Engaging decision makers and researchers to identify priorities in health systems evidence synthesis for low-income countries: lessons learned from Uganda

Article type
Authors
Obuku EA1, Nabudere H1, Semakula D1, Sewankambo NK1
1Africa Centre for Systematic Reviews and Knowledge Translation (Africa Centre), Makerere University College of Health Sciences, Uganda
Abstract
Background:
Stakeholder involvement in priority setting may enhance the use of research in decision making, particularly in low resource settings such as sub-Saharan Africa. The Africa Centre for Systematic Reviews and Knowledge Translation identifies and synthesizes health systems evidence for decision making.

Objective:
To identify priority questions for health systems evidence synthesis for Uganda.

Methods:
We purposely selected decision makers (n = 15) from health related government departments, consumer advocacy groups and non-governmental organizations. The researchers (n = 29) were from universities and research institutes. We presented participants with background documents including the Norwegian EPOC satellite priority topics for low- and middle-income countries; and examples of research priority areas from World Health Organization health systems perspective and the Millennium Development Goals 4 (child health), 5 (maternal health) and 6 (infectious and non-communicable diseases), before completing two iterations of a mini-Delphi survey technique; followed by a feasibility scan of the PDQ-Evidence database.

Outcome measures:
Ten priority areas for health systems evidence synthesis ranked by: importance, availability of relevant research and viable options, uncertainty, opportunity for change and interest in deliberation.

Results:
Participants identified 34 priority areas for health systems research evidence synthesis. Most concerned delivery arrangements (18, 53%); followed by financial (9, 26%) and organizational (6, 18%) arrangements. However, financial arrangements (8, 80%) dominated the 10 priority questions that is; health insurance, health worker remuneration and resource allocation. We identified existing overviews (8) and systematic reviews (23) in PDQ-Evidence, addressing these topics.

Conclusions:
Our findings highlight financial arrangements as a resilient priority area for health system evidence synthesis in Uganda. The existing overviews and systematic reviews suggest a need to constantly engage decision makers about where and how to find relevant research evidence, and refine their information needs further.