Rhona Mijumbi, MD, PhD (c)

KT workshop, Ministério da Saúde, Brasília, Brasil 27 August 2014

Part I

Part I (3hrs) ◦ Rapid Response Methodologies (RRM)

◦ An overview of rapid response mechanisms using Uganda (Africa) as a case study

Model and establishment and spread

Part II (2hrs) ◦ Running (day to day)

Overview and resources

Practical bits (clarification, developing a search strategy, searching, appraising evidence, summarizing

Other issues – user testing (usability testing,

discussion (1hr)

What are RRMs

Why and when RRMs

Features of an RRM

RRMs using The REACH-SURE Model ◦ Establishment

◦ Development/set up

◦ Successes/Challenges/Issues

A form of KT strategy set up to avail already

synthesized research evidence to facilitate

decision makers in passing quick and/or urgent

decisions of policy relevance.

Avails timely and relevant research evidence ◦ Best available evidence (quality, quantity)

◦ At the time it is needed

◦ In direct response to an urgent need (individual,

institutional)

◦ Contextualized

◦ Accessible – package, language, size

Urgent needs for evidence may arise ◦ In daily context of parliament, media, meetings ◦ In real or perceived crises ◦ As spurts that are part of longer decision making

processes

** Urgent is relative (in this case it is defined by the evidence-user). ◦ However a service will provide its working definition

of what it considers as urgent

Lavis et al, 2006

Timeliness

Relevance

Interaction

Direct and tailored to one’s need

◦ contributing to the processes within the longer more

complex process of policy and guideline formulation

◦ potential impacts on decisions that are made urgently

when there is a real or perceived need to respond

◦ potential impacts on attitudes and the general climate

in which policy is developed

◦ developing a better understanding of policymakers’

needs for research evidence in their daily work

Questions

Organizations or Agencies with some form of rapid response mechanism.docx

Features ◦ Hired staff (researchers, knowledge brokers)

◦ Decision makers

◦ Link (Physical or ICT)

◦ Research (or access to)

◦

REACH-SURE model

Health systems queries

• Financing, Governance

• Organization arrangements

• Implementation strategies

• HTAs

Time within - 28days

• Search strategy drawn

and compared amongst

team

• Search is done for the

best available research

evidence

• Evidence appraised,

contextualized and

summarized

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1. Identifying literature and provide links to the policy maker

2. Appraise the literature and give summary of the evidence (evidence summaries)

3. Full document (evidence brief for policy) of appraised and contextualized evidence

4. Full document of appraised and contextualized evidence, reviewed by content experts

5. Full document of appraised and contextualized evidence, reviewed by content experts and involved in a policy dialogue

Questions

The establishment of a RRM

Case study : REACH-SURE RRS

Lavis et al. 2006

Country-level efforts to link research to action

i. The general climate

ii. The production of research

iii. A mix of four clusters of activities used to link research to action.

a. Push efforts b. Efforts to facilitate "user pull"

("one-stop shopping" and rapid-response units)

c. “User pull" efforts undertaken by those who use research

d. Exchange efforts

iv. Approaches to evaluation

Healy et al. 2007

RRMs ◦ not feasible, not

appropriate, not necessary

Because ◦ Evidence - requires careful

assessment and planning, within different contexts and highly political environments

◦ Information has to be context specific

◦ provision of information often depends on external information providers

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Healy et al.’s arguments in fact highlight three crucial issues the lack of experience with organized efforts to meet

policymakers’ needs for rapid and urgent responses

the importance of a rapid response service being based within a country or region

the important challenges that must be met by a rapid response service

REACH – PI RRM

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Continued input from •Advisory group •Inter-country network of SURE-EVIPNet partners

Item Comment

Personnel (salary and allowances) What is spent here would depend on the personnel;

these may be few but with all the skills needed or a

number of them with a skill mix.

Office space with amenities This may be part of space already present at the host

institution otherwise space may have to be hired and

amenities like water, electricity and cleaning services

paid for.

Equipment

Furniture (Desks, chairs, filing cabinets)

Computers and Printers

Stationary (paper, office equipment like staplers

etc)

Communication

Internet connection (initial and monthly

deposits)

Telephone connection

For reliability especially because of the nature of the

work and the fact that time may be a constraint many

times, more than one internet connection or provider

may be needed.

Item Comment

Transport (enable meeting policymakers and

attending meetings whenever necessary)

This may be provided when it is needed or may

be paid out as part of allowances

Subscription or access to peer reviewed

journals

If the service is a part of an institution this may

be easier as they would have access to these as

part of the institution.

Sensitization and advertisement Depends on the method chosen, choices

include brochures, flyers, sensitization

meetings, sensitization letters among others

Training in research and research methods ◦ ability to critique research objectively

Training in Health Policy (analysis) ◦ Policy and decision analysis and contextualizing, for

relevant information to be relayed and not just everything found in the research

Skills that are of advantage: ◦ Search skills ◦ Writing skills ◦ Communication skills ◦ Time management

Questions

Establishment vs Setting up

(Long term vs short term)

Timeline of events in establishment of REACH RRS

Important elements in the establishment of RRMs

Governance and organization of a RRS

Sustainability

Capacity / Capacity building

Governance of KT

Political

Leadership

•Create the environment that allows or hinders KT and

strategies for KT. They are also instrumental HR users of

the strategy

Technical

Leadership

•Give direction and mentorship to the technical personnel

• Give direction to the political leadership

Technical

Capacity

•Carry out the real KT work

Champions

This varies and each place may have advantages and disadvantages. Research is still ongoing about this for LIC.

In high income countries most of these supportive think-tanks or similar services have been based in academic institutions

Options ◦ Academic institutions ◦ Ministries or Departments of Health, Government

institutions ◦ Independent private institution

Host Institution Advantages Disadvantages

Academic institution e.g REACH-SURE RRS Uganda

•Easy access to research through institutional subscriptions •Support from other researchers e.g. for research location, reviews of briefs, etc •Neutral/unbiased view of the policy questions

• May be looked upon with suspicion by the end-users (policymakers) of the research •Do not have continued easy access to the on-going decisions in the policymaking world

Ministry/Department of Health e.g EVIPNet-SURE Burkina Faso

•Easy access to policy making process and therefore contextualizing queries •Viewed in a more acceptable and friendlier manner than a service based at a research institute •Easy to push their products of research evidence as seen to be legitimate part of the policymaking body

• Access to research may be limited and not easy • More prone to influence from within the ministry on given positions (may not be entirely neutral)

Private institution (Semi-autonomous) CDBPS – Cameroon ZAMFOHR - Zambia

• Neutral/unbiased view of the policy questions •Resources may be more than those seen in the other public institutions e.g. better internet connections, better personnel remuneration, etc

• Usually profit-making organization that might be prone to bias •Access to research may be limited by how much organization is willing to invest in resources •Support from researchers may be limited by level of interaction/networking

Consider your country and its context and discuss where the best place would be for a Rapid Response Service to be set, giving reasons why.

What challenges do you foresee in setting such a service up?

How would you overcome these?