Diffusion of evidence and knowledge into health policies and practice at country level: moving from knowledge to practice.

Evidence exits regarding the disease burden and knowledge on cost effective interventions in several areas ranging from public health to clinical medicine. Despite availability of a body of evidence, this rarely informs health policies and strategies development, especially in developing countries. There is a concern that research findings are not being utilised by health policy makers in health policy and strategy development process to the extent that they should be. Commitment to knowledge translation has been of concern to funders of research', researchers and policy makers. Waters E, Armstrong R noted that knowledge translation, synthesis and exchange has emerged as an issue in need of further exploration for practice to influence decision makers and for policy to influence practitioners." On the other hand, factors that may positively or negatively influence utilisation of research findings have been cited by some researchers as access to information, relevance of the research, authority of those who presented their view, competency in research methods, use of research perceived as a time consuming process in terms of accessing literature, priority of research in the policy process and accountability as in whose role it is to compile relevant research findings whether policy makers or specialists. iii Other researchers have documented impediments as shifting time scales and decision maker's own experiential knowledge.iv There are instances where scientific evidence has positively influenced policy in Uganda. Evidence on the ills of cost sharing as an impediment to accessing health services and a cause of further impoverishment for households", failure to improve quality of services despite charging feesvi were key concerns to a government that was pursuing poverty eradication objectives within the Poverty Eradication Action Plan framework." This created sustained dialogue between communities, civil society and government policy makers. Presidential elections presented an opportunity to intensify dialogue and demand for abolition of cost sharing and as part of the presidential campaign, user fees was abolished in all public facilities with subsequent significant increases in utilisation.viii Other successful examples include the malaria drug policy change following sensitivity studies. Resistance to first line treatment was an issue of concern for policy makers and this triggered the commissioning of sensitivity studies which recommended a change in the first line treatment. On the contrary, some good high quality research has failed to influence policy and practice. Multi-country! studies on medical adult male circumcision (MC) have shown a high efficacy of the intervention for HIV prevention.ix Male circumcision has been mentioned as one of the ten most important health findings of 2007, recommended by WHOIUNAIDS as an integral part of HIV prevention and already promoted as an HIV prevention strategy in several countries/ Although in Uganda, efforts were put in place to ensure that results influence policy including involving decision makers and other stakeholders, regular feed back and targeted dissemination, several challenges have impeded translation ofresearch results into policy. Another example of failure to Get Research into Policy and Practice (GRIPP) is failure to implement the findings of the Task force on Maternal and Child mortality. The high Maternal Mortality Rate and Child Mortality Rate figures raised concern among government policy makers and top politicians. In order to stimulate a multisectoral response to tackle the problem, the MoFPED, with the involvement of all key stakeholder, commissioned a study to identify challenges, recommend key actions for relevant sectors and suggest a framework for implementation.x Sectors plans did not focus on recommended actions and the implementation was never realised. We note that in all these case studies, efforts were made to ensure that results influence policy but realisation of this objective differed. One can not tell what knowledge translation activity and or what combination of activities and their timing, the relevant importance of each if any, the role and importance of the different actors will result in successful GRIPP Further research is required to understand the factor at play and what weighs most.

Keywords:B680-public-health