Institutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria.

BACKGROUND: Evidence-informed policy-making aims to ensure that the best and most relevant evidence is systematically generated and used for policy-making. The aim of this study was to assess institutional structures, funding, policy-maker perspectives on researcher-policy-maker interactions and the use of research evidence in policy-making in five states in Nigeria. METHODS: This was a cross-sectional study carried out among 209 participants from two geopolitical zones in Nigeria. Study participants included programme officers/secretaries, managers/department/facility heads and state coordinators/directors/presidents/chairpersons in various ministries and the National Assembly. A pretested semi-structured self-administered questionnaire on a five-point Likert scale was used to collect information on institutional structures for policy and policy-making in participants' organizations, the use of research evidence in policy and policy-making processes, and the status of funding for policy-relevant research in the participants' organizations. Data were analysed using IBM SPSS version 20 software. RESULTS: The majority of the respondents were older than 45 years (73.2%), were male (63.2) and had spent 5 years or less (74.6%) in their present position. The majority of the respondents' organizations had a policy in place on research involving all key stakeholders (63.6%), integration of stakeholders' views within the policy on research (58.9%) and a forum to coordinate the setting of research priorities (61.2%). A high mean score of 3.26 was found for the use of routine data generated from within the participants' organizations. Funding for policy-relevant research was captured in the budget (mean = 3.47) but was inadequate (mean = 2.53) and mostly donor-driven (mean = 3.64). Funding approval and release/access processes were also reported to be cumbersome, with mean scores of 3.74 and 3.89, respectively. The results showed that capacity existed among career policy-makers and the Department of Planning, Research and Statistics to advocate for internal funds (mean = 3.55) and to attract external funds such as grants (3.76) for policy-relevant research. Interaction as part of the priority-setting process (mean = 3.01) was the most highly rated form of policy-maker-researcher interaction, while long-term partnerships with researchers (mean = 2.61) had the lower mean score. The agreement that involving policy-makers in the planning and execution of programmes could enhance the evidence-to-policy process had the highest score (mean = 4.40). CONCLUSION: The study revealed that although institutional structures such as institutional policies, fora and stakeholder engagement existed in the organizations studied, there was suboptimal use of evidence obtained from research initiated by both internal and external researchers. Organizations surveyed had budget lines for research, but this funding was depicted as inadequate. There was suboptimal actual participation of policy-makers in the co-creation, production and dissemination of evidence. The implementation of contextually relevant and sustained mutual institutional policy-maker-researcher engagement approaches is needed to promote evidence-informed policy-making. Thus there is a need for institutional prioritization and commitment to research evidence generation.

Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria.

BACKGROUND: Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria. METHODS: The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada. RESULTS: At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents' mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful). CONCLUSION: The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.

Improving maternal and child healthcare programme using community-participatory interventions in Ebonyi State Nigeria.

In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP). The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government's FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers' groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities' health.