Onesimo Maguwu is a health expert in Zimbabwe. He spoke to INASP about the use of evidence in healthcare. He talked about his work and how evidence is critical for public health care in Zimbabwe. Maguwu was a speaker at ZeipNET’s knowledge café series held in Harare last year.
Why is the use of evidence in public health policy making in Zimbabwe important?
It’s about life and death of the population – evidence in public health is critical. You cannot implement any programme without any basic evidence. Once you base it on evidence, chances of succeeding are very high, chances of saving lives are very high, chances of reversing the challenges is very high because you are coming from an informed point of view. In Zimbabwe, any serious public health professional or program will always use evidence to make decisions. Policy makers too tend to make use of evidence in making policy but the nature, depth and currency of the evidence may be debatable.
In public health in Zimbabwe what are the main sources of evidence that are used?
There are so many sources of evidence feeding into public health in Zimbabwe. Just last year (2014) there was the Multiple Indicator Cluster Survey (MICS) which is essentially a national level survey and compares well with the Demographic and Health Survey (DHS), it uses many social service indicators. The last DHS was in 2011, and now the country is in the process of collecting data for the next round. We also have other surveys that are conducted by other organisations, primarily by Zimbabwe National Statistics Agency (ZIMSTAT). Annually, ZIMSTAT has conducted quite a number of both statutory and non-statutory surveys which form the bedrock of evidence for public health decision making.
You mentioned that Zimbabwe is producing some excellent research and that for various reasons this isn’t reaching policymakers effectively.
Zimbabwe has a lot of excellent researchers and produces a lot of research. If you go to any other organization, particularly development organizations and ask for the studies they have done you will find they have done a lot of research studies, be it in evaluations of their programmes, baselines or operations research. What tends to lack is translating those studies and the recommendations from those studies into policy making. In most cases, we have good researchers, but we don’t have people who are then able to package the findings into single, simple packages that make sense to policymakers and program implementers.
For example, if we are talking for argument’s sake: 20% of the Zimbabwe population are HIV positive, yes they may understand that, but what if you say one in every five is HIV positive. By rephrasing it this way it can strike some sense into this person as they can relate this to themselves, and they can count “so every fifth person may be HIV positive”. There needs to be some way of making the messages more relevant to the policymakers. You have many organizations that have a research department and programmes department, but rarely do they have a communication department. At the end of the day, we are doing the technical work but the actual communication of that work to the people that are meant to use it, besides the programmers is absent. There is a need to invest in packaging and communicating the evidence. Whilst so much has been done in researching on issues related to the public health, I will argue that not much has been done in repackaging the research results with the specific target audience in mind for better utilisation.
So what do you think needs to happen from the researcher’s side and the policymaker’s side to make sure evidence is systematically used in public health policy making in Zimbabwe?
We need to recognize we may not be competent beyond our own technical knowledge, thus we need to acknowledge our weaknesses in other fields. For example, a good researcher may not necessarily be an equally good knowledge manager or communicator. We can approach it from a team perspective where different professionals play their part and maximize the use of evidence for improved public health decision making, program implementation, and outcomes. This way, policy makers have easier access to relevantly packaged evidence for use in policy making.
Timing is very important; if you don’t time it very well you may miss the point. You may come up with a very brilliant policy recommendation, but at the wrong time, even though it has the potential to impact on lives.
For more about the use of evidence in public health policy, see INASP-EIPM and ZeipNET.