Connecting health Research in Africa and Ireland Consortium (ChRAIC)

1. Connecting health Research in Africa and Ireland Consortium (ChRAIC) Contextuality of Relationships between Researchers and Decision Makers in Strengthening Health Research Capacity Byrne E.1, Brugha R.1, Thomas S.2, Connecting health Research in Africa and Ireland Consortium (ChRAIC)3 1 Dept of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, RCSI, 2Centre for Global Health, Trinity College Dublin, 3ChRAICis a partnership of: College of Medicine, Malawi; Makerere University School of Public health (MUSPH), Uganda; Malaria Consortium, South Sudan and Uganda; Medical Research Centre (MRC), Sierra Leone; Ministry of Health, Republic of South Sudan; National University of Ireland, Galway (NUIG), Ireland; National University of Lesotho; Royal College of Surgeons in Ireland (RCSI); Trinity College Dublin (TCD), Centre for Global Health, Ireland; University of Medical Sciences and Technology, Khartoum, Sudan. Additional support to the partnership is provided by two organizations based at the World Health Organization in Geneva, the Alliance for Health Policy and Systems Research (AHPSR) and the Council on Health Research for Development (COHRED) ChRAIC is co-funded for its first five years, 2007-11, by Irish Aid through the Higher Education Authority.

2. Aim of paper Examine the processes whereby health systems researchers (ChRAIC) worked with national policy makers and knowledge users in seven African countries.

3. Rationale for partnerships • recognition that health interventions need to be rooted in evidence based policies • to increase the use of research findings by decision makers and policy makers is to involve these stakeholders from the start of the research process

4. Roots of this rationale Arguments for partnerships of policy/decision makers and researchers stem from three main premises: • The research conducted is more likely to be relevant to the context (Klein, 2000); • The research output is more likely to be used (Sobell 1996; Laycock 2000), and; • It is the ethical or right thing to do (Mumford 1984).

5. Data collection methods • proceedings from a ChRAIC partner workshop in Kampala in April 2009 in which country policy-makers participated; • a half day ChRAIC partner workshop in November 2010 to analyse the involvement of policy makers; • 8 telephone interviews with the ChRAIC country team investigators May 2011, and; • Six monthly reports to funder (x5) with section on involvement of policy makers1

6. Findings (1) • Policy makers and researchers agreed that research was more likely to be relevant to their contexts and research outputs more likely to be used if policy makers were involved in the research process (Kampala, 2009)

7. Findings (2) • Adaptability essential in negotiating ways forward in terms of alignment with other initiatives ongoing in the country • Setting up teams with key interested stakeholders rather than predetermining who was to be involved and the role to be played • Form of relationship depends on the broader political and environmental context, as well as on the personal relationships of the researchers and the policy makers.

8. Findings (3) Three forms of relationships: • policy-makers, researchers and other stakeholders being equally active members of the research team. • researchers from university/research institution taking the lead and conducting the research, but in line with terms of reference or priorities of policy makers. Consultation to take place at regular intervals with policy makers • research approved & in line with government priorities, but no involvement of policy makers in research process “Go ahead we will know when you have done it.”

9. Challenges to involvement • Developing & maintaining the partnership is a time-consuming process. “And sometimes, you know, we accepted delay because we feel that this will help engaging more policy makers and it spreads the idea about this collaboration” • Alignment and harmonisation of research processes with the activities & cycles of policy makers causes delays

10. Implications • No single approach or blueprint suited these different national contexts. • Four elements emerged: • strong institutional link and track record requires trust to be established; • expectations and motivations of the team members needs to be negotiated and reviewed periodically; • clarity is needed on, and interpretation of, the activities, roles and responsibilities for each team member, and; • recognition by all parties, including research funders, that building partnerships is a time-consuming process, which may delay outputs

11. Conclusion In line with Golden-Biddle, Reay et al. (2003) • move away from the model of knowledge-translation as a one way street of researchers packaging their findings in policy-makers language to a process of collaborative efforts • partnerships as social processes consisting of elements of linkage and exchange and emphasise the members and the communicative elements in partnerships which focus on knowledge-making and –using,

12. References • Golden-Biddle, K., T. Reay, et al. (2003). "Toward a communicative perspective of collaborating in research: the case of the researcher-decision-maker partnership." J Health Serv Res Policy 8 Suppl 2: 20-5. • Cooke, B. and U. Kothari, Eds. (2001). Participation: The New Tyranny. New York, Zed books,. • Klein, R. (2000). "From evidence based medicine to evidence based policy? (Editorial)." Journal of Health Service Research Policy5: 65-66. • Laycock, G. (2001). "Hypothesis-based research: the repeat victimization story." Criminal Justice 1: 59–82. • Mumford, E. (1984). Participation - from Aristotle to today. Beyond Productivity: Information Systems Development for Organisational Effectiveness,. T. Bemelmans, Elsevier Science Publishers B.V., North-Holland Press: 95-104. • Sobell, L. C. (1996). "Bridging the gap between scientists and practitioners: the challenge before us." Behaviour Therapy 27: 297–320.