Understanding the state of health policy and systems research in West Africa and capacity strengthening needs: scoping of peer-reviewed publications trends and patterns 1990-2015.

BACKGROUND: The need for locally-driven, locally-generated evidence to guide health policy and systems decision-making and implementation in West Africa remains urgent. Thus, health policy and systems research (HPSR) is a field with great potential for addressing many of the sub-region's intransigent health challenges. This paper presents an analysis of trends and patterns of peer-reviewed HPSR publications across the Economic Community of West African States (ECOWAS), to help understand trends and patterns of HPSR publication and the degree of involvement of West African researchers in HPSR evidence generation in the sub-region. Our goal was to use the findings to inform the development of a sub-regional strategy to strengthen HPSR and its use to inform development and improvement of health outcomes. METHODS: A scoping review was conducted over a 25-year period from January 1990 to September 2015. Literature searches were conducted in English and French using Google Scholar, PubMed Central and Cairn.info. RESULTS: A total of 258 articles were retrieved. Of these, 246 were statistically analysed, with 54% having West African lead authors. Two thirds of the papers originated from three out of the 15 countries of the ECOWAS, specifically Nigeria (28.86%), Burkina Faso (21.54%) and Ghana (17.07%). Most authors were based in academic institutions and participation of authors from ministries of health, hospitals and non-governmental organisations was limited. English was the predominant language for publication even for papers originating from Francophone West African countries. There has been a progressive increase in publications over the studied period. CONCLUSION: Despite progressive improvements over time, West Africa remains a weak sub-region in terms of peer-reviewed HPSR publications. Within the overall weakness, there is country-to-country variation. The fact that only a handful of countries accounted for nearly 70% of the total volume of publications in West Africa attests to the great disparities in individual, institutional and contextual capacities for HPSR evidence generation. Bridging the gap between lead institutions (universities and research centres) and the practice community (ministries, hospitals, non-governmental organisations) is indispensable for ensuring the practical use of HPSR evidence. There remains a major need for investments in HPSR capacity building in West Africa.

Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa.

BACKGROUND: Despite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context. METHODS: We conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid. RESULTS: A multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health. CONCLUSIONS: To accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

Historical and contemporary factors that influenced the emergence and continuity of WANEL: Lessons for sustainable HPSR network formation in LMICs.

Objectives: To explore historical and contemporary factors and processes that influenced the emergence of WANEL and analyse how the formation process has influenced the network's continued existence and sustainability and lesson for sub-regional health policy and systems research (HPSR) networking in Low -and -Middle -Income Countries (LMICs). Design: Qualitative explanatory case study which used process tracing to chart the formation and development of WANEL. Methods: Data was obtained through document reviews, semi-structured interviews, group discussions, and participant observation. Data was analysed using thematic content analysis. Results: The emergence of WANEL was made possible by several factors, including support from a network of senior HPSR champions and institutions across West Africa; sustained funding from IDRC Canada, a reputable funder with a track record in supporting research capacity development in LMICs; learning and networking opportunities provided by CHEPSAA Emerging Leaders and the Institute of Tropical Medicine Antwerp Emerging Voices for Global Health initiative. Its formation followed a mix of emergent and engineered processes. Conclusion: WANEL is the first and currently the only sub-regional network for early and mid-career health policy and systems researchers and practitioners in West Africa. To ensure its long-term sustainability, the network needs to put in place mechanisms to constantly attract and develop the next generation of early and mid-career researchers, maintain links with senior researchers, strengthen its capacity for coordination and facilitation, and develop a plan for its long-term financial sustainability. Funding: The study is funded by IDRC Canada Project 108237-001: Popularly known as the Consortium for Mothers, Newborn, Children, Adolescents and Health Policy and Systems strengthening in West and Central Africa. (COM-CAHPSS).

The experience of a regional network of health policy and systems actors in translating evidence into policy and action in West Africa.

Objectives: To identify strategies and interventions to strengthen the generation and use of research evidence in health policy and practice decision-making and implementation in the West African sub-region (knowledge translation). Design: The study design was cross-sectional. Data sources were from a desk review, West African Network of Emerging Leaders (WANEL) member brainstorming, and group discussion outputs from WANEL members and session participants' discussions and reflections during an organised session at the 2019 African Health Economics and Policy Association meeting in Accra. Results: Strategies and interventions identified included developing a Community of Practice, a repository of health policy and systems research (HPSR) evidence, stakeholder mapping, and engagement for action, advocacy, and partnership. Approaches for improving evidence uptake beyond traditional knowledge translation activities included the use of cultural considerations in presenting research results and mentoring younger people, the presentation of results in the form of solutions to political problems for decision-makers, and the use of research results as advocacy tools by civil society organisations. Development of skills in stakeholder mapping, advocacy, effective presentation of research results, leadership skills, networking, and network analysis for researchers was also identified as important. Conclusions: To strengthen the generation and use of research evidence in health policy and practice decision-making in West Africa requires capacity building and multiple interventions targeted synergistically at researchers, decision-makers, and practitioners. Funding: Funding for the study was provided by the COMPCAHSS project (#108237) supported by IDRC.