The Problem 

The East African states of Kenya, Tanzania, Uganda, Rwanda and Burundi share a common burden: Their large populations suffer some of the highest levels of ill health in the world. Much of this burden takes the form of diseases such as malaria, HIV/AIDS, pneumonia, measles, and tuberculosis. All of these are preventable with existing knowledge and resources at the global level. Yet despite this knowledge and these resources, a health crisis persists in East Africa. Furthermore, efficiency, effectiveness, equity and health systems issues in delivery of health services have remained a challenge in these states. Why?  

One obvious reason is lack of money: Under-resourced governments simply don€™t have the budget to afford the high costs of providing good medical care. Another reason is the low capacity in decentralized nature of health care delivery in these countries: The government is not always the only or even the main provider of medical services. In many low-income societies, however, a third culprit is the know-do gap. This is often described as the disconnection between knowledge and action,between evidence and practice.

The know-do gap typically takes two forms: In the first instance, a government might fail to conduct the right kind of research needed to tackle a pressing health issue. This leaves officials in government frustrated that they do not have sufficient information to make sound policy decisions. In the second, the right research sometimes fails to move to the policy arena, leaving scientists frustrated that the innovations they developed have not lead to useful programs. In addition, pilot and full scale program design often fails to adequately integrate research to support its implementation and assess the wider implications of the policy decision.  

Researchers and policy-makers need a better way of helping each other reduce the burden of disease. If pertinent research can be carried out in the first place, and if this research can then inform the policy-making process, the outcome will be a win-win situation for all partners in the effort. And if research can influence policy, resulting in sounder, more sustainablehealth programs and outcomes, it will be a victory for all EastAfricans.

The Process: Regional consultations

East Africa has seen increasing momentum towards reforms of its national health systems. In the 1990s, Canada€™s International Development Research Centre (IDRC) began working closely with Tanzania€™s Ministry of Health to explore how research could play a larger role in guiding health policy. 

  During 2004 and 2005, these issues were discussed at a series of IDRC sponsored workshops held in Tanzania, Uganda, and Kenya. The meetings were chaired by the most senior health policy and medical research officials of the three countries. The purpose of the consultations was to find country-level ways to overcome the know-do gap and to promote €œKnowledgeTranslation€  between scientists and decision-makers. 

The result of this careful and methodical process is a detailed plan to establish a new body called the Regional East African Community Health Policy Initiative (REACH-Policy Initiative). The plan has been reviewed and endorsed by the East African Community (EAC), and so it enjoys the highest political commitment. Furthermore, it has been examined by regional and international experts on knowledge translation, and their advice has been integrated into the prospectus.

The Solution: Knowledge Brokering 

When fully established, theREACH-Policy Initiative willfunction as an intermediary €“ a bridge €“ linking researchers with policy-makers. It will be an independent €œKnowledge broker€™ that provides these constituencies with common forms of expression and with shared platforms that will make it easier for them to communicate. 

The initiative is a permanent, dedicated, professional mechanism operating in the newly-formed East African Health Research Commission (EAHRC), an Institution of the EAC.

It will serve researchers by harvesting, synthesizing, re-packaging, and communicating the policy-relevant evidence from their studies and in user-friendly terms that other persons will understand. It will serve government officials by expressing their policy needs in the form of questions that can be investigated scientifically.  

While the need to bridge the realms of research and policy has been long recognized €“ worldwide, many models have attempted to put the concept into practice €“ never before has there been such a large-scale, systematic attempt to apply the brokerage idea. The REACH-Policy Initiative will be the world€™s first regional experiment in knowledge translation using knowledge brokers.

  The Mission: Practical Activities 

The REACH-Policy Initiative will carry out a range of concrete tasks aimed at fostering better links between researchers and policy-makers and other users.  It will: 

·                     Convene meetings. The initiative will host consultations that bring together researchers and policy-makers, plus other stakeholders such as non-governmental organizations and civil society groups. These meetings focus on setting priorities.  They might be confidential €œsafe harbour€ gatherings where policy options can be discussed in a neutral and non-committal setting or open meetings. 

·                     Ease the access to research. For the benefit stakeholders including policy makers, civil servants and political staff, the initiative will maintain a central clearing house of research information, as well as a related website and €œrapid response unit€ to retrieve this information as required. 

·                     Synthesize policy-relevant research information. On high priority policy issues, the initiative will either search for formal, summary reviews of existing research, or where this reviews do not exist, contract their production.

·                     Package research syntheses. The initiative will develop a range of materials designed to provide user-friendly access to complex research information. These materials will include policy options briefs executive summaries, cost/benefit breakdowns, press releases and posters.

  ·                     Fill research and policy gaps. The initiative will inform  its clients about €œorphaned€ or neglected policy issues that ought to be addressed, and about deficiencies in available research. In general, it will lobby for increased support for health systems research and evidence based policy-making. 

·                     Train policy-makers and researchers. The initiative will strengthen the regional capacity for knowledge translation by providing briefings and workshops that coach policy-makers to access and use scientific information, and that coach researchers to nderstand the policy context of theirinvestigations. 

·                     Evaluate its impact. The initiative will monitor awareness of and attitudes towards its own activities, especially on the part of policy-makers, researchers, and other stakeholders, with particular attention to any influence on policy change.

  The Organization: Centralized Structure, Professional Staffing 

While the REACH-Policy Initiative is an independententity, designed to serve a mediating role, its secretariat in will function as an integral part of the EAHRC, giving itthe advantage of proximity to the research commissioning arm of the Commission. 

The initiative will help maintain country nodes, in Tanzania, Uganda, Kenya, Rwanda and Burundi. These offices will translate the research needs of each country€™s ministries, parliament, and civil society into questions that the secretariat can investigate. Later, they will assist each country€™s government and development partners including non-government sector in converting these answers into practical policy options/ recommendations. Another important task of these offices will be to advocate the findings and recommendations of the Initiative, and to make its products and services widely known. 

All these offices will be staffed by qualified experts recruited on the basis of merit and professional standing.

Implementation  

The activities of the REACH-Policy Initiative will evolve step-by-step over its first five years as it installs the structures and processes required for a comprehensive knowledge translation system in the region.

For more information about the implementation schedule and other details about the operation of the REACH-Policy Initiative, please see the full text of its prospectus. 

The Result: Healthier People 

REACH-Policy Initiative will help ensure that health research information in East Africa is accessible, timely, credible, packaged in a user-friendly format, and relevant to the local context. The initiative will support platforms for continuing debate, and will build regional capacity for more productive links between researchers, policy makers and other users. It will accelerate the development of effective health care systems in the region, and ultimately will result in healthier populations, less vulnerable to the scourge of preventable disease.