Session 4: How can we produce better evidence to inform better decisions for better outcomes?

We know that better evidence has the potential to lead to better decisions and better outcomes. Over the last ten years there have been many efforts across Africa and further afield to improve the collation and integration of evidence into decisions, particularly policy decisions that have the potential to improve the lives of those living in poverty. Increasingly the emphasis is on the ‘institutionalization’ of evidence-into-policy, with a focus on improving the systems within the government sphere for accessing and integrating evidence for better-informed policy.

My colleagues and I have been feeling increasingly uncomfortable about the way in which this discourse around the need for systems change in the use of evidence is largely driven by those outside of government, with the focus on the need for transformation inside of government. Surely, we must also get the evidence-generation house in order. Or are researchers, and research systems really producing the relevant, reliable, and timeous evidence that is needed for decision-making already?

Along with many others, my colleagues and I have been advocating for systematic reviews: structured, reliable, comprehensive syntheses of the evidence on particular issues, we believe that systematic reviews have the potential to provide the best available evidence for decision-making. However, the COVID-19 pandemic highlighted gaps in the evidence generation machine, including the gaps in how and what systematic reviews can actually provide. The spotlight was turned on what happens when there is no systematic review and a decision is needed quickly, on how old the evidence in many reviews is, and on the inability of traditional systematic review methods to update fast enough to provide the very latest understanding of a rapidly expanding evidence base. Even more significantly, the pandemic highlighted what many of us in Africa have always known: that context matters, and evidence bases, including systematic reviews, that have been collated from the published research often exclude the locally-produced often-unpublished research and fail to take into account other forms of knowledge within our communities (sometimes referred to as ‘indigenous knowledge’).

Shifts in systematic review approaches towards living systematic reviews solve some of these challenges. Using machine learning technologies, reviewers can identify and integrate newly published research as soon as it becomes available. These developments are laudable, and I am very much looking forward to seeing how they can be utilized in and for African priorities. However, in contexts where much of the evidence, research, data, and other forms of knowledge, never find their way into published academic papers, we will need to go further. We need to force a 180 degree turn in how evidence is considered, in order that it can be collated and integrated into decision-making. This needs to start with close attention to local contexts and to the lived experiences of those in our communities. What are their needs and priorities and the potential pathways to change? What forms of knowledge are available to inform solutions to the challenges they face? How can these forms of knowledge be harnessed? What role can the published research play in finding solutions? And how can that published research be accessed and integrated with other forms of knowledge into decisions about the future? What role can the new technologies in systematically collating research into living reviews play in this new order? Can we improve how evidence is collated and integrated into decisions to give greater meaning and impact to the field of evidence-informed decision-making in Africa?

When my colleagues and I wrote about getting the evidence generation house in order we identified 10 changes that we need to see. These included a range of systems-level changes to the ways in which research is prioritized, produced, and funded. I stand by all of these as important changes that are needed globally to ensure the evidence that is produced is useful and used. But as an active member of the Africa Evidence Network, I find that I must go further, and I invite you to join me. Embracing change and questioning established methods can be challenging, but together we can make meaningful shifts in the evidence field that have potential to benefit us all. We need to prioritize the development of approaches for understanding and valuing local forms of evidence and integrating these with the best available living systematic review technologies to provide evidence for decisions that can bring meaningful solutions to the challenges our communities are facing. To this end, I am working with others to build the Africa Alliance for Living Evidence: Africa ALIVE. Please get in touch if you’d like to know more (details below).

In conclusion, encouraging better dissemination of research evidence or better curation and governance of data are not sufficient measures for ensuring that evidence is fit for informing better policy and practice. We need systems-level change to ensure that evidence production is timely, relevant, accessible, and of the highest quality. Furthermore, we need to move on from merely acknowledging the need for local evidence, towards action for meaningful change.

To find out more about the Africa Alliance for Living Evidence, please contact Ruth at ALIVE@AfricaEvidenceNetwork.org