Nelson K. Sewankambo Dean, Makerere University, Faculty of Medicine

1. JUMUIYA YA AFRIKA MASHARIKI Bridging the Worlds of Research and Policy in Kenya, Tanzania and Uganda:The Regional East African Community Health (REACH) Policy Initiative Nelson K. Sewankambo Dean, Makerere University, Faculty of Medicine May 18, 2007, Hamilton, Canada

2. “Because professionals sometimes do more harm than good when they intervene in the lives of other people, their policies and practices should be informed by rigorous, transparent, up-to-date evaluation” Chalmers I: Trying to do more good than harm in policy and practice: The role of rigorous, transparent, up-to-date evaluations. Ann Am Polit Soc Scien 2003; 589:22-40

3. Events in the recent years • Many policy dilemmas regarding scaling up global health initiatives • WHO Ministerial Summit and Global Forum on Health Research (Mexico, November 2004) • “know-do gap” • Recommended knowledge “observatories” Background: Global Perspective

4. The Changing Global Environment Bridging the know-do gap…

5. The Problem- Know-Do Gap

6. Use of evidence in WHO recommendations Andrew D Oxman, John N. Lavis, Atle Fretheim www.thelancet.com Published online May 9 2007 Leading by example: a culture change at WHO Tikki Pang WWW.thelancet.com, Published on line May 9 2007 • Scientific evidence is often not used systematically in the development of recommendations • The needs of end-users are often not taken into account • There is limited consideration of how to implement global recommendation in a local context. • WHO does not always follow its own requirements for development of guidelines

9. An East African ProposalREACH Policy Initiative Regional East African Community Health Policy Initiative Time is right to test a dedicated, credible, professional institutional mechanism to bridge this gap.

10. Goal “To improve people’s health and health equity in East Africa through more evidence-based health policies”

11. Vision “To be the East African centre of excellence for knowledge translation to support formulation of health policy and research agendas”. Mission “To access, synthesise, package and communicate evidence-based health information for influencing policy and practice and for influencing policy relevant research agendas for improved population health and health equity”.

12. Background: Regional Perspective A regional initiative Country consultations: Tanzania, Uganda, Kenya Synthesis meeting led to institutional design Sounding board meeting to test-drive ideas and package proposal Approval of proposal by EAC Ministers of Health Finalize funding proposal Meeting of potential funding partners Dec 2006 establish Secretariat, implementation starts

14. Starting point • The “Duluti Lake” Consultation, Tanzania (2001) • Brainstorming convened by MOH Tanzania • Discuss the gaps between research-policy-practice • Conclusions • Knowledge translation gap is real; and harmful • “Push” and “Pull” systems have not worked well • Need for a new model: “Credible Knowledge Broker” • Ideas for an institutional solution were proposed • Skills and functions were identified • Outcome: IDRC approached to support development of the concept towards such an institutional solution

15. Why is a mechanism needed? • The “Know-Do Gap”. • Sufficient evidence, knowledge, and financial resources exist now to reduce substantially the intolerable burdens of disease carried by the region. • Rapid and efficient translation of knowledge to policy and action is weak. • Researchers have been relatively ineffective in pushing their evidence to policy, and • Policy makers have been relatively inefficient in pulling evidence into policy and practice. It has been concluded that a dedicated, credible, professional institutional mechanism is needed to bridge this gap.

16. Steps in the process • Initially for a national mechanism (Tanzania) (Dec 2001) • TZ NIMR commissioned a consultation to examine options & models ‘03 • IDRC provided funding for concept development 2004 • Regional case studies prepared as base for country consultations (2004) • Series of country design workshops (December 04 -January 05): • Tanzania, Uganda, Kenya • Workshops focused on the need, function, institutional structure, autonomy, resources, country recommendations.

17. Country Consultations 3 countries Tanzania, Uganda, Kenya 20 researchers, policy makers and synthesis group Focus of discussions The need Institutional autonomy/relationship Structure (regional and national Resources Country recommendations

18. Tanzania Consultative meetingBagamoyo, 7-8 December 2004

19. Kenya Consultative MeetingNaivasha 13-14 January 2005

20. Steps in the process • Synthesis for regional institutional design • Health Ministers endorsed the approach in Arusha (Feb 05) • Prospectus tested by international sounding board (March 05) • Regional Council of Ministers endorsed prospectus (July 05) • Funding proposal finalized (June 2006) • Meeting of potential funding partners (Oct 06), selection of Steering Committee and Interim Executive Director

21. Implementation strategy The centre shall act as an independent knowledge broker between researchers and policy makers Obtain research findings in the region and beyond especially for key priority regional health challenges Synthesize the information Package the synthesized information for influencing health policy and practice Communicate the policy briefs. Monitor the impact on policy change and trends of key indicators Formulate research priorities based on policy concerns

22. Start Up: Interim Mechanism Interim regional tripartite committee made up of representatives of Ministries of Health, Research and Academic institutions by end of July 2005 Each country appoints three individuals representing the above named stakeholders to the interim committee. Interim committee must serve until the substantive holders of the posts take over Suitable individual with visionary leadership be hired through a competitive process. The non-voting secretary to the interim committee will be the Health Coordinator of EAC.

23. Regional Hub • Permanent Governance Structure; a tripartite committee with 3 members from each country representing the stakeholders • Substantive chief executive of the institution who will be assisted by technical officers the number which will be determined by the governance committee • Lean secretariat with flexibility for continued consultant utilization

24. East African Community Health Research Council Policy Makers Tripartite Stakeholders Committee 9 members External reviews Donors REACH Executive Director National Research Bodies, Organi- sations under- taking priority research Technical Core Team Administrative Support Regional and International Centres of Excellence for Technical Assistance & Back-stopping Kenya Node Tanzania Node Uganda Node National, Regional, International Initiatives

25. Country Nodes • Country nodes needed to coordinate and facilitate country level activities of REACH and link with the REACH regional hub • Coordinate, dynamize and catalyze the flow of information, knowledge and products of REACH • Channel national demands to the REACH hub • Liaise with related national initiatives and partners • REACH Hub to develop common TORs for the establishment and detailed functions of national nodes through a broad consultative process

26. Staffing of National Nodes To avoid country-level duplication of effort and resources, national nodes will be established and hosted by an institution with adequate physical infrastructure. To function efficiently, the node will be independent with its own identity and not answerable to the head of the hosting institution. The staff will work with a national multi-sectoral steering committee.

27. Main constituencies in the process • Chief medical officers of Ministries of Health for Kenya, Tanzania and Uganda • D-Gs of National Health Research Institutes KEMRI, NIMR, UNHRO • Leaders of academic and NGO health research communities of Kenya, Tanzania and Uganda • East African Community headquarters • International sounding board

28. Sounding Board Meeting Nairobi, 7-8 March 2005

29. Dr. Hassan MshindaIfakara Centre, Tanzania “So if you are poor actually you need more evidence than if you were rich”