Reaching out to policy-makers
The growing East African health organization REACH is making efforts to link research with policy-making
SUMMARY
Communication between researchers, policy-makers and the people could improve in East Africa, if REACH has its way. Circumcision to reduce HIV transmission and maternal mortality are to be tackled first. But growth since its inception in the Tanzanian Essential Health Interventions Project has been slow, and budgets remain more dreams than reality.
(May 07)
>by Esther Nakkazi
KAMPALA, UGANDA - Male circumcision is becoming a proven new prevention technology that substantially lowers the risk of contracting HIV. The research findings were released last year after successful research in Uganda, Kenya and South Africa.
Such research could have a powerful impact of reducing HIV/AIDS infection among the people of East Africa – but only if only the right policies were implemented, among them a policy option of offering free or subsidized circumcision to all males aged 15-49 years.
But is it as simple as that? For instance in some communities in East Africa a newly circumcised man is required to have his first sexual act with a woman outside his home. Promoting circumcision would thus be counterproductive in such a community.
So more research would have to be done on this policy to guide the actions to be implemented – research in areas like the desirable training for health workers, facilities and equipment required in health centres for mass circumcision and most importantly the type of education needed to dispel the perception that male circumcision provides complete protection against HIV.
But now these questions and others are beginning to be considered as part of a necessary interaction between researchers and health policy-makers in East Africa. For the first time in the region, a regional project that links researchers to policy makers and utilizes research findings for policy and practices that improve the health of the people has chosen to undertake male circumcision.
Thereafter maternal mortality, a serious policy issue with limited research into its high occurrence in Kenya, Uganda and Tanzania will be undertaken by the project.
The Regional East African Community Health (REACH) policy initiative intends to initially follow up these issues - one with research data available but no policy, and the other with policy but no research.
REACH will act as an intermediary in the use of research results for policy. It will put the region’s researchers and policy makers on the same platform, to discuss the best actions for better health, Nelson Sewankambo, Dean of the Medical School, Makerere University and a front runner in the REACH project, told RealHealthNews.
Choice of the first topic, male circumcision, is because HIV is a topic of common concern to all three countries in the region – Uganda, Kenya and Tanzania – he said. The data generated was from research from Africa and involved two East African countries.
“We shall pick it up and go through the whole process, synthesize, summarize it and package it for policy makers, giving them options for policy and see if these would be translated into actions that improve health. A researcher has already been identified for this,” said Sewankambo.
Another persistent problem, maternal mortality, will need deep researchers to get to the core reasons of why it is so persistent.
“I have requested for review of the whole subject. We shall have an open meeting to discuss it with all stakeholders, and the country nodes will plan deep research,” said Gabriel Upanda, the Executive Director of REACH. “Some research has been done but it is not sufficient.”
Currently REACH is establishing a regional hub to be based in Arusha, Tanzania, with country nodes in Uganda, Kenya and Tanzania. The East African Community (EAC) has given the project office space in Arusha, and the office should be running by June 2007 says Upanda.
“We have identified research centres in each country that will feed into the nodes. The country nodes will do research and policy analysis,” said Upanda.
Although funding remains one of the most pressing challenges of the project, Canada’s International Development Research Centre (IDRC), the African Development Bank (ADB) and USAID have provided seed funding, he says.
For the initial five years the budget for REACH is projected to be US$10 million, beginning at US$ 1.8 million for the first year. At least 50% of this is to be sought from the donor community. The Swiss Tropical Institute in Switzerland is ‘talking’ with REACH to provide more funds, and more donors are expected to come on board.
Member countries are also expected to contribute 2% of the annual budget every year. However for this financial year [2007] no member country has met its financial obligation. “We hope next year, countries will make their annual contributions since they have already agreed in principle and sector ministries endorsed it”, said Sewankambo. This year it was impossible because the budgets had already been allocated, he said.
According to Upanda, 15% of the budget will go into direct costs of the East African Health Research Commission - a revival of the East African Medical Research Council, a centre of great repute and excellence under the original East African Community (EAC), which collapsed in 1977. The Council was in close cooperation with the EAC partner states in health policy, research, and promotion of the exchange of research findings in the region.
The Commission was renamed and re-established after the revival of EAC in 1999. REACH will be the research wing of the Commission handling policy, research and practice.
Under REACH two types of meetings - open and ‘safe harbour’ meetings - will be held. In the latter a few key people will be identified and invited to go into deeper issues that interest individual countries, without reporting, while in the former all stakeholders will be invited to discuss and identify priority areas for research and policy openly.
REACH also aims help researchers get their work published. “Most researchers would like to present their findings to international and local publications, so we shall facilitate that,” said Upanda.
Research communications should also be improved, as the project aims to take research papers, synthesize them and put them in simple language and communicate them to the appropriate level.
“There is an urgent need to quickly get results to the public, and improve REACH’s communication with the communities who have a right to the data and can benefit from it,” said Upanda.
“We will strengthen the capacity at regional and country level in knowledge translation, so research is utilized by the communities and the decision makers,” he said. ‘Peer review papers’, where scientists will report to other scientists, will be another activity.
REACH was originally conceived in 2001 in Tanzania, after a successful project, the Tanzania Essentials Health Intervention Project between the Ministry of Health and Canada’s IDRC. TEHIP was established to test innovations in planning, priority setting, and resource allocation at the district level - and to make use of the results.
During TEHIP’s operation in the two districts of Rufigi and Morogoro, a lot of data was generated, collected and disseminated to the rest of the country. This data was also communicated to Kenya and Uganda to be adapted to solutions for local needs.
When EAC was revived, with its harmonization of the policies and operations in the three countries, Tanzania sold the REACH concept to the other states. “The idea was accepted in principle and consultations started in Uganda. We found that there was a lot in common and the needs were similar so the idea was adopted,” said Upanda.
Even if REACH has not achieved much yet, there are big plans. It has been described as ‘starting small but thinking big’. Its unique concept and set up has influenced many countries and caught the eye of WHO, REACH claims. WHO’s Evidence for Policy Network (EVIPNet) is using similar ideas to REACH, and is now working with seven countries in Africa, seven in Asia, and will soon include ten countries in Latin America, EVIPNet director Ulysses Panisset told RealHealthNews.
Meetings and collaboration between EVIPNet Asia and Africa with REACH have already begun, the last being in Bangkok, Thailand in December last year.
REACH is also poised to grow, built on he EAC regional economic grouping. Rwanda and Burundi have joined EAC, and will thus be a part of REACH. The challenge is exactly how they will be brought on board.
Things done for the first time always pose challenges. There is no experience to build on and there is continuous discovery as the project is implemented. Getting agreement between all parties in a regional project is a challenge. But now the concept has been implemented, REACH has to ensure that the system works - excellence is paramount, says Sewankambo.
“We need to build credibility and a track record. This means doing real work to the highest standards. REACH should become a household name and countries should buy more into it for sustainability,” he said.
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