An evidence-based approach to healthcare in Africa
African countries have limited healthcare resources, making it crucial that policymakers use them wisely. EU-funded researchers have helped African governments access the best healthcare research possible when planning for the future and for emergencies.
The EU-funded project SURE examined how policymakers could use evidence to link healthcare resources to needs in low-income countries, working with partners from seven countries around the centre of Africa.
Regional coordinator Professor Nelson Sewankambo of project partner Makerere University, Uganda explains that given the continent’s extremely limited resources and very high disease rates, the need for well-informed policy decisions is even more crucial than in wealthier regions.
The project team saw that without evidence-based policy, ineffective or expensive approaches to healthcare are often used while effective, cheap solutions are ignored.
SURE collaborated with two other international projects, the Evidence-Informed Health Policy Network (EVIPNet), set up under the World Health Organization, and the Regional East African Community Health (REACH) Policy Initiative, set up by stakeholders in Kenya, Uganda and Tanzania . All three bodies worked together to develop strategies to promote research-based evidence as part of healthcare policymaking.
Their strategies were based on a simple principle: fast, reliable access for policymakers to expert-assessed research with an explanation of how it relates to the problem.
The core strategies are evidence briefs, which summarise research on a topic prioritised by policymakers, and policy dialogues, in which policymakers, stakeholders and researchers discuss the briefs and how best to tackle the problems they address.
SURE has produced 35 evidence briefs. Topics cover a range of medical and administrative issues, such as maternal and child health, mental health and improving access to health services.
SURE has also published guides and capacity-building resources to help researchers and policymakers in Africa prepare and use evidence briefs.
For urgent policy decisions, SURE has developed “rapid response” evidence-briefing services to help governments choose the right solutions for such problems. These are already operational in Uganda and Burkina Faso and are being pilot tested in Cameroon and Zambia.
Better targeting for better healthcare
Healthcare policymakers have to choose spending priorities and respond in the most effective way to health emergencies. Their task is made harder as they often have access only to outdated or incomplete research when making decisions.
SURE has developed a method to gather, evaluate and summarise evidence, then present it in a format that lets policymakers and other stakeholders understand what options are available, and what outcomes to expect from each. Having the evidence in a structured and understandable format helps them make the most appropriate choice for a particular problem.
These evidence briefs were followed up with policy dialogues and workshops that included stakeholders such as civil society organisations, private healthcare providers and consumers. This helped to ensure that proposed solutions took into account local conditions, cultures and priorities.
To develop local expertise in evidence-based policy, SURE has also helped African governments develop their own services. These include Uganda’s national research communication service. With the end of the project in May 2014, the former partners are continuing to build up regional knowledge by promoting doctoral level studies on the best ways to summarise research in user-friendly formats.
Evidence-based research is not just used to choose medical solutions. It also applies to decisions on how to deliver services, on financial and governance arrangements and on how to implement change.
By helping policymakers choose proven, cost-effective solutions to problems, the SURE system aims to help them provide the best healthcare available with the resources they have – ultimately saving public money and improving people’s lives
SURE is part of the EU’s support for people in low-income countries to get better health care and meet international health targets.
According to Sewankambo the evidence-based approach is a relatively new idea for healthcare services. “A lot of policies are put into practice without real scientific evidence – this is ineffective,” he says. “The ideal is to use research evidence to inform policy decisions.”
Although SURE focused on African needs, its strategies and networks could help lower- and middle-income countries in Europe and elsewhere in the world. Sewankambo adds: “The learning has gone both ways, and exchanges through the World Health Organization have advanced global knowledge.”
An introduction to the SURE project and how it is hoping to help African countries such as Cameroon, Zambia and Uganda, improve their health systems.