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Bridging the gap between research and policy Di McIntyre Health Economics Unit University of Cape Town iHEA Early Career Researcher Special Interest Group Webinar 21 September 2018

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Page 1: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Bridgingthegapbetweenresearchandpolicy

DiMcIntyreHealthEconomicsUnitUniversityofCapeTown

iHEAEarlyCareerResearcherSpecialInterestGroupWebinar21September2018

Page 2: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Introduction

• Focus:– Someofthefactorsthatcaninfluenceresearchtopolicyprocess

– Practicaltipsoncommunicatingresearchtoandbuildingrelationshipswithpolicymakers

• Perspective:– Appliedresearcherfocusedonpolicy-relevantresearch

– Experience mainlyatmacro,healthsystemlevel

Page 3: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Research-policydiffusion

Idealmodelofnaturalsciences• Researchers:

– Dogoodresearch,and– Disseminatefindings

AND

• Policymakers:– Read,– Understand,and– Actonfindings

Policyenlightenmentmodel• Policychangeisaresultof:

– Accumulationofevidence,informationandknowledge

– Thatslowlydripsintothepolicyenvironment

– Throughinformationexchangebetweenpeople

– Withunpredictableimpacts

(Walt1994)

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Whatresearch?

“Decisionmakersrarelyusearegressioncoefficienttohelpthemsolveaparticular

problem.Rather,overlongperiodsoftime,“ideas”

enlightendecisionmakersaboutaparticularissueandhowtohandleit.”

(Lavis etal. 2003)

Page 5: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

OCTOBER 2014

What is strategic purchasing for health?

Ever since the publication of the 2000 World Health Report, there has been a growing awareness that health financing is not simply about raising money. Instead, there are three key functions of health financing: revenue generation, pooling and purchasing. Nevertheless, global debates tended to continue to focus on the revenue generation function.

More recently, the 2010 World Health Report on financing for universal coverage noted that: “Raising sufficient money for health is imperative, but just having the money will not ensure universal coverage. Nor will removing financial barriers to access through prepayment and pooling. The final requirement is to ensure resources are used efficiently.” This pointed to the importance of the purchasing function of health financing; purchasing is the critical link between resources mobilised for universal coverage and the effective delivery of quality services.

TOPIC OVERVIEW 4 | Financing research theme

Some initial concepts

Purchasing refers to the process by which funds are allocated to healthcare providers to obtain services on behalf of identified groups (e.g. insurance scheme members) or the entire population (Kutzin 2001).

Purchasing involves three sets of decisions (World Health Organisation 2000; Figueras, Robinson et al. 2005):

1. Identifying the interventions or services to be purchased, taking into account population needs, national health priorities and cost-effectiveness.

2. Choosing service providers, giving consideration to service quality, efficiency and equity.

3. Determining how services will be purchased, including contractual arrangements and provider payment mechanisms

It is undertaken by a purchasing organization which can be, for example, an insurance scheme, a Ministry of Health, or an autonomous agency. Purchasing should not be confused with procurement, which generally only refers to buying medicines and other medical supplies.

The 2000 World Health Report distinguished between passive and strategic purchasing:

Although the key role of purchasing is being recognised gradually, there remains considerable confusion about what purchasing entails. There is an even greater lack of understanding of what is required for strategic or active purchasing.

This brief attempts to fill this gap by providing an overview of the key activities that a strategic purchaser should undertake. It draws on the limited literature on strategic purchasing, and RESYST (Resilient and Responsive Health Systems) consortium members’ experience and understanding from involvement in supporting the development of purchasers. This conceptual model of strategic purchasing underpins an ongoing analysis of purchasing arrangements in 10 countries across members of RESYST and the Asia Pacific Observatory on Health Systems and Policies.

“Passive purchasing implies following a predetermined budget or simply paying bills when presented. Strategic purchasing involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, how, and from whom.”

Strategic purchasing requires the purchaser to engage actively in 3 main relationships: with Government (Ministry of Health), with healthcare providers, and with citizens.

Purchasers

1. Providers

2. Citizens 3. Government

Page 6: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Factorsinfluencinguptake

• Relevantandtimelyresearch

• Researchaccessible

• Keymessagesthatareactionable

• Relationshipsbetweenresearchersandpolicymakers

Page 7: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Relevantandtimely

• Policyrelevance:– Needstobemadeexplicit– Enhancedifclosecontactwithpolicymakerstoidentifypriorityissues

• Timely:–Windowsofopportunity– Timelaginundertakingresearch– Engagingwithpolicymakerscanimprovepredictiveabilities

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Anyquestionsorcommentsonwhathasbeencoveredsofar?

Page 9: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

Accessibleresearch

1

POLICY BRIEFS A guide to writing policy briefs for research uptake

Rebecca Wolfe RESYST Research Uptake Manager October 2013

CANYOUCOMEBACKWITHTHAT3YEARSTUDYSUMMARISEDINSIXBULLETPOINTSINPOWERPOINT

©[email protected]

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1

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Health'Economics'UnitSchool&of&Public&Health&&&Family&MedicineUniversity&of&Cape&Town

About'the'study:'�"��,�-��,�"�*,�-�(.���#(�."#-�*�*�,�6�-�4(��,.�%�(��)&&��),�/5�&8��8�."����&."���)()'#�-��(#.;���"))&�)���4�&#����&."��(����'#&8����#�#(�;��(#5�,-#.8�)����*���)6(�C�,��8�%)�)(����(���,)���#���(.8,�D;�."��(-/.4.��)���)�#�&��(����)()'#����-��,�";��(#5�,-#.8�)���")��-�C�,)���)��#��5�(� #�%�,%D��(��."����&."���)()'#�-���-��,�"��(#.;��(#5�,-#.8�)�����,���(�C�,)����(�8��8�(D>��.�#-�*�,.�)�����,)���,�*,)!,�''��)��6),%�)(��&#�#/(!�*4�&#��*,���,�(��-�4(��,.�%�(�#(��)&&��),�/)(�6#."�."���&��%���-"��(����&."B�� �6-���,5#��>

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Community'preferences'for'improving'public'sector'health'services'in'South'AfricaWhat'aspects'of'public'sector'health'service'quality'��������������������������������"

HEU'Policy'Brief'''''''March'2012

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Box 1: What is a Discrete Choice Experiment?

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Page 11: Bridging the gap between research and policy › › ... · • Policy makers: – Read, – Understand, and – Act on findings Policy enlightenment model • Policy change is a

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3

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Findings

Overall health service preferences

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Accessibleresearch

http://www.rationalreflection.net/against-jargon/

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Makingfindingsaccessible

Routineavailabilityofmedicinesistentimesmoreimportantthanbeingtreatedbyadoctor

• UnnecessarytopresentlogitcoefficientsorWTPdata

• Professional,butnottechnical• Viewyourreaderorlistenerasanintelligentnon-expert

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Keymessages

• Shouldbeabletopassthe‘elevatortest’

• Distinctionbetweenresearchfindingsandamessage

Communitiestoleratepoorqualitypublicsectorservicecharacteristicssuchaslongwaitingtimesandpoorstaffattitudesiftheyreceivethemedicinetheyneed

Governmentcanachieve‘quickwins’byaddressingmedicinedistribution(potentiallythroughtheuseofprivatedistributors)sothatallpublicfacilitieshaveconstantavailabilityofallessentialmedicines.

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Simplebitofinformation

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1

Given the large number of pa ents who need an retroviral treatment (ART) in South Africa, it is necessary to decentralise ART services and integrate them into the primary health care system. This will require pharmacy services to be scaled-up, including pharmaceu cal supply systems, infrastructure and staff to dispense ARTs. At the same me, it is important to ensure that

the pharmaceu cal service is safe and effi cient. All of this must be achieved within the context of a scarcity of health care professionals.

Task-shi ing has been shown to be an eff ec ve and safe way of addressing the problem of insuffi cient professional staff . Task-shi ing refers to the delega on of tasks from highly skilled workers to those

with either less training or training in undertaking specifi c tasks. In South Africa, the shortage of pharmacists in the public sector has led to the use of Pharmacists Assistants (PA) and nurses to support the expansion of the ART programme (see Box 1).

ObjectivesThe objec ve of the research reported here was to cri cally evaluate the two diff erent task-shi ing models and the pharmacist model for dispensing ART. The costs and impact on access to ART services for pa ents of each model were compared. The infrastructure costs of introducing the ISPA model were also calculated to assist in planning for accessible ART services.

Health Economics UnitSchool of Public Health & Family MedicineUniversity of Cape Town

About the study:The research presented in this paper was conducted by Nicola Foster in par al fulfi lment of the requirements for a MPH (health economics) from the University of Cape Town. Prof Di McIntyre supervised the study.

Acknowledgement:The study was funded by the Na onal Research Fund (NRF) South African Research Chair: Health and Wealth program.

For more informa on, please [email protected]

Diff erent models of pharmaceu cal care in South AfricaWhat is the cost and impact on pa ents’ access to an retroviral therapy?

HEU Policy Brief August 2011

HEU Policy Briefs present summarised research fi ndings and key policy recommenda ons on important health care policy issues in Sub-Saharan Africa.

Key points South Africa is commi ed to providing an retroviral treatment (ART) to all South

Africans who need it. There are insuffi cient pharmacists working in public sector facili es to dispense ART to all these pa ents, and so dispensing tasks must be shi ed to pharmacists assistants and/or nurses (‘task-shi ing’).

The pharmacists assistant pharmaceu cal care model has the lowest cost to the health system and would support a more integrated primary health care service.

Pa ents ge ng their ART by a ending pharmacists assistant model and nurse model facili es experienced rela vely be er geographic access to facili es and lower transport costs, compared to those a ending more central facili es that employ pharmacists.

Pa ents prefer a nurse to dispense their ARTs as this reduces the risk of being iden fi ed by other pa ents as being HIV-posi ve.

The pharmacists assistant model can be made more acceptable to pa ents by ensuring that there are no diff erences between pa ent folders (e.g. those on ART should not have diff erent coloured folders) and dispensing all medica on (not only ARTs) in brown paper bags.

Introduction

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Actionablemessages

RemoveanyARTserviceidentifiersfrompatientfoldersbyensuringthatallpatientsaccessingthefacilityhavethesamecolour andtypeoffolder

Improvepatientconfidentialityinthepharmacybyputtingupscreensnexttothedispensingwindow,limitingtheviewfromthewaitingarea,anddispensingallmedication(notjustARTs)inbrownpaperbags

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Anyquestionsorcommentsonwhathasbeencoveredsofar?

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Buildingrelationships

• Invest,invest,invest:

– Understandtheconcernsofpolicymakersandimplementers

– Understandpolicyprocessesandenvironment

– Buildlegitimacy,mutualrespectandtrust

– Beresponsivewheneverpossible

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Wheretostart?

Research

Teaching

Policy

Research

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Beentrepreneurial

• Seekoutforumswhereresearchersandpractitioners(policymakers,implementers)meet

• Engagewithpractitionersaroundresearchfromoutset

• Usenetworks,particularlyseniorcolleagues• Don’tputallyoureggsinonebasketgivenstaffturnover

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Knowledgebrokers

• Needtodevelopyourownskills

• Butrecognisethatsometimes:– youwillnotnecessarilybethebestmessenger– mayneedtofinda credible‘messenger’thatthetargetaudiencerespectsandtrusts

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Keymessages

• Behumbleandrespectful

• Buildlong-termrelationshipswithpractitioners

• Investinidentifyingyourkeymessages

• Keepitsimple:brief,clear,jargon-free

• Notjustdata,alsoideasandconcepts

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References• WaltG(1994).HealthPolicy:AnIntroductiontoProcessandPower. London:Zed

Books.• Lavis JN,RossSE,HurleyJE(2002).Examiningtheroleofhealthservicesresearchin

publicpolicymaking.MilbankQuarterly;80(1):125-154.• Lavis JN,RobertsonD,WoodsideJM,McLeodCB,AbelsonJ,andKnowledgeTransfer

StudyGroup(2003).Howcanresearchorganizationsmoreeffectivelytransferresearchknowledgetodecisionmakers?MilbankQuarterly;81(2):221-248.

• GoldM(2009).PathwaystotheUseofHealthServicesResearchinPolicy.HealthServicesResearch;44(4):1111–1136.

• Liverani M,HawkinsB,ParkhurstJO(2013).PoliticalandInstitutionalInfluencesontheUseofEvidenceinPublicHealthPolicy.ASystematicReview.PLoS One; 8(10):e77404.

• OliverK,Lorenc T,Innvær S(2014).Newdirectionsinevidence-basedpolicyresearch:acriticalanalysisoftheliterature.HealthResearchPolicyandSystems;12:34.

• BennettS,Corluka A,DohertyJ,etal (2012).Influencingpolicychange:theexperienceofhealththinktanksinlow- andmiddle-incomecountries.HealthPolicyandPlanning;27:194-203.

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http://www.publichealth.uct.ac.za/phfm_health-economics-unit-heu

www.facebook.com/uct.heu

@HEU_UCT

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Questionsandcomments

www.healtheconomics.org