Academic journal article International Perspectives on Sexual and Reproductive Health

An Assessment of Family Planning Decision Makers' and Advocates' Needs and Strategies in Three East African Countries

Academic journal article International Perspectives on Sexual and Reproductive Health

An Assessment of Family Planning Decision Makers' and Advocates' Needs and Strategies in Three East African Countries

Article excerpt

Despite global and national efforts to promote consultation between decision makers and public health researchers, (1) and to include stakeholders in research processes, empirical studies on the influence of health research findings on the knowledge, attitudes and actions of decision makers--especially in developing countries--are scant. (2) Likewise, few systematic studies have been conducted to examine how decision makers view advocacy, how they use public health research findings and advocacy, what types of research and advocacy they consider persuasive, and how and why they choose to support policies indicated by research. (3) Findings from those studies suggest that many advocates who strive to help decision makers use research findings to inform health policy fail to adequately consider political realities or to present advocacy messages in a persuasive package. (2-8) In low-income countries, decision makers are further hampered in connecting health research to policy by weak health systems, lack of professional regulation and poor access to evidence. (9)

To our knowledge, no studies have specifically investigated decision makers' views on and use of family planning research and advocacy. Thus, under the Health Policy Project funded by the U.S. Agency for International Development (USAID), we conducted a qualitative study of how parliamentarians, government officials and their technical advisors in three East African countries--Ethiopia, Kenya and Malawi--make decisions related to family planning, what types of evidence they find compelling, what other factors compete with research evidence to influence their decision making and what advocacy approaches are most effective. We chose the three countries because of the progress their governments have made in strengthening family planning programs: Modern contraceptive use has risen substantially among married women in each in recent decades (Ethiopia, from 6% in 2000 to 29% in 2011;1011 Malawi, from 7% in 1992 to 42% in 2010;12-13 and Kenya, from 18% in 1989 to 39% in 2008-200914-15). In addition, the countries were selected because both the African Institute for Development Policy and Health Policy Project/ Futures Group had conducted or were currently conducting work on family planning and reproductive health there and, thus, had access to contacts. Research findings from these countries may provide valuable lessons for evidence-informed family planning advocacy elsewhere.

METHODS

Literature Review

We began by searching PubMed and Google Scholar to identify peer-reviewed journal articles from 1999-2012 related to decision makers' needs and experiences with health advocacy and evidence. We used the following search terms: "policy," "policymaker," "decision maker," "advocacy," "research," "data," "evidence," "health" and "family planning." Articles were selected if they reported high-level decision makers' opinions, experience and recommendations regarding health advocacy, research or the use of data in decision making. These filters yielded 10 articles for review, of which eight included some developing countries; none focused on family planning.

Six themes emerged. First, the trustworthiness of those who present research findings and the perceived quality of those findings are important to their uptake. (3-4-6-16-17) Second, decision makers are less influenced by research quality than by such pragmatic issues as the cost of implementation. (3-8) Third, timeliness, relevance, format and clarity of evidence matter. (2-4-6-8-16-18) Fourth, political interests, social consensus, constraints on budgets and other resources, mass media and foreign donors strongly influence policymaking; (2-3-5-7-16) advocacy messages must take these influences into account, (2-5) and must articulate and package them to speak to the specific needs of distinct audiences. (4) Fifth, gaps in communication and understanding between researchers or advocates and decision makers are barriers to evidence-informed decisions; (2-16) decision makers may resist using research because they fear that doing so will be time-consuming, complex and difficult, (4-6-7) while researchers and advocates may fail to grasp the complexities of the policy process. …

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