Translating Health Research into Policy in the Western Cape Provincial Health System

 

The gap between health research, policy and practice is an enduring challenge in the health system and is impeding efforts to achieve health for all. This has led to global interest in knowledge translation (KT), a field of research that includes examining how research-based knowledge is used (or not) in policy and practice. However, despite its increasingly prolific nature, there is little clarity on how KT functions, especially in African settings. Recognising the need for a more coordinated approach to closing the gap between research, policy and practice, the Western Cape Health Impact Assessment established a project in 2016 to improve how research-based knowledge informs provincial health policy. The initial objective of this project was informed by a study as part of a Masters dissertation in Public Health at UCT’s School of Public Health and Family Medicine (Health Policy and Systems Division). 

The initial phase of the project set out to map the local KT system, including the mechanisms that are used to translate research by health researchers and provincial policymakers. Specific barriers and facilitators to research use, as well as evidence of research impact, were explored within the specific context of the Western Cape (WC). The study used a mixed-methods approach that synthesised data from in-depth interviews with high-level health system researchers and provincial policymakers, a detailed review of key policy documents, and a sample of study protocols registered on the National Health Research Database. A mapping review of the literature on KT in African health systems further informed the study. 

The findings highlighted the presence of a strong health research system and institutions specifically geared towards KT, including the Knowledge Translation Unit at the University of Cape Town’s Lung Institute, the Centre for Evidence-Based Healthcare at Stellenbosch University, and the Cochrane Centre at the South African Medical Research Council. 

Impact of many used KT mechanisms is unclear

Researchers employed a diverse range of KT mechanisms to foster research uptake by policymakers. Commonly reported mechanisms included briefs and bulletins, executive summaries, journal publications, leveraging networks, presentations and annual research days. 

Despite these varied mechanisms, no distinct outcome for the use of KT mechanisms was reported and both researchers and policymakers were often unclear about the final impact of research on policy decision-making. Global debates on research impact indicate, however, that this situation is not unique to the WC, or to South Africa.

A culture of mutual learning and knowledge sharing

Facilitating factors for KT in the WC rely on organisational processes within the Department of Health. These processes have built and sustained capacity, developed a culture of learning and leadership, and fostered ongoing engagements between researchers and policymakers. Notable examples include the development of a multidisciplinary Provincial Health Research Council and the embedding of public health researchers and registrars within the department. 

Opportunities for informal interactions, such as health policy and systems journal clubs, were also reported as key to creating safe spaces for mutual learning between researchers and policymakers. Such spaces were recognised for fostering cooperative and trusting relationships that span institutional boundaries, promote engagement and support the brokering of new research evidence in the WC health system. 

Barriers to knowledge translation

Despite these platforms, barriers to KT remain. Resource constraints, particularly time and funding, politics and differing incentives and priorities complicate what research gets translated and by whom. Chronic disease burdens; ageing infrastructure; increasing reliance on donor funds; and hierarchical, siloed and competitive institutions serve as additional barriers for policymakers and researchers who seek to ensure decisions are informed by the best available research.  

Recommendations for improved KT

This study highlights key issues in the translation of research-based knowledge by local health researchers and policymakers:

• Firstly, there is a need for more systematic and contextualised understanding of KT. This will facilitate the selection of appropriate KT mechanisms and pathways for targeted audiences and will foster understanding of why research is used (or not). 
• There is value in a learning systems approach that integrates service delivery with the generation of new knowledge. Trust, credibility, open communication, mutual respect and sustained leadership over time are central to such systems.
• An embedded approach to KT has the potential to strengthen links between researchers and policymakers, enhance ownership of research and develop institutional capacity for integrating research findings into policy.
• There is a need for researchers and policymakers to view KT as an ethical imperative so that quality research-based knowledge is generated, shared and used to inform policy and achieve intended health outcomes.

Successful KT requires ongoing and conscious processes for learning

Although context specific, these lessons are likely to resonate beyond the WC health system as they highlight the need to view KT as an ethical issue and to consider the potential of an embedded learning systems approach. As stakeholders in the development of health policy that relies on good research and evidence-based knowledge, we must recognise that the adoption of new knowledge is neither a spontaneous achievement, nor a forgone conclusion. 

As one leading WC policymaker noted: “You can never say that you know it all, or that you have the answers. You have to listen and learn and be a student of the system.”

This study formed part of a Masters in Public Health by Amanda Edwards in the Health Policy and Systems Division at UCT’s School of Public Health and Family Medicine. The study was co-supervised by Virginia Zweigenthal (UCT School of Public Health and Family Medicine and Health directorate, Western Cape government), and Associate Prof. Jill Olivier (UCT School of Public Health and Family Medicine (Health Policy and Systems Division).

For further information about the study, contact amanda.edwards@uct.ac.za

Full thesis: 
Edwards A. 2018. Exploring knowledge translation mechanisms in the Western Cape provincial health sytem. Masters in Public Health. University of Cape Town, Cape Town.

School of Public Health & Family Medicine Noon Meeting Presentation, 10 May 2018: 
“You might have your cake, but who gets to eat it? Translating health research into policy in the Western Cape.”