1
|
Onwujekwe O, Etiaba E, Mbachu C, Arize I, Nwankwor C, Ezenwaka U, Okeke C, Ezumah N, Uzochukwu B. Does improving the skills of researchers and decision-makers in health policy and systems research lead to enhanced evidence-based decision making in Nigeria?-A short term evaluation. PLoS One 2020; 15:e0238365. [PMID: 32881986 PMCID: PMC7470383 DOI: 10.1371/journal.pone.0238365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health care decision makers require capacity to demand and use research evidence for effective decision making. Capacity to undertake health policy and systems research (HPSR) and teaching is low in developing countries. Strengthening the capacity of producers and users of research is a more sustainable strategy for developing the field of HPSR in Africa, than relying on training in high-income countries. METHODS Data were collected from 118 participants who had received the capacity building, using a pre-tested questionnaire. Respondents included health research scientists from institutions (producers) and decision makers (users) in the public health sector, in Anambra and Enugu states, southeast Nigeria. Data were collected on participants' progress with proposed group activities in their short- term goals; effects of these activities on evidence-informed decision making and constraints to implementing activities. Univariate analysis was done using SPSS version 16. FINDINGS All prioritised activities were carried out. However, responses were low. Highest response for an activity amongst producers was 39.1%, and 44.4% for users. Some of the activities implemented positively influenced changes in practice; like modification of existing policies and programme plans. There was a wide range of responses between producers of evidence (0.0-39.1%) and users (2.7-44.4%) across both study states. Lack of authority to implement activities was the major constraint (42-9-100.0% across activities), followed by financial constraints (70.6%). CONCLUSION Capacity building intervention improved skills of a critical mass of research scientists, policymakers and practitioners, towards evidence-based decision making. Participants committed to undertake proposed activities but faced a number of constraints. These need to be addressed, especially the decision space and authority, improving funding to implement activities that influence Getting Research into Policy & Practice (GRIPP). Being at different stages of planning and implementing proposed activities; participants require continuous technical and financial support to successfully implement activities and engage meaningfully within and across professional boundaries and roles, in order to achieve short-, medium- and long- term goals.
Collapse
Affiliation(s)
- Obinna Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Enyi Etiaba
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- * E-mail:
| | - Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Ifeyinwa Arize
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Chikezie Nwankwor
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| |
Collapse
|
2
|
Fraser BA, Powell RA, Mwangi-Powell FN, Namisango E, Hannon B, Zimmermann C, Rodin G. Palliative Care Development in Africa: Lessons From Uganda and Kenya. J Glob Oncol 2018; 4:1-10. [PMID: 30241205 PMCID: PMC6180772 DOI: 10.1200/jgo.2017.010090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Despite increased access to palliative care in Africa, there remains substantial unmet need. We examined the impact of approaches to promoting the development of palliative care in two African countries, Uganda and Kenya, and considered how these and other strategies could be applied more broadly. METHODS This study reviews published data on development approaches to palliative care in Uganda and Kenya across five domains: education and training, access to opioids, public and professional attitudes, integration into national health systems, and research. These countries were chosen because they are African leaders in palliative care, in which successful approaches to palliative care development have been used. RESULTS Both countries have implemented strategies across all five domains to develop palliative care. In both countries, successes in these endeavors seem to be related to efforts to integrate palliative care into the national health system and educational curricula, the training of health care providers in opioid treatment, and the inclusion of community providers in palliative care planning and implementation. Research in palliative care is the least well-developed domain in both countries. CONCLUSION A multidimensional approach to development of palliative care across all domains, with concerted action at the policy, provider, and community level, can improve access to palliative care in African countries.
Collapse
Affiliation(s)
- Brooke A. Fraser
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Richard A. Powell
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Faith N. Mwangi-Powell
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Eve Namisango
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Breffni Hannon
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Camilla Zimmermann
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| | - Gary Rodin
- Brooke A. Fraser, Richard A. Powell,
Faith N. Mwangi-Powell, Breffni Hannon,
Camilla Zimmermann, and Gary Rodin, University of
Toronto, University Health Network, Toronto, ON, Canada; Richard A.
Powell and Faith N. Mwangi-Powell, MWAPO Health
Development Group, Nairobi, Kenya; and Eve Namisango, African
Palliative Care Association, Kampala, Uganda
| |
Collapse
|
3
|
Clark J, Gardiner C, Barnes A. International palliative care research in the context of global development: a systematic mapping review. BMJ Support Palliat Care 2016; 8:7-18. [DOI: 10.1136/bmjspcare-2015-001008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 05/17/2016] [Accepted: 07/14/2016] [Indexed: 01/18/2023]
Abstract
ContextAn increasing amount of health policy is formulated at global level. At this global level, palliative care has attracted support primarily from normative institutions (WHO), not funding agencies. To attract greater global attention from policymakers, it has been argued that an international approach to research is required. However, the extent to which an international approach is being undertaken is unknown.ObjectivesTo systematically identify and thematically synthesise all international palliative care research, defined as research involving two or more countries, or focused on the global level.MethodsFive bibliographic databases (CINAHL, Cochrane Library, ASSIA, Web of Knowledge, Psychinfo) were searched for journal articles relevant to international and global palliative care and end-of-life care. Data were extracted using a piloted extraction form and findings were synthesised.Results184 studies were included, published across 75 different academic journals. Research emanates from and focuses on all world regions and there is increasing focus on the global level. Thematically, there is a high focus on Evaluation (n=53) and views of Stakeholders (n=38). The review revealed a predominantly observational research approach and few interventional studies were identified.ConclusionsInternational palliative care research is a relatively new, but growing field. However, many gaps in the evidence base remain and palliative care research continues to take place outside broader discourses of international development. The relative absence of interventional research demonstrating the effectiveness and cost-effectiveness of palliative care risks limiting the tools with which advocates can engage with international policymakers on this topic.
Collapse
|
4
|
Godoy-Ruiz P, Cole DC, Lenters L, McKenzie K. Developing collaborative approaches to international research: Perspectives of new global health researchers. Glob Public Health 2015; 11:253-275. [PMID: 25642809 PMCID: PMC4819581 DOI: 10.1080/17441692.2014.999814] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Within a global context of growing health inequities, the fostering of partnerships and collaborative research have been promoted as playing a critical role in tackling health inequities and health system problems worldwide. Since 2004, the Canadian Coalition for Global Health Research (CCGHR) has facilitated annual Summer Institutes for new global health researchers aimed at strengthening global health research competencies and partnerships among participants. We sought to explore CCGHR Summer Institute alumni perspectives on the Summer Institute experience, particularly on the individual research pairings of Canadian and low- and middle-income countries researchers that have characterised the program. The results reveal that the Summer Institute offered an enriching learning opportunity for participants and worked to further their collaborative projects through providing dedicated one-on-one time with their international research partner, feedback from colleagues from around the world and mentorship by more senior researchers. Positive individual relationships among researchers, as well as the existence of institutional collaborations, employer and funding support, and agendas of local and national politicians were factors that have influenced the ongoing collaboration of partners. There is a need to more fully examine the interplay between individual and institutional-level collaborations, as well as their social and political contexts.
Collapse
Affiliation(s)
- Paula Godoy-Ruiz
- a Social Aetiology of Mental Illness Program , Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Global Health Program, Department of Family and Community Medicine , University of Toronto , Toronto , ON , Canada
| | - Donald C Cole
- c Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Lindsey Lenters
- d Centre for Global Child Health , The Hospital for Sick Children , Toronto , ON , Canada
| | - Kwame McKenzie
- a Social Aetiology of Mental Illness Program , Centre for Addiction and Mental Health , Toronto , ON , Canada.,e Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,f Wellesley Institute , Toronto , ON , Canada
| |
Collapse
|
5
|
Development of a regional nursing research partnership for academic and practice collaborations. Nurs Res Pract 2013; 2013:473864. [PMID: 23984059 PMCID: PMC3745952 DOI: 10.1155/2013/473864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Collaborative nursing research across academic and practice settings is imperative to generate knowledge to improve patient care. Models of academic/practice partnerships for nursing research are lacking. This paper reports data collected before and during a one-day retreat for nurse researchers and administrators from local universities and health care organizations designed to establish a regional nursing research partnership. Methods. Quantitative and qualitative methods were used to address the study aims: (1) to assess research involvement and institutional research resources; (2) to assess interest in and concerns regarding cross-institutional collaborations; and (3) to describe perceptions of the purpose of a partnership and resources needed to ensure success. Results. Participants (n = 49) had differing perceptions of accessibility to resources; participants in practice settings reported less accessibility to resources, notably grant development, informatics, and research assistant support. Participants were interested in collaboration although concerns about conflict of interest were expressed. Four themes related to partnering were identified: harnessing our nursing voice and identity; developing as researchers; staying connected; and positioning for a collaborative project. Conclusion. Academic-practice research collaborations will become increasingly important with health care system changes. Strategies to develop and sustain productive partnerships should be supported.
Collapse
|
6
|
Abstract
Health research capacity strengthening (HRCS) is a strategy implemented worldwide to improve the ability of developing countries to tackle the persistent and disproportionate burdens of disease they face. Drawing on a review of existing HRCS literature and our experiences over the course of an HRCS project in Vietnam, we summarise major challenges to the HRCS enterprise at the interpersonal, institutional and macro levels. While over the course of several decades of HRCS initiatives many of these challenges have been well documented, we highlight several considerations that remain underarticulated. We advance critical considerations of the HRCS enterprise by discussing (1) how the organisation of US public health funding shapes the ecology of knowledge production in low- and middle-income country contexts, (2) the barriers US researchers face to effectively collaborate in capacity strengthening for research-to-policy translation, and (3) the potential for unintentional negative consequences if HRCS efforts are not sufficiently reflexive about the limitations of dominant paradigms in public health research and intervention.
Collapse
Affiliation(s)
- Emily E Vasquez
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | | | | |
Collapse
|
7
|
Zuyderduin A, Obuni JD, McQuide PA. Strengthening the Uganda nurses' and midwives' association for a motivated workforce. Int Nurs Rev 2010; 57:419-25. [PMID: 21050192 DOI: 10.1111/j.1466-7657.2010.00826.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ugandan Association of Nurses and Midwives (UNANM) is a dynamic proactive community. This survey of nurses, both members and non-members of the association, was implemented in April 2007. It was the first phase of a programme-funded Capacity Project/USAID to strengthen professional associations as part of a strategy to retain nurses. AIM To better understand the needs and strengths of the association and to develop policy recommendations on how to strengthen the UNANM to retain nurses in the health sector. METHODS Three hundred self-completion questionnaires were distributed, of which 217 (72%) were returned. The participants were 126 non-members and 91 members of the UNANM. RESULTS Just over a third of the 91 members rated the UNANM to be very effective in promoting nursing (35%) and information sharing (36%). Non-members want to receive nursing information from the UNANM (89%) and were less critical of the UNANM than members. Respondents were interested in counselling training (83%), research capacity building (80%) and sharing best practice (74%). Nurses under 30 years (12%) look to more experienced peers for guidance on coping in a stressful profession. CONCLUSION The nurses lack continuing professional development, mentoring and networking opportunities. Tangible support for communication, nurse education and research is needed and will stimulate the development of nursing in Uganda. Most nurses do not have the means to pay for training, research or travel to attend professional meetings. Motivation to stay in nursing and quality of care can increase through investing in nursing, and this support can be channelled through associations such as the UNANM.
Collapse
Affiliation(s)
- A Zuyderduin
- School of Nursing, International Health Science University, Kampala, Uganda.
| | | | | |
Collapse
|
8
|
Edwards N, Webber J, Mill J, Kahwa E, Roelofs S. Building capacity for nurse-led research. Int Nurs Rev 2009; 56:88-94. [DOI: 10.1111/j.1466-7657.2008.00683.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Harding R, Powell RA, Downing J, Connor SR, Mwangi-Powell F, Defilippi K, Cameron S, Garanganga E, Kikule E, Alexander C. Generating an African palliative care evidence base: the context, need, challenges, and strategies. J Pain Symptom Manage 2008; 36:304-9. [PMID: 18722312 DOI: 10.1016/j.jpainsymman.2008.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 04/15/2008] [Accepted: 04/26/2008] [Indexed: 11/30/2022]
Abstract
The enormous burden of progressive, incurable disease in sub-Saharan Africa is reflected in the epidemiology of cancer and HIV. However, there has been little research activity and evidence generated to inform appropriate and effective responses. A collaborative of clinicians, academics and advocates have been active in the design, delivery and reporting of research activities in African palliative care. Here, they report the methodological, ethical, logistic and capacity-based challenges of conducting research in the sub-Saharan context from their experience. A number of strategies and responses are presented.
Collapse
Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London School of Medicine, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|