Applying the Evidence Ecosystem concept as a tool to demonstrate the successful implementation of evidence-based practice in international aid: the example of ‘Water, Sanitation and Hygiene’ (WASH)

Tags: Oral
Van Remoortel H1, De Buck E2, Schelstraete C3, Lievens T3, Vandekerckhove P4
1Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium, 2Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; Cochrane First Aid, 3Belgian Red Cross, International Cooperation Department, Mechelen, Belgium, 4Belgian Red Cross, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium

Background: the Belgian Red Cross (BRC) is an aid organization with a wide range of activities, from blood collection and banking, to first-aid education, to international disaster and development aid. Evidence-based decision-making is embedded in the long-term strategic vision of BRC for all its activities.

Objectives: to underpin BRC activities scientifically by implementing the principles of evidence-based practice (EBP) in its international aid activities.

Methods: since 2010, BRC has invested in a Centre for Evidence-Based Practice (CEBaP) where 10 full-time researchers in EBP support the international aid activities by conducting type A research (monitoring and evaluation), type B research (systematic reviews and evidence-based guidelines) and type C research (impact evaluations such as randomized controlled trials). Educational approaches have been used to train BRC employees in EBP, such as initial blended learning (E-learning module + classroom session) followed by monthly journal clubs (presentation and discussion of primary or secondary research papers).

The Evidence Ecosystem will be used to demonstrate how we underpin the WASH (Water, Sanitation and Hygiene) activities of our International Co-operation Department (ICD) scientifically.

Results: CEBaP conducted a systematic review on approaches to promote handwashing and sanitation behaviour change in low- and middle-income countries (‘evidence synthesizers’). The conclusions of this review were disseminated by CEBaP/ICD via internal and external platforms (websites, social media, internal science day, stakeholder meetings, webinar, international conferences, publications in peer-reviewed journals) (‘evidence disseminators’), and are currently implemented in the WASH programs by ICD and our African Red Cross Society partners (ARCS) (Tanzania, Malawi, Rwanda, Burundi) (‘evidence implementers’). These programs are consistently evaluated via output, outcome and impact indicators by ICD/ARCS, with specific methodological support from CEBaP concerning the data-analysis (sample size calculations and statistical analysis in R software package) (‘evidence evaluators & improvers’). Based on an evidence gap map analysis, CEBaP and ICD decided to set-up a randomized controlled trial in Tanzania to investigate the (cost-)effectiveness of two add-on software interventions for improving handwashing and sanitation behaviour (‘evidence production’). (Figure 1)

Conclusions: the Evidence Ecosystem demonstrates that the EBP principles are successfully implemented in the BRC.

Patient or healthcare consumer involvement: a top-down managerial focus on EBP increased the awareness of all employees and volunteers, and resulted in a positive attitude towards EBP. In addition, this evidence-based approach supports the quality of BRC research projects, and will result in more (cost-)effective interventions, ultimately benefiting the beneficiaries of these projects/programs.