An assessment of policymakers’ engagement initiatives to promote evidence informed health policy making in Nigeria

In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.


Introduction
The process of utilizing evidence from research to make health policy which is known as evidence-informed policy-making is characterized by the systematic and transparent access to, and appraisal of, evidence as an input into policy-making [1,2]. In evidence-informed policy-making, there is a shift away from opinion-based policies and practices to a more rigorous, rational approach that gathers, critically appraises, and uses high-quality research evidence to inform health policy-making, professional practice, and systems operations [3]. Numerous reports from previous investigations have provided convincing information which proves that evidence from research can enhance health policy process and development by identifying new issues for the policy agenda, informing decisions about policy content and direction and evaluating the impact of policy [4][5][6][7]. Currently there is a global recognition that strong and effective health systems that are evidence-based in their operations are vital to achieve continued improvement in health outcomes in an efficient and equitable manner [8,9]. According to World Health Organization (WHO), better use of research evidence in development policy making can save lives through more effective policies that respond to scientific and technological advances, use resources more efficiently and better meet citizens' needs [10]. In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence [11,12]. A major factor responsible for this is the lack of engagement/involvement of policymakers in the evidence generation process. In a previous report, Dawad and Veenstra [13] noted that without adequate capacity, in knowledge translation/management and health policy research, policymakers will not have the capacity to access and synthesize sound information on which to base decisions and the potential for shared learning will be lost. According to Green and Bennett [14], knowledge and skill constraints associated with accessing evidence from various sources and competency in making use of the evidence appropriately are among the most important capacity needs of policymakers. It is important to note that capacity strengthening to enhance evidence to policy process will undoubtedly require sustainable platforms and mechanisms that will bring both policymakers and researchers together for interaction [13,15].
According to Lavis and colleagues [16], there is growing interest in identifying interactive knowledge-sharing mechanisms that allow research evidence to be brought together with the views, experiences and tacit knowledge of those who will be involved in, or affected by, future decisions about high-priority issues. This interest has been fuelled by the recognition of the need for locally contextualized ´decision support´ for policymakers and other stakeholders [17,18]. This locally contextualized decision support mechanism is one of the main capacity gaps that require to be bridged especially in low and middle income countries (LMICs) where health systems are weak and policies are hardly evidence informed. Deans and Ademokun [19] had noted in their report that those who seek to build capacity for evidence-informed policy need to understand the actual capacity gaps of policy-makers.
Furthermore, Green and Bennett [14] had argued that to achieve evidence informed policy making in any area of the health improvement, policy-makers and their advisers, need a set of skills to enable them to use research in their decision-making. They also noted that in particular, policy-makers need to be able to: identify situations where research can help; articulate research questions for topics of policy-relevant research; and access and assess research findings and incorporate them in decision making [14]. Thus, there is a need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policymakers and other stakeholders who can influence the uptake of research findings [20]. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. This is with the view to providing scientific information required to build sustainable interactive mechanisms and platforms between those who generate research evidence (researchers) and those in the position to use the evidence generated for decision making (policymakers and implementers).

A MEDLINE Entrez Pubmed search was performed in August 2015
and studies published in English that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. The keywords used for the search included: Nigeria, evidence, health policy; these yielded 132 entries. These 132 publications were subjected to the study inclusion criteria which included the following: (i) must have been conducted in Nigeria; (ii) must be a primary scientific investigation and not a review article; (iii) must target policymakers and researchers or only policymakers; (iv) must address health issue of policy relevance to Nigeria; (v) must produce evidence that is policy relevant; (vi) may of may not have an intervention component. Of the 132 publications found, a total of 14(10.6%) fulfilled these study inclusion criteria and were selected and included in this review [21][22][23][24][25][26][27][28][29][30][31][32][33][34] (Table 1, Table 2, Table   3, Table 4). The selected publications were categorized according to the following information: Author/year of publication; Study methods/key activities; Primary study subjects/targets; health issue investigated; evidence-based intervention; evidence produced from study and policy relevant conclusion (Table 1, Table 2, Table   3, Table 4). The references of the selected publications were reviewed for the identification of studies that may provide additional vital information for this paper.  (Table 1,Table 2, Table 3). Also only five research teams [21-23, 31,34] have undertaken scientific research that involved the deliberate engagement of the policymakers for capacity enhancement for evidence-informed policymaking and knowledge transfer/exchange. Sutcliffe and Court [35], noted in their report that using evidence to inform policy is not really a new idea, and that what is new and interesting is the increasing emphasis that has been placed on the concept in recent times. This explains why the concept is quickly gaining so much recognition globally and so it is not unexpected for policymakers and researchers in Nigeria to be aware of the concept as was observed in our previous studies conducted in Nigeria [29,30,[36][37][38][39].
political environment, incentives facing policy makers that support the use of evidence in policy cycles; (ii). function of a Knowledge Translation platform to bridge the gap between research and policy; (iii). Research priority setting exercise for reversing inequities and strengthening the health systems; (iv). design and use of evidence briefs and deliberative dialogues to improve evidence-to-policy link; (v). enhancing competencies of policy makers to adopt an evidence-  insights. According to Choi and colleagues [42], scientists could become "policy sensitive" through training and participation in the policy-making process, while policy-makers could be exposed to science through training and participation in the research process so they can apply a "science lens" to policy-making. This would promote communication among the policy-makers and researchers by creating a common language and which can help the policymaking process more effective [43,44].

Quantifiable improvement in policymakers' knowledge and
competence in evidence to policy process: Most of the studies reporting policymakers' capacity enhancement process for evidence informed policymaking were mostly recent ranging from 2012-2015 (Table 1, Table 2, Table 3). All these studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Six of the selected studies were cross sectional intervention studies [26,27,29,30,31,34]. In one of the scientific publications it was noted that sustainability of evidence-informed policy making requires strengthening institutional capacity, as well as understanding and addressing the political environment, and incentives facing policy makers that support the use of evidence in policy cycles [22] (Table 1). Although the studies reviewed did not assess the long term impact of these trainings on the policymaking process in Nigeria, there is however little doubt that the knowledge and skill acquired by the participants, particularly the policymakers will improve their attitudes towards use of evidence in decision making process. Varkevisser and colleagues [45] observed in their study that capacity enhancement on health systems research (HSR) of policy-makers and other stakeholders in the health sector increased the national expertise for operational health research, and strengthen decision-making at all levels. In an earlier WHO expert consultation report [15], it was clearly noted that strengthening capacity for evidence-informed policymaking should involve both policymakers and researchers since capacity strengthening is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence. It is based on this premise that Dawad and Veenstra [13] argued that as researchers strive to develop the means to obtain timely information on health system impacts, policymakers need to be carried along to enable them become skilled at translating this information into appropriate action, to avoid forfeiting any progress made in developing and reforming the health system.

Conclusion
In Nigeria, the grossly deficient capacity among policy-makers to use of evidence for policy-making remains a major challenge associated with evidence-to-policy link [36,39]. The promotion of evidence-informed policymaking cannot be adequately achieved without bridging the gap between researchers and policymakers. It is already well established that some differences exist between those who do research and those who may be in a position to use it.
Some of these differences including include mutual mistrust and poor attitudes towards information among others have been found to persist largely due to the absence of opportunities to bring researchers, policy-makers together to consider issues around the research to policy and practice interface [30]. According to Green and Bennett [14] a major factor that can bridge the gaps in evidence-to-policy process is sufficient contact between researchers and policy-makers. Stressing on the need to promote the interaction between researchers and policy-makers, Choi and colleagues [30] noted that it is desirable for scientists and policy-makers to communicate their knowledge effectively or run the risks of barriers in language and understanding. They further noted that more incentives and opportunities to collaborate will help scientists and policy-makers appreciate their different goals, career paths, attitudes towards information, and perception of time. Long-term mechanisms that allow for periodic interactions between researchers and policymakers are therefore needed especially in LMICs. Studies show that establishing such long-term links between policymakers and researchers can result in greater involvement of policymakers in setting research priorities and increases the use of research [6].

What is known about this topic
 There is currently a shift away from opinion-based policies to a more rigorous approach that uses high-quality research evidence to inform health policy-making;

Competing interests
The authors declare no competing interests.

Authors' contributions
All authors participated in the design and development of the study.