Health Strategy of Zimbabwe 2016-20202 seeks to create an enabling environment for quality health care provision through evidence based, effective management. Strategic Objective 21 is, “To improve uptake of scientific research evidence for decision making and policy development.” The specific objective of the same is for the Ministry of Health and Child Care (MoHCC) to promote the translation of research into policy and practice. The ERAZ project started at a time when the ministry is carrying out the mid-term review of the National Health Strategy. Similarly the ERAZ team is leading on building evidence to inform the proposed National Health Insurance Bill. This was a deliberate move to create demand for the evidence synthesis platform and demonstrate its relevance. This is prime time for rapid evidence synthesis and not the lengthy research cycles the Ministry was used to. Now in a couple of weeks the Ministry can now produce a rapid evidence synthesis product like a policy brief using a streamlined systematic review approach.
Previous Challenges & Future Opportunities
Rapid evidence synthesis is a fairly new concept and initially there has been some bit of resistance to change particularly in view of the fact that the ERAZ project seeks to institutionalize and embed certain skills and processes. The Ministry and other stakeholders in the research-to-policy mix used to work in silos. Although policy makers in the ministry have always acknowledged the importance of evidence, they were not used to getting quality evidence quickly. There is also the sticky relationship between policy makers’ strategic priority to quickly and conveniently inform decision-making by the best available evidence and the scientific necessity to be rigorous in coming up with robust, high-quality research. However within a short space of time, rapid reviews have started to be recognized as an ideal approach to obtain the necessary context specific evidence pertinent to varied health policy and health system backdrops. There is now need for extensive stimulation of demand for these products among policy makers because rapid reviews often originate directly from requests or queries from end-users. This demand-driven quality is the one that strengthens their relevance and impact in health policy and systems decision-making. The Director’s partying short was that although embedding evidence synthesis platforms is difficult for starters due to the structural and other changes that are required, once established the benefits are immense. Consequently, other government institutions should consider institutionalising rapid evidence synthesis platforms.