EDITORIAL G L O B A L H E A LT H
From Knowledge to Policy: Lessons from Africa
Juliet Nabyonga is the regional advisor on health systems partnerships, monitoring, and evaluation, World Health Organization (WHO) Regional Ofce for Africa, Cite de Djoue, Post Ofce Box 6, Brazzaville, Republic of Congo. Citation: J. Nabyonga, J. Orem, From knowledge to policy: Lessons from Africa. Sci. Transl. Med. 6, 240ed13 (2014).
CREDIT: J. SSALI/UGANDA CANCER INSTITUTE
10.1126/scitranslmed.3008852
www.ScienceTranslationalMedicine.org 11 June 2014 Vol 6 Issue 240 240ed13
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Jackson Orem is the Director and Senior Consultant (Oncology) at the Uganda Cancer Institute, Upper Mulago Hill Rd, Post Ofce Box 3935, Kampala, Uganda; a Member at The Fred Hutchison Cancer Research Center, Seattle, WA 98109, USA; and an Honorary Lecturer at Makerere University School of Medicine, Kampala, Uganda. E-mail: jorem@ mucwru.or.ug
LOWINCOME COUNTRIES ARE FACED WITH THE DOUBLE BURDEN OF COMMUNICABLE and noncommunicable diseases (NCDs), such as diabetes and cancer, and several of these countries are unlikely to meet the Millennium Development Goals laid out by the United Nations (www.un.org/millenniumgoals). High-quality, essential health interventions are scarce in low-income countries, partly because of a lack of local fnancial investment in health care and weak health care systems. However, there are other opportunities to increase fnancial investments in health care in these countries. Indeed, fnancial commitments have already been made by some African heads of state and by World Health Organization (WHO) member states (1). Moreover, substantial funding has been solicited from and awarded by global health initiatives such as Te Global Fund against AIDS, Tuberculosis, and Malaria (www.theglobalfund.org/en), and the Global Alliance for Vaccines and Immunisation (GAVI; www.gavialliance.org), among others. Despite all these eforts, the majority of low-income countries still have a long way to go to achieve universal access to essential health interventions. New technological developments may provide some solutions to increase this access in low-income countries, especially in Africa, but the disciplines of science and technology are still in their infancy in these countries. Moreover, high production costs and a limited market for health care technologies in low-income countries hinder eforts to create locally produced, cost-efective solutions. Tis is especially apparent in the unfolding challenge of NCDs in sub-Saharan Africa. Terefore, when tackling these health issues we need to maximize the potential offered by translational science and innovation from high-income countries and apply it in low-income countries. Tere are opportunities to apply fndings, or replicate research from high-income countries in low-income countries (2). We need to explore how we can ensure the rapid transfer of high-quality, low-cost innovations and technologies that are developed in high-income countries to these low-resource settings. Funding bodies, researchers, and policy-makers tend to focus on the role of evidence for new technologies, without investing enough efort in ensuring their wide application and sustainability in communities that could beneft from them the most. If the goal of application and sustainability is to be achieved, several factors must be addressed. Policy-makers and communities in the recipient country must be involved in the generation and application of knowledge. Tis involvement has to go beyond the current emphasis on sharing research reports and publishing in scientifc journals. Indeed, in order to turn knowledge into policy, partnerships must be built and trust among relevant stakeholders cultivated early on; these partnerships can be realized in any forum in which researchers and policy-makers engage in a systematic manner. Policy-makers in low-income countries must also launch— and take responsibility for—the entire process, from the generation of evidence and new technologies to their application. Last, we need to be mindful of the fact that the translation of evidence must be performed within a given context and culture, because the critical lack of appreciation of these facts has curtailed the usefulness of some otherwise novel innovations and technologies that have been generated in high-income countries for use in lowincome countries. A case in point is a perception that chemicals in insecticide-treated nets are harmful to pregnant women and unborn children, which has negatively afected uptake of bed nets in some parts of Uganda (3). If our desire is the successful difusion of new technologies from developed to developing countries, we must concentrate on exploiting factors that are known to maximize the transfer of innovation, and a clear defnition of knowledge translation must be understood and appreciated because it embodies the entire spectrum: from evidence generation to synthesis, to interpretation, and last, application (4). We need to tap into unexplored potential in the populations of low-income countries and all stakeholders have a potential role to play. For example, communities can put pressure on their leaders and demand that scientifc evidence be translated into policy and applied in the implementation of health programs; research institutions and hospitals can both generate evidence and implement corresponding health services; the media can efectively disseminate research results, transmitting them to com1
EDITORIAL
Downloaded from http://stm.sciencemag.org/ on November 19, 2015
munities at the grassroots level; politicians can not only infuence resource allocation but also disseminate evidence to the communities that elected them, as can local leaders who are respected by the communities they lead. To achieve the difusion of new technologies, we need to understand the positive roles these parties can play and identify and address the challenges they face (5). Te role of professional associations and multinational agencies, such as the WHO, needs to be capitalized on by interested researchers because they are respected partners with infuence on health policy in low-income countries. Researchers from high-income countries must take the time to interface with their peers from low-income countries. Although research capacity is limited in low-resource settings, local researchers are still efective conduits for interaction with local policy-makers. Given the enormous technological advantages that exist in high-income countries, proper synergy with low-income countries can be used to meet the challenges of health care delivery in lowincome countries by building partnerships that focus on the research and implementation of low-tech innovations (5). If properly implemented, an inadvertent beneft of this synergy could be more cooperation between low-income countries themselves. Te key middlemen in this process are the policy-makers in these countries; the sooner they become involved in the process, the greater the impact will be on communities in need in low-income countries. Te advantage of this strong synergy could go even further because it could build local research capacity and scale up the use and sustainability of innovations, with local researchers in charge—even afer researchers from high-income countries leave—bringing services closer to the communities that need them the most. Tis will extend the usefulness of innovation from the notion of “bench to bedside” to “bench to the communities in most need.” – Juliet Nabyonga and Jackson Orem
1. Word Health Organization, The Abuja Declaration: Ten Years On (WHO, Brazzaville, 2011). 2. S. Ebrahim, N. Pearce, L. Smeeth, J. P. Casas, S. Jaffar, P. Piot, Tackling non-communicable diseases in low- and middle-income countries: Is the evidence from high-income countries all we need? PLOS Med. 10, e1001377 (2013). 3. A. K. Mbonye, S. Neema, P. Magnussen, Preventing malaria in pregnancy: A study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan. 21, 17–26 (2006). 4. J. Nabyonga Orem, B. Marchal, D. Mafigiri, F. Ssengooba, J. Macq, V. C. Da Silveira, B. Criel, Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda. BMC Health Serv. Res. 13, 324 (2013). 5. H. Varmus, Medical Research Centers in Mali and Uganda: Overcoming obstacles to building scientific capacity and promoting global health. Science and Diplomacy 3, March (2014).
www.ScienceTranslationalMedicine.org 11 June 2014 Vol 6 Issue 240 240ed13
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From Knowledge to Policy: Lessons from Africa Juliet Nabyonga and Jackson Orem (June 11, 2014) Science Translational Medicine 6 (240), 240ed13. [doi: 10.1126/scitranslmed.3008852] Editor's Summary
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Science Translational Medicine (print ISSN 1946-6234; online ISSN 1946-6242) is published weekly, except the last week in December, by the American Association for the Advancement of Science, 1200 New York Avenue, NW, Washington, DC 20005. Copyright 2015 by the American Association for the Advancement of Science; all rights reserved. The title Science Translational Medicine is a registered trademark of AAAS.
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From Knowledge to Policy: Lessons from Africa
Juliet Nabyonga is the regional advisor on health systems partnerships, monitoring, and evaluation, World Health Organization (WHO) Regional Ofce for Africa, Cite de Djoue, Post Ofce Box 6, Brazzaville, Republic of Congo. Citation: J. Nabyonga, J. Orem, From knowledge to policy: Lessons from Africa. Sci. Transl. Med. 6, 240ed13 (2014).
CREDIT: J. SSALI/UGANDA CANCER INSTITUTE
10.1126/scitranslmed.3008852
www.ScienceTranslationalMedicine.org 11 June 2014 Vol 6 Issue 240 240ed13
Downloaded from http://stm.sciencemag.org/ on November 19, 2015
Jackson Orem is the Director and Senior Consultant (Oncology) at the Uganda Cancer Institute, Upper Mulago Hill Rd, Post Ofce Box 3935, Kampala, Uganda; a Member at The Fred Hutchison Cancer Research Center, Seattle, WA 98109, USA; and an Honorary Lecturer at Makerere University School of Medicine, Kampala, Uganda. E-mail: jorem@ mucwru.or.ug
LOWINCOME COUNTRIES ARE FACED WITH THE DOUBLE BURDEN OF COMMUNICABLE and noncommunicable diseases (NCDs), such as diabetes and cancer, and several of these countries are unlikely to meet the Millennium Development Goals laid out by the United Nations (www.un.org/millenniumgoals). High-quality, essential health interventions are scarce in low-income countries, partly because of a lack of local fnancial investment in health care and weak health care systems. However, there are other opportunities to increase fnancial investments in health care in these countries. Indeed, fnancial commitments have already been made by some African heads of state and by World Health Organization (WHO) member states (1). Moreover, substantial funding has been solicited from and awarded by global health initiatives such as Te Global Fund against AIDS, Tuberculosis, and Malaria (www.theglobalfund.org/en), and the Global Alliance for Vaccines and Immunisation (GAVI; www.gavialliance.org), among others. Despite all these eforts, the majority of low-income countries still have a long way to go to achieve universal access to essential health interventions. New technological developments may provide some solutions to increase this access in low-income countries, especially in Africa, but the disciplines of science and technology are still in their infancy in these countries. Moreover, high production costs and a limited market for health care technologies in low-income countries hinder eforts to create locally produced, cost-efective solutions. Tis is especially apparent in the unfolding challenge of NCDs in sub-Saharan Africa. Terefore, when tackling these health issues we need to maximize the potential offered by translational science and innovation from high-income countries and apply it in low-income countries. Tere are opportunities to apply fndings, or replicate research from high-income countries in low-income countries (2). We need to explore how we can ensure the rapid transfer of high-quality, low-cost innovations and technologies that are developed in high-income countries to these low-resource settings. Funding bodies, researchers, and policy-makers tend to focus on the role of evidence for new technologies, without investing enough efort in ensuring their wide application and sustainability in communities that could beneft from them the most. If the goal of application and sustainability is to be achieved, several factors must be addressed. Policy-makers and communities in the recipient country must be involved in the generation and application of knowledge. Tis involvement has to go beyond the current emphasis on sharing research reports and publishing in scientifc journals. Indeed, in order to turn knowledge into policy, partnerships must be built and trust among relevant stakeholders cultivated early on; these partnerships can be realized in any forum in which researchers and policy-makers engage in a systematic manner. Policy-makers in low-income countries must also launch— and take responsibility for—the entire process, from the generation of evidence and new technologies to their application. Last, we need to be mindful of the fact that the translation of evidence must be performed within a given context and culture, because the critical lack of appreciation of these facts has curtailed the usefulness of some otherwise novel innovations and technologies that have been generated in high-income countries for use in lowincome countries. A case in point is a perception that chemicals in insecticide-treated nets are harmful to pregnant women and unborn children, which has negatively afected uptake of bed nets in some parts of Uganda (3). If our desire is the successful difusion of new technologies from developed to developing countries, we must concentrate on exploiting factors that are known to maximize the transfer of innovation, and a clear defnition of knowledge translation must be understood and appreciated because it embodies the entire spectrum: from evidence generation to synthesis, to interpretation, and last, application (4). We need to tap into unexplored potential in the populations of low-income countries and all stakeholders have a potential role to play. For example, communities can put pressure on their leaders and demand that scientifc evidence be translated into policy and applied in the implementation of health programs; research institutions and hospitals can both generate evidence and implement corresponding health services; the media can efectively disseminate research results, transmitting them to com1
EDITORIAL
Downloaded from http://stm.sciencemag.org/ on November 19, 2015
munities at the grassroots level; politicians can not only infuence resource allocation but also disseminate evidence to the communities that elected them, as can local leaders who are respected by the communities they lead. To achieve the difusion of new technologies, we need to understand the positive roles these parties can play and identify and address the challenges they face (5). Te role of professional associations and multinational agencies, such as the WHO, needs to be capitalized on by interested researchers because they are respected partners with infuence on health policy in low-income countries. Researchers from high-income countries must take the time to interface with their peers from low-income countries. Although research capacity is limited in low-resource settings, local researchers are still efective conduits for interaction with local policy-makers. Given the enormous technological advantages that exist in high-income countries, proper synergy with low-income countries can be used to meet the challenges of health care delivery in lowincome countries by building partnerships that focus on the research and implementation of low-tech innovations (5). If properly implemented, an inadvertent beneft of this synergy could be more cooperation between low-income countries themselves. Te key middlemen in this process are the policy-makers in these countries; the sooner they become involved in the process, the greater the impact will be on communities in need in low-income countries. Te advantage of this strong synergy could go even further because it could build local research capacity and scale up the use and sustainability of innovations, with local researchers in charge—even afer researchers from high-income countries leave—bringing services closer to the communities that need them the most. Tis will extend the usefulness of innovation from the notion of “bench to bedside” to “bench to the communities in most need.” – Juliet Nabyonga and Jackson Orem
1. Word Health Organization, The Abuja Declaration: Ten Years On (WHO, Brazzaville, 2011). 2. S. Ebrahim, N. Pearce, L. Smeeth, J. P. Casas, S. Jaffar, P. Piot, Tackling non-communicable diseases in low- and middle-income countries: Is the evidence from high-income countries all we need? PLOS Med. 10, e1001377 (2013). 3. A. K. Mbonye, S. Neema, P. Magnussen, Preventing malaria in pregnancy: A study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan. 21, 17–26 (2006). 4. J. Nabyonga Orem, B. Marchal, D. Mafigiri, F. Ssengooba, J. Macq, V. C. Da Silveira, B. Criel, Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda. BMC Health Serv. Res. 13, 324 (2013). 5. H. Varmus, Medical Research Centers in Mali and Uganda: Overcoming obstacles to building scientific capacity and promoting global health. Science and Diplomacy 3, March (2014).
www.ScienceTranslationalMedicine.org 11 June 2014 Vol 6 Issue 240 240ed13
2
From Knowledge to Policy: Lessons from Africa Juliet Nabyonga and Jackson Orem (June 11, 2014) Science Translational Medicine 6 (240), 240ed13. [doi: 10.1126/scitranslmed.3008852] Editor's Summary
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Visit the online version of this article to access the personalization and article tools: http://stm.sciencemag.org/content/6/240/240ed13 The editors suggest related resources on Science's sites: http://stm.sciencemag.org/content/scitransmed/5/214/214ed21.full http://stm.sciencemag.org/content/scitransmed/5/199/199ed13.full http://stm.sciencemag.org/content/scitransmed/3/101/101cm28.full http://stm.sciencemag.org/content/scitransmed/5/214/214ra170.full http://stm.sciencemag.org/content/scitransmed/4/152/152ra129.full http://stm.sciencemag.org/content/scitransmed/6/245/245ed17.full http://stm.sciencemag.org/content/scitransmed/6/253/253rv2.full Obtain information about reproducing this article: http://www.sciencemag.org/about/permissions.dtl
Science Translational Medicine (print ISSN 1946-6234; online ISSN 1946-6242) is published weekly, except the last week in December, by the American Association for the Advancement of Science, 1200 New York Avenue, NW, Washington, DC 20005. Copyright 2015 by the American Association for the Advancement of Science; all rights reserved. The title Science Translational Medicine is a registered trademark of AAAS.
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