Panel of 4 presentations done at Second Global Symposium on Health Systems Research. Promoting evidence-based decision-making to improve access to health care for vulnerable populations: Knowledge translation strategies in West Africa

1. Promoting evidence-based decision
making to improve access to healthcare
for vulnerable populations: Knowledge
translation strategies in West Africa
Global symposium on health system research
(Beijing, 31 oct. – 3 nov. 2012)
Chair : Valéry Ridde

2. 1. Successes and challenges of the Observatory of
free healthcare in Mali
2. Favoriser la prise de décision fondée sur des
données probantes au Burkina Faso: une
initiative de courtage de connaissances
3. Sharing and using evidence on a free healthcare
programme in BurkinaFaso: An evaluation
4. Capitalizing on local knowledge about free
healthcare policy in West Africa: the experience
of 7 countries

3. Global symposium on health system research
(Beijing, 31 oct. – 3 nov. 2012)
Producing and transferring local knowledge
Successes and challenges of the Observatory of free
healthcare in Mali
Emilie Robert
Dembélé Youssouf

4. Outline
1. Context
2. What research knowledge (RK) was transferred?
3. To whom was the RK transferred?
4. By whom was the RK transferred?
5. How was the RK transferred?
6. With what effect was the RK transferred?

5. Context
Several free care policies:
• Free care for under 5 (NGO)
• Distribution of free mosquito bednets
(gvt+NGO)
• Free malaria treatment (gvt)
• Caesarian (gvt)
• HIV treatment (gvt)
Objectives:
To use existing data from the
information system and to
produce new knowledge to
fuel decisions on user fee
exemption policies.
MALI

6. 1. What RK was transferred? (1)
Dimensions RK produced by the Ministry of RK produced by
health University of Montréal
- Curative consultation coverage in Kangaba - Effects of free care of
- Access to C-section in Bamako. curative care for children
- Effects of free ACT on accessibility of under 5 on consultation in
Utilization of children living further than 5 km from a Kangaba
health services community health centre (CsCom)
- Effects of free mosquito bednets on prenatal
care in Sikasso
- Effects of free anti malaria on financial - Costs of curative
capacity of community health centres consultation for children
Financial
(CSCom) in Bamako under 5 (scaling up)
aspects / costs
of UF exemption - Effects of free care on financial capacity of
policies community health management (ASACO) in
Kangaba
- Perception of health staff on free anti
malaria in Sikasso and Kayes
Actors’ - Perception of users on free anti malaria in
perceptions of Sikasso
free care - Opinion of Kangaba population on cessation
of free care for children under 5

7. 2. To whom was the RK transferred?

8. 3. By whom was the RK transferred?
• Supervision team
– University of Montreal, researchers with technical
expertise
– Médecins Sans Frontières – Belgium: coordination of the
strategy and fundraising
– National Directorate of the Ministy of Health: operational
side of the research, access to the health system
information

9. 4. How was the RK transferred?
• Modelization of the knowledge translation strategy
theory (post-intervention)
• Objective:
→ To evaluate the potential for achievement
of the KT strategy
• Sources:
– Interviews
– project documents
– KT literature

10. INPUTS
Administrative and financial support during 12 months; UdeM / MoH / MSF-B / ECHO partnership ; human
resources; equipments; consumables; infrastructures
Participative process
Participative process
PROCESS
Implication of target users in Involvement of local Support to the Adaptation and
identifying needs for stakeholders in Observatory to dissemination of
knowledge producing knowledge produce knowledge knowledge
Preparation of protocoles Building of the teams’ Publication of policy briefs
Workshop for the
by the Observatory teams technical capacities on new knowledge
identification of needs for
ACTIVITIES
knowledge Presentations at local
Conduct of studies by the Supervision of the
Observatory teams production of knowledge meetings
Prioritizing needs for
knowledge with Utilization of HIS data Conduct of independant National dissemination
Observatory teams studies by UdeM workshop
EXPECTED
RESULTS
Knowledge is useful to The legitimacy of the The credibility of Knowledge is Process
target users. Obs. is established. knowlege is ensured. accessible. utilization
Better utilization of knowledge in decision-making on user fee exemption measures
OBJECTIVE
At the
At the
At the local
At the local At the
At the internat.
internat.
level
level national level
national level level
level
© Robert, 2011

11. 5. With what effect was the RK transferred?
Expected Facilitators Obstacles Potential for
results achievement
1) Knowledge is KT strategy: KT strategy:
useful to target • Involvement of potential users in • Poor targeting of
users. the identification of needs decision and policy
makers
Context: ++
• Answer to an explicitly
formulated need
• MDGs context
2) The legitimacy KT strategy:
of the • Endogeneous process of
Observatory is knowledge production
established. • Technical support from partners
+++
Context:
• Local initiative and institutional
anchoring

12. 5. With what effect was the RK transferred?
Expected Facilitators Obstacles Potential for
results achievement
3) The credibility KT strategy: KT strategy:
of knowledge is • Scientific support from partners • Validity of data
ensured. Context: produced by the
Observatory +
• Long-term collaboration between
partners • Short-term trainings and
one-year strategy
4) Knowledge is KT strategy: KT strategy:
disseminated and • Workshop and policy briefs • Push strategy
accessible. • No dissemination plan
Context:
• Participants with low
-
• Strong involvement of key
stakeholder (messenger) leverage
5) Process KT strategy: KT strategy:
utilization • Better understanding of the ins • No national potential
and outs of free healthcare at the users involved in the
local level process
• Trainings • Life span of the KT
+
Context: strategy
• Mid-term sustainability

13. Youssouf Dembélé is the Executive Director of the Alliance Médicale Contre le
Paludisme au Mali.
Emilie Robert is a Ph.D. student in public health at Montreal University (Canada).
She is working under the supervision of Dr. Valéry Ridde. She is a senior fellow of
the Global Health Research Strengthening Program (GHR-CAP), funded by the
Canadian Institutes of Health Research and the Population Health Research
Network of Quebec. She holds a scholarship from the Quebec Fund for Nature and
Technology Research. She has a travel grant from the Research centre of
University of Montreal hospital centre (CRCHUM).
Contacts: youssoufaly@yahoo.fr / emilie.robert.3@umontreal.ca
Acknowledgments to the team:
• Dr. Valéry Ridde, Montreal University
• Dr. Slim Haddad, Montreal University

14. Favoriser la prise de décision fondée sur des
données probantes au Burkina Faso: une
initiative de courtage de connaissances
Christian Dagenais
Michèle Boileau-Falardeau
ValÉry ridde
Second global symposium on health system research
Beijing, Novembre 2012

15. Contexte
• En Afrique, les coûts d’utilisation représentent une
barrière financière importante pour l’accès aux soins de
santé
• L’utilisation des résultats de recherche: un élément qui
favorise l’amélioration des pratiques et de la prise de
décision

16. « Le rapport est disponible, mais il n’a pas
encore été exploité … »

17. Contexte
• Cette situation résulte principalement d’un manque
d’interaction entre les chercheurs et les utilisateurs
potentiels
• Les stratégies de transfert de connaisances ayant
recours à un intermédiaire, aussi appelé courtier de
connaissance (Knowledge broker) représente une
solution potentielle à ce problème: c’est précisément
cet objectif que vise notre projet

18. Quelles connaissances font l’objet de
la stratégie d’AC?
• Données probantes concernant quatre
domaines d’intervention dans un district du
Burkina Faso:
• Nutrition et gratuité des soins
• Prise en charge du paludisme
• Santé maternelle
• Mutuelles de santé

19. Comment se présente la
stratégie?
• Activités de planification
• Activité de courtage de connaissances
• Activités de soutien au courtier

20. Planification de la stratégie
Activités de préparatoire au
projet Activités de consultation Construction de la stratégie
Atelier participatif de présentation
Atelier participatif de présentation
d’activités de courtage suggérées
d’activités de courtage suggérées
Recension des écrits
Recension des écrits
sur le courtage de
sur le courtage de
connaissances
connaissances Qui a participé?
Modélisation de la
Modélisation de la
Chercheurs stratégie de courtage
stratégie de courtage
de Planificateur
Adaptation du contenu
Adaptation du contenu au niveau
l’Université
sous la forme d’une note
sous la forme d’une note national
de Montréal
de synthèse
de synthèse
Planificateur
Chercheurs niveau
burkinabè régional

22. Activités de courtage
Liaison et transfert entre le
chercheurs et les utilisateurs
Identification des besoins des
utilisateurs Intervenants
Décideurs: locaux, régionaux,
Gestion de l’information nationaux
Identification des réseaux de Chercheurs
diffusion
Préparation de matériel pour
diffusion (résumé synthèse, PPT,
etc.)

23. Activité de soutien au courtier
Formation sur le courtage de
Formation sur le courtage de
connaissances (1 semaine)
connaissances (1 semaine)
Formation
Formation
Formation sur
l’accompagnement du
changement (1 semaine)
Soutien technique pour la
Soutien technique pour la
recherche documentaire Courtier
recherche documentaire
Accompagnement
Accompagnement
Supervision Skype
Supervision Skype
hebdomadaires
hebdomadaires
Stage d’observation au Canada
Stage d’observation au Canada

24. 5. Évaluation de la mise en œuvre et
des effets de la stratégie
1. Mesurer les réactions des courtiers de connaissances
et des chercheurs après les activités de formation
2. Documenter la mise en oeuvre des activités de
courtage et les résultats produits
3. Identifier les éléments qui facilitent ou gênent la mise
en oeuvre de l’intervention
4. Mesurer l’attitude et l’intention d’utiliser
5. Mesurer les effets de la stratégie de courtage sur les
pratiques et la prise de décision

25. Sharing and using evidence on a free
healthcare programme in BurkinaFaso:
An evaluation
Christian Dagenais
Ludovic Queuille
Valéry ridde
Second global symposium on health system research
Beijing, November 2012

26. Evaluation objectives
1. To evaluate the strategy’s
implementation processes
2. To document the extent to which the
targeted effects were achieved

27. Methodology (in short)
• Questionnaire (n = 50)
• Face-to-face interviews(n = 38)
• Analysis of documents (reports of
meetings, terms of reference, research
notes and reports, etc.)

28. Logic model of the knowledge transfer strategy
KNOWLEDGE KNOWLEDGE EVIDENCE DECISION
COALITION
PRODUCTION SHARING/DISSEMINATIO USERS MAKERS Integration of user
N Intervention fees exemption for
Policy Briefs improvement PNDS
PNDS vulnerable
Relevance
2011/2020
2011/2020 population in the
MINISTRY of District/Regional evidence  Implementors commissions
commissions 2011/2020 PNDS
Process sharing workshops RHD/DMO knowledge (GO/NGO)
HEALTH
(MoH)
District/Regional/Central National budget
Health services MoH Evidence Inter-
Inter-
communications allocation for user
outcomes dissemination ministerial
ministerial
workshops fees exemptions
RHD/HD committee
committee
partners CSO Financial accessibility about the
about the
Health Facilities Technical and Financial
strategies include in worst-off
worst-off
outcomes MoH Partners
Health District Plans
communications INGO International funds
workshops SCO
SCO for user fees
Patients satisfaction
UNIVERSITY exemptions
 user fees
National sharing Technical and exemptions in ECHO
Community outcomes experiences workshop Financial MoH and others partners Politicians
Politicians
Partners projects
National Dissemination research (TFP)
Household outcomes Formulate a
NGOs evidence to CSO, media
National strategy
and decision-makers  evaluation in ECHO
to exemption the
Individual outcomes MEDIA and other partners
TFP
TFP worst-off
National/International projects
ECHO scientific communications
PROJECT Direct and indirect RESEARCHERS Evidence cited by
PARTNERS costs Scientific
Scientific Increase the level
Advocacy publication scientific community
community
community of researches on
user fees
Etc. Press conference
exemptions
INPUTS, ACTIVITIES & OUTPUTS FIRST-LEVEL TARGETS OUTCOMES SECOND-LEVEL TARGETS IMPACTS

29. RESULTS

30. 1a. Implementation processes
• Broad scope of the efforts invested in KT
• Expertise required to use the knowledge
• Low interest in reading
• Dissemination workshops seem to have
the greatest impact

31. 1b. Implementation processes
• Open-minded attitude to research
• Difficulty reaching all target groups to the
same extent
• Presentation of the information in an
appropriate format

32. 2a. Achievement of the targeted
effects
Three (main) types of research utilization
• Conceptual
• Instrumental
• Persuasive (strategic)
32

33. 2b. Achievement of the targeted
effects
• A number of significant efforts were invested in
KT activities, and they led to every type of use
• However, some tools were more effective than
others (for example, the dissemination
workshops)
• Users developed an increasingly positive
attitude toward research and considered it useful

34. 2c. Achievement of the targeted
effects
• Additional effort is needed to make information
more accessible, to explain how to put
knowledge into practice, and to adapt to users’
work calendars
• Written documents were not the best
means of dissemination
• Trying to involve high-ranking officials
remains a significant challenge

35. Types and examples of knowledge use by different target groups
Instrumental Conceptual Persuasive
NGO • Putting in place a • Reflecting on how they use • Confirming how they do
mechanism for more rapid knowledge things
reimbursement • Convincing decision
makers
CSO • Total exemption from • Paiement is recognized as • Utilisation des résultats
payment of maternal one of the most important dans les démarches de
health care now among its barriers in access to plaidoyer
claims maternal health
Local health workers • Changing practices • Knowing the community •
(prescriptions, reception of and its needs better
women, etc.) • Becoming aware of
priorities (indigents, etc.)
Local et regional • Redistributing the workload • Planning certain activities • Using the program as an
decision-makers • Changing the allocation of (annual action plans) example
resources • Understanding the effects
of the intervention
TFP • Being concerned about • Using the project as a • Using the program as an
obtaining scientific data source of inspiration for example
the health insurance
program

36. Key lessons learned (a)
• Create homogeneous groups for the
dissemination workshops to adapt the content
to the audiences
• Focus the presentations on a few key
messages
• Transform and synthesize information

37. Key lessons learned (b)
• Use a specially trained person to present the
information
• Adjust the knowledge dissemination strategy to
suit users’ planning calendars
• Train and support “multiplying agents” to
retransmit information in the various settings

38. For more details:
• Dagenais C., L. Queuille & V. Ridde (in press).
A knowledge transfer evaluation of a user fees
exemption intervention in Burkina Faso. Global
Health Promotion, Special Issue.
• Available at:
http://ped.sagepub.com/content/by/year

39. Capitalizing on local knowledge about
free healthcare policy in West Africa:
the experience of 7 countries
Speakers:
Zakillatou ADAM, HIV/AIDS Department, Ministry of Health (Togo )
Yamba KAFANDO, IRSS/CNRST (Burkina Faso)
Co-authors
Ludovic QUEUILLE (NGO HELP, CRCHUM Canada)
Valery RIDDE (CR – CHUM/Department of social and preventive health,
Montreal University, QUEBEC)

40. Outline
Context
Objective of the presentation
What research knowledge was transferred?
To whom and by whom was the research
knowledge transferred?
How was the research knowledge transferred?
With what effect was the research knowledge
transferred?

41. Context
• Common problematic on access to health care in West Africa
• Implementation of user fee exemption policies in order to improve
the coverage of vulnerable population
• Limited evidence on these policies
• Strong expertise from the in-charge of these policies but not
available; no or limited sharing of experience
• Regional capitalisation strategy with HELP/CRCHUM
• Objective = To transform this expertise into knowledge that can be
shared out and to capitalise on field experiences

42. Objective of the presentation
General objective: To describe and analyse this knowledge
translation strategy in 7 West-African countries.
Specific objectives
 To assess the process of capitalisation and its
implementation
 To analyze the results that were achieved thanks to this
KT strategy

43. What research knowledge was
transferred?
 Subsidizing deliveries and emergency obstetric and
neonatal care (Burkina Faso)
• Free caesarian and free prevention and treatment of
malaria (Mali)
• Free caesarian and free care for children under 5 (Niger)
• Free care for the elderly (plan Sésame – Senegal)
• User fee exemption for HIV care (antiretroviral therapy)
(Togo)

44. Analytical framework
Strategies Attitudes and behaviours Outputs
- Management - Motivation/satisfaction of - Incidence of
health staff catastrophic
- Communication
expenditures
- Relationship between
- Monitoring /
users and health - Health care seeking
evaluation /
providers behaviours
coordination
- Users’ satisfaction - Utilization of modern
- Community
health services
participation - Perception of target
population on the - Utilization of
- Service provision
outcomes of the policy traditional health
and referral
services
- Coping strategies of
health staff - Quality of services

45. To whom and by whom was the
research knowledge transferred?
Country teams (7 countries)
Mixed teams (60 participants)
– Policy in-charge or policy makers
– Technicians from the Ministries of Health
– Members of the national civil society
– Researchers
– Membres of non-governmental organisations and of international
organisations

46. How was the research knowledge
Implementation of transferred?
country team in Benin,
Burkina, Ghana, Mali,
Niger, Togo, Senegal
on several topics Knowledge
Country case Regional
(caesarian, free care studies capitalization dissemination
for elderly, etc.)
Knowledge synthesis
 gaps in knowledge
Prerequisite (…) SHARING & CAPITALISING on EXPERIENCES
Technical and financial support and supervision
Workshop 1 Workshop 2 Workshop 3
June-10 July-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 June-11

47. With what effect was the research
knowledge transferred? (1)
• Scoping study on public policies and NGOs
interventions in participant countries
• Knowledge production through participatory case
studies
• Results of the scoping study and results of the case
studies from the countries converge.
The credibility of the case studies is
ensured.

48. With what effect was the research
knowledge transferred? (2)
The knowledge that has been produced is useful to both
the participants and the policy makers:
• Better understanding of the policies
• Identification of bottlenecks
Opportunities for actors:
• Capacity building (analytical and writing skills)
• Networking
• Strengthening of professional skills

49. Conclusion
Participation in knowledge building in West Africa
The point of view of « insiders » is as important as
the one of researchers.
User fee exemption policies in the participating
countries face the same challenges and it is crucial
that in-charges of these policies regularly meet to
share their experience.
Lessons learns must be shared, disseminated and
put into practice.

50. THANK YOU FOR YOUR ATTENTION!!!