A scoping review of researchers’ involvement in health policy dialogue in Africa

The gap between research and health policy development in low- and middle-income countries appears uncontended. Mounting evidence demonstrates that the health policy-making process in these countries is prescriptive, insufficiently evidence-based, and inconsiderate of contexts [1, 2]. The political tussle over the formation of values and ideas informing health policy directives increases the propensity for misusing the already scarce resources, which hampers the economic growth and worsens the instability of social systems [3]. Globally, researchers and academic experts, largely considered to be well-informed citizens, discourage the formation of policies based on decision-makers’ personal ideas, interests, or experiences [1, 4]. Looking at the formation of health policies in the African context, Siron and his colleagues [5] identified that the increasingly politicized health policy decisions are driven by the ideological motivations of stakeholders who overlook research evidence to advance their political interests.

The global concern for evidenced-informed policies in Africa relates to the humanitarian call to build the capacity of local policy actors for developing evidence informed health policies [3, 6, 7]. For instance, in 2011 the European Union, World Health Organization (WHO), and the Government of Luxembourg formed a partnership to help build the capacity of developing countries for evidence-informed health policies using policy dialogue [6]. Nonetheless, researchers’ involvement in policy dialogue in Africa remains unclear.

The complicated relationship between researchers and politicians sparked the creation of deliberative dialogue platforms, to facilitate the process of multiple stakeholders participating in evidence-informed policy decision-making [7]. Policy dialogue is a participatory approach to policy making based on evidence, deliberative discussion, workshop interaction, and consultation [8, 9]. A strong and independent policy research organization can play an important role in informing and shaping policies for the greatest good of the public [10]. The sustained development of capacity for health policy research and uptake of evidence is a key priority for WHO. The Organization promotes efforts towards fostering and encouraging a culture of evidence-informed decision-making through strengthening the capacity of research institutions and stimulating the interest of policymakers [11].

The process of policy influence through research is complex and non-linear and demands much more than an ability to produce high caliber research [12]. Some researchers operate in environments with traditions of social participation; others have limited input. Despite these differences, all health researchers must grapple with political realities in their local contexts. A reflective and cross-sectional analysis of national deliberative policy dialogue workshops in six west African countries reported by Riddle and Dagenais [7] suggested that there are several challenges related to the facilitation of successful evidenced-informed policy dialogue. As such, researchers need the capacity not just to produce knowledge, but to navigate in complex terrain. There is scant evidence on factors that affect researchers’ involvement and contribution to health policy dialogue in Africa. This paper explores the current practice of policy dialogue in relation to the incorporation of research evidence for health policy formation in the African context. Therefore, a scoping review was conducted to examine the researchers’ involvement range, researchers’ roles, facilitators, and barriers to researcher’s involvement in health policy dialogue in Africa.

A scoping review was conducted to determine the range and nature of research activity concerning the barriers and facilitators of researchers’ involvement in health policy dialogues in Africa. A scoping review is a research methodology used to identify key factors related to a concept, to map the available evidence, and discuss the concept or key factors [13]. The preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist was used to present the study methodology and findings [14, 15].

This scoping review aimed to analyse the barriers and facilitators of researchers’ involvement in health policy dialogue in Africa. This study found that internal factors (related to researchers) that motivated researchers include advocacy, personal, and professional development. The main factor hampering their involvement in policy dialogue was the absence of a conducive environment, which include financial resources to focus their research on relevant public health issues and to get involved in policy-making activities. External factors (related to the political environment) that enabled researchers’ involvement in policy dialogue include the following: an appreciation for researchers’ contribution, the presence of a knowledge translation platform, funding, and clear communication between researchers and policymakers. Findings of this scoping review are consistent with other research. Several research studies revealed numerous factors that determine whether and how research evidence is taken into account in decision-making: decision-makers’ opinions about research utility, their skill in interpreting and using research evidence, and whether there is a supportive context for its use [2, 40]. Likewise, Moat and colleagues show that decision-makers are influenced by institutional constraints, interest group pressures, personal convictions and values, external factors such as economic recession or elections, external funding, and research data [12]. It is worth noting that in many African countries, researchers’ involvement in health policy dialogue remains sub-optimal. Thirty-three percent of the countries (n = 9) represented in this study did not report the participation of researchers in the policy process. In an additional 15% (n = 4) of the countries, researchers were involved in only half of the health policy dialogues. Major issues reported in such instances are lack of evidence on public health issues discussed and poor methodology during the policy dialogue. The absence of research evidence during the policy dialogue generally results in the use of anecdotal evidence [20], which hardly yield effective interventions. Participation of researchers in the policy process has also been reported to be beneficial to policymakers because capacity-building activities could be developed to improve their skills regarding evidence-based policy-making processes [16]. This finding highlights the need to develop knowledge translation platforms that encourage the involvement of all key stakeholders in the entire process of health policy-making.

In most African countries, international donors can have an influence on policy processes with a bearing on the proposed solutions [41]. It has been reported that external donors impose their preferences rather than discussing several options for addressing a locally identified problem [42]. However, country ownership and donors’ influence has successfully coexisted in several contexts [43]. In this study, local researchers were involved in policy dialogues even when funding originated from international organizations or partnerships. Although the studies reviewed do not provide a distinction between the roles of local and external researchers, the involvement of local researchers was reported where researchers contributed to policy dialogues. Previous research has emphasized the importance of engaging local researchers on public health issues relevant to their countries and expertise. Local researchers have pivotal roles to play, first and foremost by assisting the MoH with key studies and localized and decentralized information. They also have an important advocacy role, i.e. bringing to attention priority health issues and offering options to solve them [9]. In practice, however, stakeholders who provide funding may be perceived as more important than others. A tacit establishment of a certain hierarchy of stakeholders can affect local researchers’ abilities to influence health policy dialogues.

In many African countries, the production of research evidence is often very limited [44]. Due to limited funding in the research sector, researchers are highly involved in consultancy tasks. These consultancy contracts require commissioned reports and researchers may not have enough time to increase their ability to apply scientific reflection [45]. Furthermore, evidence shows that researchers’ influence on policy is shaped by their reputations as independent researchers that provide credible research and their agility in navigating the local policy landscape and participating in policy debates [45]. Independence is closely linked to financial sustainability. Core funding can help position grantees for policy influence by increasing their independence and credibility, staff reputations, and communication skills. Sustaining this independence over the long-term demands strengthening internal capacities [11].

Engaging policymakers early in the research cycle helps to ensure uptake of evidence. Researchers’ ability to influence policies is strongly shaped by external factors, especially political barriers. Their agility in responding to these shifts rests in part on their skills in engaging with stakeholders, so that they are attuned to the environment. Choosing the right points of entry for policy engagement is equally important [46]. WHO stresses the value of closer collaboration between research organizations and the policymakers they seek to influence, so that evidence creation is better aligned with policy priorities [11]. At the same time, researchers need to maintain an ethical and impartial stance, ensuring that multiple perspectives inform their research. Achieving this balance demands considerable skill. Achieving policy influence takes a “whole organization” approach. Strong research institutions alone are insufficient to create a culture of evidence-based policy-making [12]. Citizens must be able to demand accountability and participate in decision-making [47]. It is important that research institutions involve community representatives, the media, and advocates for marginalized groups directly in research, from project proposal to completion stages. This strengthens research design while helping communities understand the value of evidence and their own participation in the policy-making process [10]. Donors can help position researchers for influence through flexible funding arrangements that provide for organizational strengthening, while reinforcing researchers’ independence.

To properly evaluate the effectiveness of policy dialogues in Africa, more studies describing policy-making processes around various public health issues need to be published. Out of the 21 countries included in our review, only four countries (15%) had at least three studies. As more studies per country are being published, a more complete picture of country-level policy landscapes could be presented, and country-specific tailored interventions could be implemented to develop productive and consultative platforms where health policies could be discussed.

The major strength of this scoping review is the focus on researchers’ involvement in health policy dialogues in Africa. Many studies have been published on policy-making processes in various African countries, but there is limited evidence on barriers and facilitators of researchers’ involvement in this process. The main limitation of this study is the limited amount of information on the policy-making process available at the country-level as most countries represented in this scoping review had only one publication (n = 11) and were sometimes published as part of multinational studies (n = 8).

This review provides an overview of evidence on researchers’ involvement in health policy dialogue in Africa and highlights barriers and facilitators of this involvement. The most important factor related to researchers’ involvement was the presence of a conducive environment that would support and value research while promoting knowledge translation activities. Such an environment would only be functional with adequate funding, trust and communication between policymakers and researchers, and promising personal and professional development opportunities for researchers. Discrepancies exist across countries and sometimes within a specific country. More than half of the countries represented had partial to no researchers’ involvement in policy dialogues. While low- and middle-income countries are still striving to increase the uptake of evidence in health policies, these findings highlight areas for improvement. Further evidence on policy processes within specific settings are needed to better inform interventions or practices.