Article type
Abstract
"Background: Most countries have established technical advisory bodies to assist policymakers in making evidence-informed decisions on introducing and/or implementing new health programmes and commodities including vaccines. However, we know little of how policymakers and their technical advisory bodies contextualise and use global guidance documents and evidence as well as how they elicit and use local evidence, including the knowledge of stakeholders such as civil society groups, during policymaking processes in low-and middle-income countries (LMICs).
Objectives: To investigate how health system policymakers and their technical advisory bodies use global and local evidence and include stakeholders in decision-making processes for the introduction and roll-out of HPV and malaria vaccines at the national level in Kenya.
Methods: We employed a qualitative multiple case study design. Data were collected through document review (n=52), in-depth interviews (n=30) and observations. Modified framework analysis was used to analyse data and generate findings.
Results: The World Health Organization’s (WHO) global guidance and Ministry of Health (MOH) programmatic data were the most used explicit evidence. These two sources of evidence were perceived by decision-makers within the National Vaccines and Immunisation Programme’s officials as legitimate sources of sufficient and readily available evidence to inform health systems and policy decisions. The consistent involvement of WHO and MOH officials in these decision spaces allowed them to easily share the information required to inform decisions. In contrast, the use of local primary research findings largely occurred when imposed by donors as part of funding requirements, and when non-government actors represented in the decision-making process had earlier on conducted research specifically to inform these decisions. Local tacit evidence from the MOH and partners involved in the decision-making was used largely to interpret and contextualise WHO guidance documents. Specifically, these actors used their local programmatic knowledge and experiences to make broad WHO recommendations locally relevant.
Conclusions: While both global and local evidence can play key roles in informing decisions on implementing health interventions, the range of stakeholders represented in these decision-making spaces influences the diversity of global and local evidence that is available.
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Objectives: To investigate how health system policymakers and their technical advisory bodies use global and local evidence and include stakeholders in decision-making processes for the introduction and roll-out of HPV and malaria vaccines at the national level in Kenya.
Methods: We employed a qualitative multiple case study design. Data were collected through document review (n=52), in-depth interviews (n=30) and observations. Modified framework analysis was used to analyse data and generate findings.
Results: The World Health Organization’s (WHO) global guidance and Ministry of Health (MOH) programmatic data were the most used explicit evidence. These two sources of evidence were perceived by decision-makers within the National Vaccines and Immunisation Programme’s officials as legitimate sources of sufficient and readily available evidence to inform health systems and policy decisions. The consistent involvement of WHO and MOH officials in these decision spaces allowed them to easily share the information required to inform decisions. In contrast, the use of local primary research findings largely occurred when imposed by donors as part of funding requirements, and when non-government actors represented in the decision-making process had earlier on conducted research specifically to inform these decisions. Local tacit evidence from the MOH and partners involved in the decision-making was used largely to interpret and contextualise WHO guidance documents. Specifically, these actors used their local programmatic knowledge and experiences to make broad WHO recommendations locally relevant.
Conclusions: While both global and local evidence can play key roles in informing decisions on implementing health interventions, the range of stakeholders represented in these decision-making spaces influences the diversity of global and local evidence that is available.
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