Improving Nigerian health policymakers’ capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop

Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers’ ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.


Introduction
All over the world, there is increasing recognition of importance of making health policies with best available evidence. The process which is known as evidence-informed health policymaking is characterized by the systematic and transparent access to, and appraisal of, evidence as an input into policymaking [1]. According to Bowen and Zwi [2], evidence encompasses research, opinion and views of individuals or groups, results of consultative processes and published reports and documents; facts which may be actual or asserted which may be known through experience or observation.
However, numerous reports have consistently indicated that evidence from research is among the most reliable category of evidence and can greatly enhance health policy development [3][4][5][6].
One of the most challenging aspects of evidence-to-policy link especially in developing countries is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence [7,8]. Studies have shown that one of the major areas of policymakers' capacity constraints in developing world is in the use information and communication technology (ICT) [9]. ICTs have been defined as "tools that facilitate communication and the processing and transmission of information and the sharing of knowledge by electronic means encompassing the full range of electronic digital and analogue ICTs" (9). ICTs have been reported to have greatly improved access to health information, research, literature and training materials, thereby supporting the health research enterprise and enabling comprehensive, evidence-based policymaking [10]. In Nigeria, the lack of adequate knowledge and capacity on the use of ICT by health sector policymakers constitute a major impediment to the uptake of research evidence into the policymaking process [11][12][13]. Gething and colleagues [14], had observed in their report that in most African setting, there is a paucity of ICT-related knowledge and skills limiting capacities of national health management information systems (HMIS) to generate, analyze and disseminate information for use in decisionmaking. The United Nations Economic commission for Africa (UNECA) recognized the importance of ICT in the improvement of the health sector in the African region. According to the UNECA report, ICTs have a crucial role to play in improving the effectiveness of the health sector by maximizing the use of scarce knowledge and limited resources as well as bringing life-enhancing knowledge to people in ways they can use, when and where they need it [15]. A number of previous published works have suggested that a relationship exists between effective job performance of a health sector stakeholder (policymaker or service provider) and ICT use [9,10,15]. Therefore to address the competency problem in ICT use by health sector policymakers, there is a dire need for a capacity enhancement training activity for policymakers. This is supported by Peizer [16] who in a paper on strategies to bridge the digital divide, made a case for a significant time and resource commitment to invest in training to enhance ICT competence of those involved in making health policy.

Aim of the Workshop
The aim of this study is to improve the knowledge and capacity of Nigerian policymakers to access and utilize policy relevant evidence via an ICT training workshop. In this workshop, a modified "before and after" intervention study design was used in which outcomes were measured on the eligible population (target participants) both before the programme (intervention) is implemented and after [17]. The difference between the before and after measurements was taken to be the impact of the intervention. (In this instance, the "before"-or "baseline"-measurements served as the control measurements).

Study area and participants
This research was a sub-national study and participants consisted of individuals whose geographical area of operation is south-eastern Nigeria, with emphasis on Ebonyi State. The target participants were the career health policy makers, this category of policymakers included: health professionals in charge of the health systems; regional, state and local government directors of the health ministry; directors of primary health care at the local government level; health professionals working with specific programmes in the health ministry; staff and consultants involved in public health issues within the health ministry; programme/project managers under the health ministry; chief executive officers of civil society groups, including non-governmental organizations; leaders of national health-based associations (for example, Nigerian Medical Association; National Association of Nigeria Nurses and Midwives; and Pharmaceutical Association of Nigeria) This category of policymakers were selected as key participants in this study because findings from our previous studies [7,18,19] clearly indicate that at the State and Local Government levels, they play the most vital role in "evidence-to-policy" making process. They are the principal actors involved in the generation, collection and assembling of policy relevant information, and processing of data and reports on healthrelated issues from the different sectors of the health system. They also prepare these into forms that can be submitted for the drafting of policy documents.

Ethical consideration
Approval for this study was obtained from the Directorate of

Pre-Workshop tasks
A total of 70 policymakers were mapped out for this study. The mapped out participants were divided into two batches of 35 persons each. We organized a two-day intensive health-policy based ICT training workshop at the Ebonyi State University, Information and Communication Technology (ICT) (E-Library) Centre Abakaliki Nigeria, for the policymakers. All the policymakers were invited to the workshop by invitation letters which were sent 2 weeks before the event and was followed-up with a text message reminder to their mobile phones a day before the programme.  Table 2, while the POST-ICT knowledge and skill assessment is presented in Table 3. The outcome of the assessment of the impact of the training workshop with the comparison of the PRE-ICT mean and POST-ICT mean is presented in Table 4.
Result showed a progressive increase in the POST-ICT mean over the PRE-ICT mean. In terms of the "intersectoral partnership/ collaboration in health policymaking", the PRE-ICT mean ranged from 2.99-3.05, while the POST-ICT mean ranged from 3.37-3.67, with the percentage increase ranging from 14.3%-22.6%. In terms of "engaging ICT in evidence-informed policy making for control of infectious diseases of poverty and in running the health", the PRE-ICT mean ranged from 2.26-2.55, while the POST-ICT mean ranged from 3.14-3.41, with the percentage increase ranging from 25.

Competing interests
Authors declare no competing interests.