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Published in: BMC International Health and Human Rights 1/2011

Open Access 01-12-2011 | Research

Research translation to inform national health policies: learning from multiple perspectives in Uganda

Authors: Freddie Ssengooba, Lynn Atuyambe, Suzanne N Kiwanuka, Prasanthi Puvanachandra, Nancy Glass, Adnan A Hyder

Published in: BMC International Health and Human Rights | Special Issue 1/2011

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Abstract

Background

Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.

Methods

A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12).

Results

Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions.

Conclusions

This study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.
Literature
1.
go back to reference Uganda Bureau of Statistics (UBOS) and Macro International Inc.: Uganda Demographic and Health Survey 2006. 2007, Calverton, Maryland, USA: UBOS and Macro International Inc. Uganda Bureau of Statistics (UBOS) and Macro International Inc.: Uganda Demographic and Health Survey 2006. 2007, Calverton, Maryland, USA: UBOS and Macro International Inc.
2.
go back to reference Ministry of Health: Health Sector Strategic Plan III 2010-2015 (draft). 2010, Kampala, Uganda: Government of Uganda Ministry of Health Ministry of Health: Health Sector Strategic Plan III 2010-2015 (draft). 2010, Kampala, Uganda: Government of Uganda Ministry of Health
3.
go back to reference Campbell DM, Redman S, Jorm L, Cooke M, Zwi AB, Rychetnik L: Increasing the use of evidence in health policy: practice and views of policy makers and researchers. Australia and New Zealand Health Policy. 2009, 6 (21): Campbell DM, Redman S, Jorm L, Cooke M, Zwi AB, Rychetnik L: Increasing the use of evidence in health policy: practice and views of policy makers and researchers. Australia and New Zealand Health Policy. 2009, 6 (21):
4.
go back to reference Innvær S, Vist G, Trommald M, Oxman A: Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002, 7: 239-244. 10.1258/135581902320432778.CrossRefPubMed Innvær S, Vist G, Trommald M, Oxman A: Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002, 7: 239-244. 10.1258/135581902320432778.CrossRefPubMed
5.
6.
go back to reference World Health Organization: World report on knowledge for better health—strengthening systems. 2004, Geneva, Switzerland: WHO World Health Organization: World report on knowledge for better health—strengthening systems. 2004, Geneva, Switzerland: WHO
7.
go back to reference Majdzadeh R, Sadighi J, Nejat S, Mahani AS, Gholami J: Knowledge translation for research utilization: design of a knowledge translation model at Tehran University of Medical Sciences. J Contin Educ Health Prof. 2008, 28 (4): 270-7. 10.1002/chp.193.CrossRefPubMed Majdzadeh R, Sadighi J, Nejat S, Mahani AS, Gholami J: Knowledge translation for research utilization: design of a knowledge translation model at Tehran University of Medical Sciences. J Contin Educ Health Prof. 2008, 28 (4): 270-7. 10.1002/chp.193.CrossRefPubMed
8.
go back to reference Lavis JN, Lomas J, Hamid M, Sewankambo N: Assessing country-level efforts to link research to action. Bulletin of the World Health Organization. 2006, 84 (8): 620-628. 10.2471/BLT.06.030312.PubMedCentralCrossRefPubMed Lavis JN, Lomas J, Hamid M, Sewankambo N: Assessing country-level efforts to link research to action. Bulletin of the World Health Organization. 2006, 84 (8): 620-628. 10.2471/BLT.06.030312.PubMedCentralCrossRefPubMed
9.
go back to reference Bennett S, Ssengooba F: Closing the gaps: from science to action in maternal, newborn, and child health in Africa. PLoS Med. 2010, 7 (6): e1000298-10.1371/journal.pmed.1000298.PubMedCentralCrossRefPubMed Bennett S, Ssengooba F: Closing the gaps: from science to action in maternal, newborn, and child health in Africa. PLoS Med. 2010, 7 (6): e1000298-10.1371/journal.pmed.1000298.PubMedCentralCrossRefPubMed
10.
11.
go back to reference COHRED: Synthesis Report Alignment and Harmonization in Health Research: AHA Study. 2008, Geneva: Council on Health Research for Development (COHRED) COHRED: Synthesis Report Alignment and Harmonization in Health Research: AHA Study. 2008, Geneva: Council on Health Research for Development (COHRED)
12.
go back to reference Talisuna AO, Langi P, Bakyaita N, Egwang T, Mutabingwa TK, Watkins W, Van Marck E, D’Alessandro U: Intensity of malaria transmission, antimalarial drug use and resistance in Uganda: what is the relationship between these three factors?. Trans R Soc Trop Med Hyg. 2002, 96: 310-317. 10.1016/S0035-9203(02)90108-2.CrossRefPubMed Talisuna AO, Langi P, Bakyaita N, Egwang T, Mutabingwa TK, Watkins W, Van Marck E, D’Alessandro U: Intensity of malaria transmission, antimalarial drug use and resistance in Uganda: what is the relationship between these three factors?. Trans R Soc Trop Med Hyg. 2002, 96: 310-317. 10.1016/S0035-9203(02)90108-2.CrossRefPubMed
13.
go back to reference Francis D, Nsobya SL, Talisuna A, Yeka A, Kamya MR, Machekano R, Dokomajilar C, Rosenthal PJ, Dorsey G: Geographic differences in antimalarial drug efficacy in Uganda are explained by differences in endemicity and not by known molecular markers of drug resistance. J Infect Dis. 2006, 193: 978-986. 10.1086/500951.CrossRefPubMed Francis D, Nsobya SL, Talisuna A, Yeka A, Kamya MR, Machekano R, Dokomajilar C, Rosenthal PJ, Dorsey G: Geographic differences in antimalarial drug efficacy in Uganda are explained by differences in endemicity and not by known molecular markers of drug resistance. J Infect Dis. 2006, 193: 978-986. 10.1086/500951.CrossRefPubMed
14.
go back to reference Lee SA, Yeka A, Nsobya SL, Dokomajilar C, Rosenthal PJ, Talisuna A, Dorsey G: Complexity of Plasmodium falciparum infections and antimalarial drug efficacy at 7 sites in Uganda. J Infect Dis. 2006, 193: 1160-1163. 10.1086/501473.CrossRefPubMed Lee SA, Yeka A, Nsobya SL, Dokomajilar C, Rosenthal PJ, Talisuna A, Dorsey G: Complexity of Plasmodium falciparum infections and antimalarial drug efficacy at 7 sites in Uganda. J Infect Dis. 2006, 193: 1160-1163. 10.1086/501473.CrossRefPubMed
15.
go back to reference Okello P, Van Bortel W, Correwyn A, Roelants P, Talisuna AO, D’Alessandro U, Coosemans M: Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg. 2006, 75: 219-225.PubMed Okello P, Van Bortel W, Correwyn A, Roelants P, Talisuna AO, D’Alessandro U, Coosemans M: Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg. 2006, 75: 219-225.PubMed
16.
go back to reference Guay L, Musoke P, Flemming T, et al: Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial. Lancet. 1999, 354: 795-802.CrossRefPubMed Guay L, Musoke P, Flemming T, et al: Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial. Lancet. 1999, 354: 795-802.CrossRefPubMed
17.
go back to reference Marseille E, Kahn J, Mmiro F, et al: The cost-effectiveness of a single dose nevirapine regimen to mother and infant to reduce vertical HIV transmission in Uganda. Lancet. 1999, 354: 803-9.CrossRefPubMed Marseille E, Kahn J, Mmiro F, et al: The cost-effectiveness of a single dose nevirapine regimen to mother and infant to reduce vertical HIV transmission in Uganda. Lancet. 1999, 354: 803-9.CrossRefPubMed
18.
go back to reference Gray H, Kigozi G, Serwadda D, et al: Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet. 2007, 369: 657-66. 10.1016/S0140-6736(07)60313-4.CrossRefPubMed Gray H, Kigozi G, Serwadda D, et al: Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet. 2007, 369: 657-66. 10.1016/S0140-6736(07)60313-4.CrossRefPubMed
19.
go back to reference Gove S: Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ. 1997, 75 (Suppl 1): 7-24.PubMedCentralPubMed Gove S: Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ. 1997, 75 (Suppl 1): 7-24.PubMedCentralPubMed
20.
go back to reference Wanyenze RK, Nawavvu C, Namale AS, Mayanja B, Bunnell R, Abang B, Amanyire G, Sewankambo NK, Kamya MR: Acceptability of routine HIV counseling and testing, and HIV seroprevalence in Ugandan hospitals. Bull World Health Organ. 2008, 86 (4): 302-9. 10.2471/BLT.07.042580.PubMedCentralCrossRefPubMed Wanyenze RK, Nawavvu C, Namale AS, Mayanja B, Bunnell R, Abang B, Amanyire G, Sewankambo NK, Kamya MR: Acceptability of routine HIV counseling and testing, and HIV seroprevalence in Ugandan hospitals. Bull World Health Organ. 2008, 86 (4): 302-9. 10.2471/BLT.07.042580.PubMedCentralCrossRefPubMed
21.
go back to reference Wanyenze R, Kamya M, Liechty CA, Ronald A, Guzman DJ, Wabwire-Mangen F, Mayanja-Kizza H, Bangsberg DR: HIV counseling and testing practices at an urban hospital in Kampala, Uganda. AIDS Behav. 2006, 10 (4): 361-7. 10.1007/s10461-005-9035-9.CrossRefPubMed Wanyenze R, Kamya M, Liechty CA, Ronald A, Guzman DJ, Wabwire-Mangen F, Mayanja-Kizza H, Bangsberg DR: HIV counseling and testing practices at an urban hospital in Kampala, Uganda. AIDS Behav. 2006, 10 (4): 361-7. 10.1007/s10461-005-9035-9.CrossRefPubMed
22.
go back to reference Pariyo G, Serwadda D, Sewankambo N, Groves S, Bollinger RC, Peters DH: A grander challenge: the case of how Makerere University College of Health Sciences (MakCHS) contributes to health outcomes in Africa. BMC International Health and Human Rights. 2011, 11 (Suppl 1): S2-10.1186/1472-698X-11-S1-S2.PubMedCentralCrossRefPubMed Pariyo G, Serwadda D, Sewankambo N, Groves S, Bollinger RC, Peters DH: A grander challenge: the case of how Makerere University College of Health Sciences (MakCHS) contributes to health outcomes in Africa. BMC International Health and Human Rights. 2011, 11 (Suppl 1): S2-10.1186/1472-698X-11-S1-S2.PubMedCentralCrossRefPubMed
23.
go back to reference COHRED: Working Group on Research to Action and Policy. 2000, Geneva: Council on Health Research for Development (COHRED) COHRED: Working Group on Research to Action and Policy. 2000, Geneva: Council on Health Research for Development (COHRED)
24.
go back to reference Syed S, Hyder AA, Bloom G, Sundarami S, Bhuiya A, Zhenzhong Z, Kanjilal B, Oladepo O, Pariyo G, Peters DH, Future Health Systems: Innovation for Equity: Exploring evidence-policy linkages in health research plans: A case study from six countries. Health Res Policy Syst. 2008, 6: 4-10.1186/1478-4505-6-4. doi:10.1186/1478-4505-6-4PubMedCentralCrossRefPubMed Syed S, Hyder AA, Bloom G, Sundarami S, Bhuiya A, Zhenzhong Z, Kanjilal B, Oladepo O, Pariyo G, Peters DH, Future Health Systems: Innovation for Equity: Exploring evidence-policy linkages in health research plans: A case study from six countries. Health Res Policy Syst. 2008, 6: 4-10.1186/1478-4505-6-4. doi:10.1186/1478-4505-6-4PubMedCentralCrossRefPubMed
25.
go back to reference Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed
26.
go back to reference Homsy J, Kalamya JN, Obonyo J, Ojwang J, Mugumya R, Opio C, Mermin J: Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr. 2006, 42 (2): 149-54. 10.1097/01.qai.0000225032.52766.c2.CrossRefPubMed Homsy J, Kalamya JN, Obonyo J, Ojwang J, Mugumya R, Opio C, Mermin J: Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr. 2006, 42 (2): 149-54. 10.1097/01.qai.0000225032.52766.c2.CrossRefPubMed
27.
go back to reference Nuwagaba-Biribonwoha H, Mayon-White RT, Okong P, Carpenter LM: Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda. J Public Health (Oxf). 2007, 29 (3): 269-74. 10.1093/pubmed/fdm025. Epub 2007 May 30CrossRef Nuwagaba-Biribonwoha H, Mayon-White RT, Okong P, Carpenter LM: Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda. J Public Health (Oxf). 2007, 29 (3): 269-74. 10.1093/pubmed/fdm025. Epub 2007 May 30CrossRef
28.
go back to reference MOH: Annual Report of the Uganda AIDS Control Program (ACP). 2009, Ministry of Health Kampala Uganda MOH: Annual Report of the Uganda AIDS Control Program (ACP). 2009, Ministry of Health Kampala Uganda
29.
go back to reference Auvert B, Taljaard D, et al: Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Medicine. 2005, 2 (11): e298-10.1371/journal.pmed.0020298.PubMedCentralCrossRefPubMed Auvert B, Taljaard D, et al: Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Medicine. 2005, 2 (11): e298-10.1371/journal.pmed.0020298.PubMedCentralCrossRefPubMed
30.
go back to reference Bailey C, Moses S, et al: Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007, 369: 643-656. 10.1016/S0140-6736(07)60312-2.CrossRefPubMed Bailey C, Moses S, et al: Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007, 369: 643-656. 10.1016/S0140-6736(07)60312-2.CrossRefPubMed
31.
go back to reference Shiffman J: Generating Political Priority for Maternal Mortality Reduction in 5 Developing Countries. American Journal of Public Health. 2007, 979 (5): Shiffman J: Generating Political Priority for Maternal Mortality Reduction in 5 Developing Countries. American Journal of Public Health. 2007, 979 (5):
32.
go back to reference Kingdon JW: Agendas, Alternatives and Public Policies. 1984, Boston, MA: Little, Brown and Company Kingdon JW: Agendas, Alternatives and Public Policies. 1984, Boston, MA: Little, Brown and Company
33.
go back to reference Walt G: Health Policy: An introduction to Process and Power. 1994, London: Zed Books Walt G: Health Policy: An introduction to Process and Power. 1994, London: Zed Books
34.
go back to reference Bowen S, Zwi B: Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action. PLoS Medicine. 2005, 2 (7): e166-10.1371/journal.pmed.0020166.PubMedCentralCrossRefPubMed Bowen S, Zwi B: Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action. PLoS Medicine. 2005, 2 (7): e166-10.1371/journal.pmed.0020166.PubMedCentralCrossRefPubMed
35.
go back to reference Fisher C, Vogel I: Locating the power of in-between: How research brokers and intermediaries support evidence-based pro-poor policy and practice. 2008, University of Sussex Brighton UK: Institute of Development Studies Fisher C, Vogel I: Locating the power of in-between: How research brokers and intermediaries support evidence-based pro-poor policy and practice. 2008, University of Sussex Brighton UK: Institute of Development Studies
36.
go back to reference Williams BG, Lloyd-Smith JO, et al: The potential impact of male circumcision on HIV in sub- Saharan Africa. PLoS Med. 2006, 3 (7): e262-10.1371/journal.pmed.0030262.PubMedCentralCrossRefPubMed Williams BG, Lloyd-Smith JO, et al: The potential impact of male circumcision on HIV in sub- Saharan Africa. PLoS Med. 2006, 3 (7): e262-10.1371/journal.pmed.0030262.PubMedCentralCrossRefPubMed
Metadata
Title
Research translation to inform national health policies: learning from multiple perspectives in Uganda
Authors
Freddie Ssengooba
Lynn Atuyambe
Suzanne N Kiwanuka
Prasanthi Puvanachandra
Nancy Glass
Adnan A Hyder
Publication date
01-12-2011
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1472-698X-11-S1-S13

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