Promoting the Use of Evidence in Health Policymaking in Nigeria
Evidence-informed decision-making (EIDM) entails identifying, appraising, and mobilizing the best available evidence for safe and effective health policies and programs. EIDM is a mainstay of the World Health Organization’s science-based mandate and a pivotal stepping stone towards achieving the Triple WHO’s triple billion targets and the 2030 Agenda for Sustainable Development (WHO, 2022). There are moral, socioeconomic, and political arguments for increasing the use of research in decision- and policy-making to improve health and wellbeing and accelerate the achievement of the Triple Billion targets. By leveraging the best available evidence, countries can improve the effectiveness, efficiency, and equity of health policies and interventions, use scarce public resources effectively, and increase the transparency and accountability of policies and interventions (WHO, 2022). There is a global recognition that strong and effective health systems and health policies that are evidence-based in their operations are vital to achieving continuous improvement in health outcomes in an efficient and equitable manner. According to the WHO, better use of evidence in development policymaking can save lives through more effective policies that respond to scientific and technological advances, use resources more efficiently, and better meet citizens’ needs (WHO, 2004; 2007; 2008).
The poor health outcomes in West Africa are associated with diverse contextual and health systems factors inherent within the sub-region, and these all act together to exacerbate the poor health outcomes in the region. A joint report by the WHO, World Bank, USAID, and UNICEF, among others, emphasized the need for increased investment in health interventions and health systems strengthening evidence-based approaches (Harmonization for Health in Africa, 2011). In addition to scientific evidence, which typically includes research/surveys, quantitative/statistical data, qualitative data, and analysis, evidence can also include economic, attitudinal, behavioral, and anecdotal information, along with knowledge and opinions of experts, as well as judgments, insight/experience, history, analogies, local knowledge and culture (Alliance for Health Policy and Research, 2022; Uneke et al., 2020). Thus, most countries have promoted evidence-informed decision-making to aid policy development.
The Nigerian health system and policymaking
In Nigeria, the Federal Ministry of Health (FMoH) is responsible for policymaking, and health policies are made at that level by senior government officials with significant contributions from partners and stakeholders in the public and private sectors (FMoH, 2018). Although the State Ministries of Health can make policies at their level, most policies at the state level are adapted from the national level policies and made to fit the state’s context. Following the recognition of the usefulness of evidence in policymaking for the effective implementation of the country’s Health System Research Policy (HSRP), evidence-based policymaking initiatives were established in line with global development and practices. One such example is the Nigerian Evidence-Based Health System Initiative (NEHSI). NEHSI in Nigeria was a six-year initiative program that began in 2008 and was developed to inform a plan to support a fair and effective primary healthcare system in Nigeria (FGN, Trade and Development Canada, International Development Research Center, 2023). However, this program’s focus on only two States limited research uptake to inform policy in other parts of the country. More so, the program ended in 2013. Over the years, the use of research evidence to inform policy in clinical decision-making in teaching hospitals and policy implementation in Nigeria has been minimal or completely absent.
Recommended strategies for EBPM/EIDM
The policymaking process remains complex, necessitating a step-by-step approach toward achieving evidence-based policymaking. The Economic Commission of the West African States (ECOWAS), through its specialized health institution, the West African Health Organization (WAHO), is vigorously supporting evidence-based policymaking (EBPM) among the member states. As a part of its mandate to promote evidence-to-policy-to-practice processes in West Africa, the WAHO commissioned a project to develop an adapted guide for using evidence in developing and implementing health policies, plans, and protocols in the ECOWAS region. The EBPM guidelines developed by (Uneke et al., 2020) are one of the emerging tools that can enhance the understanding of evidence to policy process. The strategies to facilitate the use of evidence in policymaking outlined in the guidance can be adapted to the local context and incorporated validated approaches that can be used to promote the evidence-to-policy-to-practice process in West Africa.
On a global scale, the WHO 2022 guide and associated tool repository titled “Evidence, Policy, Impact” provides WHO staff, Member States, and partner organizations with vetted methods and tools to better leverage diverse forms of evidence for more effective policy and practice in the clinical, public health and health system fields. The document introduced a comprehensive, multidisciplinary framework to plan and implement evidence-to-policy processes. The guide also aims to foster better collaboration and create synergies among actors and workstreams of the evidence ecosystem.
The framework demonstrated that the evidence creation domain – represented by the evidence funnel – consists of three phases: (i) evidence inquiry (primary research), which feeds into (ii) evidence synthesis (secondary research) and culminates in the creation of (iii) evidence products (tertiary research), which are more user-friendly and help to translate the research into action.
• The evidence application domain – represented by the policy/action cycle – encompasses three main phases: (i) understand the problem; (ii) design the solution; and (iii) achieve impact.
• To ensure the most significant impact, cross-cutting activities are required in capacity-building at different levels and continuous communication.
• The principles implicit in the work of WHO in improving EIDM include the use of systematic and transparent processes, continuous improvement processes, needs-based approaches, inclusiveness, integration, and equity.
Poorly-informed decision-making is partly responsible for the weakness of the health systems of most West African countries. Therefore, an adequate combination of both scientific and other forms of evidence is a strategy that must be employed if effective and result-oriented health policies are to be achieved in Nigeria and other African countries.
Alliance for Health Policy and Research (2022). What is health policy and systems
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Federal Government of Nigeria, Trade and Development Canda, IDRC (2023). Nigeria Evidence-Based Initiative. Available at https://idl-bnc-idrc.dspacedirect.org/handle/10625/52231 Accessed 22 March 2023
Federal Ministry of Health (2018). Second National Strategic Health Development Plan 2018–2022: ensuring healthy lives and promoting the wellbeing of the Nigerian populace of all ages. Abuja (NG): Federal Government of Nigeria; 2018. https://ngfrepository.org.ng:8443/jspui/bitstream/123456789/3283/1/SECOND%20NATIONAL%20STRATEGIC%20HEALTH%20DEVELOPMENT%20PLAN%202018%20%E2%80%93%202022.pdf
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Uneke, J.C., Sombie, I., Johnson, E., Uneke, B.I. and Okolo, S. (2020). Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance. Globalization and Health, 16 (73), pp. 1-12. https://doi.org/10.1186/s12992-020-00605-z
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