The Evidence-Informed Policy Network (Evipnet) in Chile: Lessons Learned from a Year of Coordinated Efforts

Pan American Journal Special report of Public Health

The Evidence-Informed Policy Network (EVIPNet) in Chile: lessons learned from a year of coordinated efforts

Cristián Mansilla,1 Cristian A. Herrera,1 Andrea Basagoitia1 and Tomás Pantoja2

Suggested citation Mansilla C, Herrera C, Basagoitia A, Pantoja T. The Evidence-Informed Policy Network in Chile: lessons learned from a year of coordinated efforts. Rev Panam Salud Publica. 2017;41:e36.

ABSTRACT Informing the health policymaking process with the best available scientific evidence has become relevant to health systems globally. Knowledge Translation Platforms (KTP), such as the World Health Organization’s Evidence Informed Policy Networks (EVIPNet), are a recog- nized strategy for linking research to action. This report describes the experience of implementing EVIPNet in Chile, from its objectives, organizational structure, strategy, activities, and main outputs, to its evolution over the course of its first year. Lessons learned are also covered. Of the activities initiated by EVIPNet-Chile, the Rapid Response Service proved to be a good starting point for engaging policymakers. Capacity building workshops and policy dialogues with relevant stakeholders were also successful. Additionally, EVIPNet-Chile developed a model for engaging academic institutions in policymaking through a network focused on preparing evidence briefs. A number of challenges, such as changing methods for producing rapid evidence syntheses, were also identified. This KTP implementation model located in a Ministry of Health could contribute to the development of similar initiatives in other health systems.

Keywords Health policy, planning and management; public health policy; policy making; strategies; health systems; Chile.

Decision makers use a number of dif- In this context, the World Health Orga- health services” (4)—in order to obtain ferent inputs to address a wide range of nization (WHO) 2004 Annual Report in- Universal Health Coverage. questions about the relevance and size of cluded a chapter on the need for linking Despite these global calls to use scien- a policy issue, the impacts of different research to action (1). Later, in May 2005, tific knowledge in policymaking, research policy options, and the implementation the World Health Assembly encouraged evidence has not been systematically used of these options in their health systems. countries to “establish or strengthen mech- to make recommendations (5). Although Research evidence is one of these key in- anisms of knowledge-transfer to support policymakers are actually using the avail- puts in the policymaking process, and public health development, health-related able evidence to make decisions, there is could contribute to making better deci- policies, and evidence-based health sys- still a gap between the availability of sci sions. Although efficient use of available tems” (2). Afterwards, this call was rein- entific knowledge and its systematic use resources has special relevance for Low- forced by the 2008 Bamako “Call to Action across different levels of the health system, and Middle-Income Countries (LMICs), on Research for Health” (3), and more re- including the policymaking process (6). it also pertains to High-Income Coun- cently, by the 2013 World Health Report Evidence Informed Health Policy- tries (HICs) where policymakers strive to (4). The 2013 report issued a strong call for making (EIHPM) aims to ensure that the make the best use of resources. “closer collaboration between researchers decision-making process is systemati- and policymakers, i.e., research needs to cally and transparently informed by the 1 Ministry of Health of Chile. Send correspondence be taken outside the academic institutions best available scientific evidence (7). The to Cristian Herrera, email: [email protected] 2 Department of Family Medicine. Pontificia and into public health programs that are community and civil society could also Universidad Católica de Chile, Santiago, Chile. close to the supply of and demand for become part of EIHPM by representing

Rev Panam Salud Publica 41, 2017 1 Special report Mansilla et al. • Evidence-informed policymaking in Chile stakeholders in a variety of health poli- and international evidence. In 2004, a this initiative within the MoH, includ- cies, transforming policymaking into a law that established “Explicit Guaran- ing objectives, organizational structure, participative process (8). tees in Health” for 80 prioritized health strategy, activities, and main outputs conditions took into account local during the period from October 2014 to KNOWLEDGE TRANSLATION prevalence and incorporated specific October 2015. PLATFORMS AND EVIPNET guidelines for clinical practice for each condition. In 1997, the Ministry of EVIPNET-CHILE Knowledge Translation (KT), defined Health (MoH) created a Health Tech- as “a dynamic and iterative process in- nology Assessment (HTA) unit. In 2012, Governance, structure, and cluding synthesis, dissemination, ex- a National Committee was officially stakeholders change, and application of knowledge in formalized to propose an institutional- order to improve population health, pro- ization plan for HTA. Currently, this The structure of a KTP within a coun- vide more effective health services and Committee is cooperating with the HTA try could have an important impact for products, and strengthen health sys- unit to expand its scope to develop evi- EIHPM. However, there is not a unique tems,” is closely related to EIHPM (9). In dence-based recommendations for cov- “organizational solution” to where the this sense, the development and imple- erage decisions through the recently platform should be located in the na- mentation of Knowledge Translation created Financial Protection System for tional health system. There are examples Platforms (KTP)—partnerships among High Cost Diagnostics and Treatments. of KTPs in universities, non-governmen- policymakers, researchers, civil society Between 2010 and 2013, the Secretariat tal organizations, government institu- organizations, and other stakeholders of EVIPNet Americas organized a num- tions, and public agencies (21). that promote the use of evidence in poli- ber of training activities in this WHO Re- EVIPNet-Chile is coordinated by a cymaking—provide the infrastructure gion, aiming to promote EIHPM and to Secretariat hosted by the Cabinet of for country-level efforts to link research build capacity on preparing evidence the Minister at the MoH. This hosting to action (10). briefs for policy (18) and organizing pol- enables a direct connection with the A number of experiences in LMIC icy dialogues (19). Some of these activi- highest authorities of the MoH and other countries—e.g., Evidence Informed Pol- ties were carried out and coordinated by secretariats, with policymakers, local icy Network (EVIPNet) in Cameroon a group of Chilean researchers interested governments, public health care provid- (11), Regional East African Community in the field (20). ers, civil society, and other stakeholders Health Policy Initiative (REACH-PI) in Despite these initiatives, the scientific in health policymaking. In addition, Uganda (11), and Zambia Forum for evidence was still not being used system- EVIPNet-Chile Secretariat facilitates a Health Research (ZAMFOHR) in Zam- atically in every policy decision in Chile. fluid dialogue with universities and re- bia (12)—and in high-income coun- Moreover, research was not always an search groups (Figure 1). tries—e.g., McMaster Health Forum in important input for decision makers and As a first step, in 2015, EVIPNet-Chile Canada (13), Center on Knowledge health policy. Finally, in 2014, the MoH initiated a partnership with the Network Translation for Disability and Rehabili- opened a full-time position exclusively of Schools and Departments of Public tation Research (KTDRR) in the United dedicated to establishing an EVIPNet Health at a number of universities in States of America (14), and EVIPNet in working group in Chile. Chile. This partnership—called the Europe (15)—have shown the feasibility This paper describes the development EVIPNet-Chile Network—is supported of implementing this type of initiative. and evolution of EVIPNet-Chile and by the Country Office of the Pan Ameri- The EVIPNets are KTPs sponsored by identifies some of the lessons learned and can Health Organization (PAHO). It WHO with variable levels of activ- challenges met after a year of experience. aims to expand the capacity of EVIPNet- ity across the different WHO Regions. It describes the process of developing Chile, to organize activities and prepare EVIPNet promotes partnerships at the country level among policymakers, researchers, and civil society, in order to FIGURE 1. Governance, structure, and stakeholders of the Evidence-Informed Policy facilitate both policy development and Network (EVIPNet)-Chile, 2015 implementation using the best scientific Ministry of Health Health care evidence available. EVIPNet comprises Civil society networks that bring together country- providers level teams that are coordinated at both Under-Secretariat Under-Secretariat the regional and global levels. of Public of Health Care Health Networks Regional Policymakers PROMOTING USE OF EVIDENCE governments FOR POLICYMAKING IN CHILE

Chile has some experience using evi- EVIPNet Research Chile Universities dence in policymaking. The processes of centers formulating and evaluating the Na- Secretariat tional Health Objectives for 2000–2010 (16) and the National Health Plan for 2011–2020 (17) were informed by local Source: Prepared by the authors from the study data.

2 Rev Panam Salud Publica 41, 2017 Mansilla et al. • Evidence-informed policymaking in Chile Special report evidence syntheses to policymakers, and TABLE 1. Description of Evidence-Informed Policy Network (EVIPNet)-Chile activities/ increase the numbers of those trained products developed to better inform health policy decision-making, Chile, 2015 (critical mass) in EIHPM concepts across the country. Activities Description i. Rapid Response Service A service that systematically responds to urgent evidence needs within the Ministry of Health. It aims to balance Strategy opportunity (urgency) with the depth of the synthesis. ii. Website (one-stop shop): Quick access to several tools and evidence for better EVIPNet-Chile aims to support the informed health decisions. health policymaking process, in order to iii. Capacity building workshops Training sessions for Ministry of Health professionals improve public health and reduce health aimed to improve current capacities in evidence-informed inequities in Chile. It has three main stra- health policymaking. tegic objectives: iv. Evidence briefs for policy A relatively new form of research synthesis where the best available global research evidence, such as systematic i. To use the best available evidence to reviews, and relevant local data and studies are produce outputs that can inform de- synthesized to clarify the problems associated with the cisions in the health policymaking issue, describe what is known about options resolving these, and identify key considerations for implementing process. each option. ii. To promote the systematic use of evi- v. Policy dialogues Activities that facilitate interaction among researchers, dence in the health policymaking policymakers, and stakeholders. These consider the best process. available global and local research evidence, along with the iii. To promote collaboration among pol- tacit knowledge of the key health system “actors,” who are icymakers, researchers, and civil soci- either involved in the issue or likely to be affected by the ety organizations. decision/outcome. Source: Prepared by the authors from the study data. In order to accomplish these objectives, EVIPNet-Chile has outlined five main TABLE 2. Evidence-Informed Policy Network (EVIPNet)-Chile matrix showing the types of activities/products (Table 1): relationship between strategic objectives and activities, where a checkmark indicates i. Rapid Response Service for rapid ev- the activity/product addresses the objective directly, Chile, 2015 idence synthesis ii. Website (one-stop shop) Activities/products Strategic objectives Rapid response Capacity–building Evidence briefs Policy iii. Capacity-building workshops Website iv. Evidence briefs for policy service workshops for policy dialogues v. Policy dialogues a) To use the best available √ √ evidence to produce outputs The overall strategy of EVIPNet-Chile that can inform decisions in is organized in a matrix where each ac- the health policymaking tivity/product is aligned with each ob- process jective. The matrix shown in Table 2 is a b) To promote the systematic √ √ √ use of evidence in the health visual display of the relationship be- policymaking process tween objective and activity/product. c) To promote collaboration This matrix allows identification of a among policymakers, √ √ √ portfolio of activities/products to ad- researchers, and civil society dress specific objectives. For instance, organizations when a team is particularly interested in Source: Prepared by the authors from the study data. promoting collaboration among policymakers, researchers, and civil society, its in Chile the aforementioned five were less than 20 working days, based mainly time would be best invested in writing chosen as a good starting point, and a on relevant systematic reviews. The rapid evidence syntheses, preparing evi- balanced combination that would ad- depth of the evidence analysis depends dence briefs for policy, and/or organiz- dress all the strategic objectives. on the time available to deliver the ing policy dialogues, rather than website Rapid Response Service (preparing product (Figure 2). development or capacity-building work- rapid evidence syntheses). On a daily Although the types of questions that shops. This matrix also allows more effi- basis, decision makers require urgent the Rapid Response Service answers are cient monitoring and evaluation of evidence-informed answers to a num- mainly related to the impact of health EVIPNet-Chile activities, allocating indi- ber of policy questions. The Rapid policies or health system interventions, cators, results, and targets to each Response Service aims to improve decision makers’ needs are frequently activity–objective. evidence accessibility to them by sig- broader. Therefore, many requirements nificantly reducing the time needed start with an unstructured question that Activities to summarize the existing research. needs to be clarified and framed before The EVIPNet-Chile Secretariat prepares the Rapid Response Service can provide Although there is a variety of existing rapid evidence syntheses (summaries of an answer. In its first 12 months of activities in which a KTP might engage, the impact of specific interventions) in operation, the Rapid Response Service

Rev Panam Salud Publica 41, 2017 3 Special report Mansilla et al. • Evidence-informed policymaking in Chile received and responded to 23 questions approaches vary considerably (23–25). Website (one-stop shop). One-stop from various departments within the The methods used by the EVIPNet-Chile shops are a useful strategy for improving MoH, addressing a number of different Secretariat to produce rapid evidence accessibility to research evidence by policy issues (Table 3). syntheses have been continuously mod- health policymakers. There are a number The process of preparing a rapid evi- ified to consider the specific challenges of successful initiatives in this area, such dence synthesis shares several steps faced in preparing each of them. None- as Health Systems Evidence in Canada with that of preparing a systematic re- theless, the process of developing a (26), PDQ-Evidence (27), and CIPHER in view (22). However, there is not an handbook is underway and will provide Australia (28). agreed-upon method to write a rapid a step-by-step guide to produce this Following EVIPNet Global templates, evidence synthesis, and methodological type of product systematically. EVIPNet-Chile developed a website

FIGURE 2. Process to create a rapid evidence synthesis, a main activity of the Evidence-Informed Policy Network (EVIPNet)- Chile, 2015

Decision makers and civil society Revision, selection, and Evidence Decision Question/ Product appraisal of informed makers problem choice evidence answer

From 1 – 20 working days

Source: Prepared by the authors from the study data.

TABLE 3. List of rapid evidence syntheses prepared by the Evidence-Informed Policy Network (EVIPNet)-Chile, 2015

Synthesis topic Description Working days Requested by Defibrillators Impact of a public access defibrillation program 5 Cabinet of the Minister Human milk banks Impact of human milk banks 10 Cabinet of the Minister Food labeling Joint impact of three policies: food-labelling, food advertising restriction, 15 Public Policies Division and food sell restriction Primary care receptionist Impact of a receptionist in a primary care center on patient satisfaction 5 Cabinet of the Minister Female condom Impact of a policy to promote female condom 15 Prevention and Disease Control Division Sugar food tax Impact of a sugar-sweetened solid food tax 7 Public Policies Division Condom dispensers Impact of condom dispensers in public places 5 Cabinet of the Minister Omega-3 fatty acids Benefits of Omega-3 fatty acids 15 Public Policies Division Acupuncture Describe implementation strategies for acupuncture in a primary care setting 10 Public Policies Division Menthol in cigarettes Impact of a restriction of menthol in tobacco cigarettes 10 Public Policies Division Financial mechanisms in Describe possible indicators, in order to adjust the financial mechanism for 5 Primary Care Division primary care communal primary care Medical leave for parents Impact of a medical leave for parents with severe ill children 5 Prevention and Disease Control Division Probiotics Safety of probiotics in infants formula 10 Public Policies Division Medical use of cannabis Benefits of medicinal use of cannabis 10 Cabinet of Undersecretary of Public Health Medical Loss Ratio Impact of setting a Medical Loss Ratio in private health insurance market 5 Cabinet of the Minister MRP vaccine Risk of Measles-Rubella-Parotitis vaccine in adults 5 Prevention and Disease Control Division Pharmaceutical market Impact of market competition in pharmaceutical industry 5 Cabinet of the Minister Daylight Saving Time Impact of the daylight saving time setting 4 Cabinet of Undersecretary of Public Health Sexual health & indigenous Educational interventions in sexual and reproductive health for 10 Prevention and Disease Control Division people indigenous people Births and hospitals Risk of planned births in settings other than hospitals 10 Prevention and Disease Control Division Water supply Water supply mechanism for isolated coastal communities 5 Public Policies Division Cannabis smoking Benefits and risks of smoking marijuana 15 Cabinet of Undersecretary of Public Health Dental dams Risk of using dental dams to prevent sexually transmitted infections 5 Prevention and Disease Control Division Source: Prepared by the authors from the study data.

4 Rev Panam Salud Publica 41, 2017 Mansilla et al. • Evidence-informed policymaking in Chile Special report accessible from within the MoH. This The problem identified for an evidence a MoH. This model has allowed a closer website provides access to the rapid ev- brief should be broad and also, a politi- relationship with policymakers and idence syntheses prepared by the team cal priority. In addition, it should be more permanent relationships within (Table 3), as well as evidence briefs developed together with the MoH the Government, a main objective of a for policy, policy dialogue summaries, “issue-owner,” i.e., those charged with KTP (21). and workshop presentations. In addi- managing the issue. Second, the balanced portfolio of ini- tion, the EVIPNet-Chile website allows As mentioned before, participation in tiatives that a KTP decides to incorporate users to access relevant KT resources, the EVIPNet-Chile Network is a key el- is very important to comprehensively such as news, publications, multimedia, ement in this process. Evidence briefs addressing its objectives. Although and events, and offers a specialized for policy are mainly prepared by aca- EVIPNet-Chile has defined five main ac- search engine for locating relevant liter- demic teams that have attended a ca- tivities/products, there are others that ature. There is a slightly different ver- pacity-building workshop organized could be used to further develop EIHPM, sion of the website accessible from by the EVIPNet-Chile Secretariat. The such as summaries of systematic reviews outside the MoH. From its launch in PAHO Country Office has also played a (31), citizen panels (32), and communities February 2015, through October 2015, crucial role in this partnership by sup- of Practice (33). the EVIPNet-Chile website had been porting the preparation of these prod- Third, the Rapid Response Service has visited more than 1 000 times from ucts. The policy issues addressed by the been the most used and valued activity within Chile alone. evidence briefs for policy are related to in our MoH because it is perceived as Capacity-building workshops. Since the MoH priorities and communicated providing timely evidence for policy- 2014, EVIPNet-Chile has organized four to the network by the EVIPNet-Chile making. A rapid evidence synthesis is a half-day workshops within the MoH, and Secretariat. very efficient instrument for engaging one with the EVIPNet-Chile Network. Organizing policy dialogues. Struc- policymakers with KT, since it quickly These workshops are designed to build tured discussions about an evidence gets an evidence-informed answer to a capacity on the systematic and transpar- brief for policy or a rapid evidence syn- specific policy question. In this sense, ent use of evidence in policymaking. thesis can contribute to the development Rapid Response Services can be a very There are two types of workshops: of evidence-informed health policies, good starting point when introducing a helping to clarify the problem and solu- KTP within a MoH. Although EVIP- • Driven by the EVIPNet-Chile Secretar- tions, and to develop a shared under- Net-Chile has used mainstream methods, iat: workshops that address the gen- standing among stakeholders (19, 29). mainly based on the use of systematic eral concepts of EIHPM and the use of Over the course of the first year, EVIP- reviews, the specific processes have con- systematic reviews. These workshops Net-Chile organized three policy dia- tinuously changed over the study period. are built mainly from contents devel- logues based on three rapid evidence We are now using rapid evidence synthe- oped by the team at the McMaster syntheses: human milk banks, female ses as an input for policy dialogues; this Health Forum (13). condoms, and acupuncture (see Table 3). represents an innovation to prior KT re- • User-demanded: workshops that ad- Health care providers, ministries, non- search (19, 29). dress specific training needs. For ex- governmental organizations (associa- Fourth, collaboration with academic ample, methods to produce rapid tions of patients and workers), academic groups arose from the EVIPNet-Chile evidence syntheses, requested by institutions, and scientific societies have Secretariat’s need for human resources; the HTA Unit at the MoH, and meth- attended these meetings, contributing to previously, their availability was not ods for preparing evidence briefs for the deliberations and adding inputs to enough to prepare evidence briefs for policymakers in the EVIPNet-Chile the process, beyond scientific evidence. policy. A lack of resources for any KTP, Network. especially initially, can be used as an These workshops have reached more DISCUSSION opportunity to expand the network than 30 of the almost 50 eligible pro by engaging other stakeholders in the fessionals at the MoH and 20 members Implementing KTPs is an effective process. of EVIPNet-Chile Network across the strategy to inform decision-making pro- Lastly, it is important for KTP profes- country. cesses with evidence, providing an effi- sionals to be up-to-date in terms of cur- Preparation of evidence briefs for pol- cient route to improving health policies, rent technologies and methodologies icy. These evidence summaries take a especially in LMICs (30). EVIPNet-Chile that could be used to better link research policy problem/issue as a starting point, provides a clear experience of how a KTP to action in policymaking. The EVIP- describe its underlying factors, and can be established and institutionalized Net-Chile Secretariat has been paying frame a number of relevant policy op- within a MoH and is a good example of a close attention to new developments tions while identifying barriers and facil- working KTP with a portfolio of different and innovations in this area. Some ex- itators to their implementation. Then the activities and products. After this first amples are Epistemonikos (evidence focus turns to finding and distilling the year, lessons learned from the experience matrix systematic reviews with primary full range of research evidence relevant in Chile can be summarized in five main studies cited) (27), Health Systems to the various features of the problem/ points. Evidence new web interface (34) (en- issue, such as the impact of the different First, EVIPNet-Chile provides a con- hanced features), and RevMan (to de- options or the effectiveness of implemen- crete example of how a KTP can be es- velop meta-analysis for rapid evidence tation strategies (18). tablished and institutionalized within synthesis) (35).

Rev Panam Salud Publica 41, 2017 5 Special report Mansilla et al. • Evidence-informed policymaking in Chile

Barriers and challenges dialogues has successfully responded to terms of developing methodologies. the needs of policymakers and relevant The Rapid Response Service was the There are important barriers that we stakeholders in a variety of scenarios and most challenging part of this effort be- addressed during this first year. For in- stages of the policymaking process. cause there is no standard method for stance, although the EVIPNet-Chile Net- A number of challenges should be con- producing the summaries; regardless, work has been positively evaluated to sidered when implementing a KTP. First, the service has been widely demanded date, it is necessary to consolidate the as a part of the KT process, it is necessary within the MoH. relationships among KT, the policymak- to have a plan for incorporating new de- Finally, in order to concretely evaluate ing process, and academic institutions. velopments on EIHPM. For example, the impact of EVIPNet-Chile on the poli- This network has been a major advance text mining (36) and living evidence (37) cymaking process, it is necessary to in terms of preparing evidence briefs for are current evolving topics worth incor- conduct rigorous evaluations. A good policy, but the work could be expanded porating in the foreseeable future in our starting point could be an analysis of the into other new activities/products in the portfolio of methods. Acting on what has strategy matrix presented in Table 2, de- future. been learned from past experiences with fining indicators related to each activity. Secondly, as a new program inside a evidence briefs is also imperative (38). Such analysis would determine how well Ministry, it is necessary to make a cul- the objectives are being addressed by the tural change for promoting the use of ev- Conclusions and recommendations work of EVIPNet-Chile, and how its im- idence in policymaking processes. This is plementation has specifically improved generally a hard process, considering the A KTP can certainly be enriched evidence-informed policymaking in our existing different uses of evidence. In this by collaboration with international or- health system. sense, Rapid Response Service has been a ganizations, such as PAHO and WHO, useful tool, consolidating an important but also by engaging with other coun- Conflict of interests. None declared. position within the MoH. tries of Latin America that are work- Lastly, uses of evidence in the different ing on similar initiatives. Also, closer Disclaimer. Authors hold sole respon- stages of the policymaking process have contact with non-governmental organi- sibility for the views expressed in the also been challenging. The balanced zations working in this field, such as manuscript, which may not necessarily combination of rapid evidence synthe- the Cochrane Collaboration, would be reflect the opinion or policy of the RPSP/ ses, evidence briefs for policy, and policy a major improvement, especially in PAJPH and/or PAHO.

REFERENCES

1. World Health Organization. The World from: www.implementationscience.com/ 14. SEDL. Center on Knowledge Translation Health Report 2004: changing history. content/5/1/33 Accessed on 15 July 2016. for Disability and Rehabilitation Research. Geneva: WHO; 2004. 9. Straus SE, Tetroe J, Graham I. Knowledge Available from: http://ktdrr.org/ 2. World Health Assembly. Resolution on translation in health care. 2nd ed. Straus Accessed on 30 January 2017. health research. Geneva: WHO; 2005. SE, Tetroe J, Graham ID, eds. Chichester, 15. World Health Organization. Evidence- 3. The Lancet. The Bamako call to action: UK: John Wiley & Sons; 2013. Available informed Policy Network (EVIPNet) / research for health. Lancet. 2008;372 from: http://doi.wiley.com/10.1002/978 WHO European Region. Available from: (9653):1855. 1118413555 Accessed on 15 July 2016. www.euro.who.int/en/data-and- 4. World Health Organization. Research for 10. Lavis JN, Lomas J, Hamid M, Sewankambo evidence/evidence-informed-policy- universal health coverage: World health NK. Assessing country-level efforts to link making/evidence-informed-policy- report. Geneva: WHO; 2013. research to action. Bull World Health network-evipnet Accessed on 30 January 5. Oxman AD, Lavis JN, Fretheim A. Use of Organ. 2006;84(8):620–8. Available from: 2017. evidence in WHO recommendations. www.ncbi.nlm.nih.gov/pubmed/ 16. Ministry of Health of Chile. Objetivos san- Lancet. 2007;369(9576):1883–9. Available 16917649 Accessed on 15 July 2016. itarios para la decada 2000-2010. Avail- from: http://linkinghub.elsevier.com/ 11. Ongolo-Zogo P, Lavis JN, Tomson G, able from: https://www.healthresearch retrieve/pii/S0140673607606758 Accessed Sewankambo NK. Initiatives supporting web.org/files/Politicas_Nacionales_ on 15 July 2016. evidence informed health system policy- Salud-Chile_2000-2010.pdf Accessed on 6. Oliver K, Innvar S, Lorenc T, Woodman J, making in Cameroon and Uganda: 30 January 2017. Thomas J. A systematic review of barriers a comparative historical case study. 17. Ministry of Health of Chile. Estrategia na- to and facilitators of the use of evidence by BMC Health Serv Res. 2014;14(1):612. cional de salud para el cumplimiento de policymakers. BMC Health Serv Res. Available from: www.biomedcentral. los Objetivos Sanitarios de la Década 2014;14(1):2. com/1472-6963/14/612 Accessed on 15 2011–2020. Available from: http://www. 7. Oxman A, Lavis J, Lewin S, Fretheim A. July 2016. minsal.cl/portal/url/item/c4034eddbc- SUPPORT Tools for evidence-informed 12. Kasonde JM, Campbell S. Creating a 96ca6de0400101640159b8.pdf Accessed health Policymaking (STP) 1: What is evi- knowledge translation platform: nine les- on 30 January 2017. dence-informed policymaking? Heal Res sons from the Zambia Forum for Health 18. Lavis JN, Permanand G, Oxman AD, Policy Syst. 2009;7(suppl 1):S1. Available Research. Heal Res Policy Syst. Lewin S, Fretheim A. SUPPORT Tools for from: http://health-policy-systems.bio- 2012;10(1):31. Available from: http:// evidence-informed health policymaking medcentral.com/articles/10.1186/1478- health-policy-systems.biomedcentral. (STP) 13: Preparing and using policy 4505-7-S1-S1 Accessed on 15 July 2016. com/articles/10.1186/1478-4505-10-31 briefs to support evidence-informed 8. Wilson MG, Lavis JN, Travers R, Rourke Accessed on 15 July 2016. policymaking. Heal Res Policy Syst. SB. Community-based knowledge transfer 13. McMaster University. McMaster Health 2009;7(suppl 1):S13. Available from: and exchange: Helping community-based Forum. Available from: https://www.mc- http://health-policy-systems.biomed- organizations link research to action. masterhealthforum.org/ Accessed on 30 central.com/articles/10.1186/1478-4505- Implement Sci. 2010;5(1):33. Available January 2017. 7-S1-S13 Accessed on 15 July 2016.

6 Rev Panam Salud Publica 41, 2017 Mansilla et al. • Evidence-informed policymaking in Chile Special report

19. Lavis JN, Boyko JA, Oxman AD, Lewin S, reviews. Rockville, MD: Agency for who.int/bulletin/volumes/89/1/10- Fretheim A. SUPPORT Tools for evi- Healthcare Research and Quality; 2015. 075481.pdf Accessed on 15 July 2016. dence-informed health policymaking Available from: www.ncbi.nlm.nih.gov/ 32. McMaster University. Citizen briefs and (STP) 14: Organising and using policy pubmed/25654160 Accessed on 15 July panels. Available from: www.mcmaster- dialogues to support evidence-informed 2016. healthforum.org/citizens/citizen- policymaking. Heal Res Policy Syst. 26. Lavis JN, Wilson MG, Moat KA, Hammill briefs-and-panels Accessed on 31 January 2009;7(suppl 1):S14. Available from: AC, Boyko JA, Grimshaw JM, et al. 2016. http://health-policy-systems.biomed- Developing and refining the methods for 33. Kothari A, Boyko JA, Conklin J, Stolee P, central.com/articles/10.1186/1478-4505- a “one-stop shop” for research evidence Sibbald SL. Communities of practice for 7-S1-S14 Accessed on 15 July 2016. about health systems. Heal Res Policy supporting health systems change: a 20. Chapman E. Reporte evaluación de la Red de Syst. 2015;13(1):10. Available from: www. missed opportunity. Heal Res Policy Syst. Políticas Informadas por Evidencias health-policy-systems.com/con- 2015;13(1):33. Available from: www. (EVIPNet), Agosto 2010 - Diciembre 2013. tent/13/1/10 Accessed on 15 July 2016. health-policy-systems.com/con- Available from: www.paho.org/hq/index. 27. Rada G, Pérez D, Capurro D. tent/13/1/33 Accessed on 15 July 2016. php?option=com_content&view= Epistemonikos: a free, relational, collabo- 34. McMaster University. Health systems evi- article&id=8382%3A2013-report-evalu- rative, multilingual database of health evidence. Available from: www.healthsys- ation-evidence-informed-policy-net- dence. Stud Health Technol Inform. temsevidence.org Accessed on 31 January works-evipnet-august-2010-july-2012&cat- 2013;192(1):486–90. Available from: www. 2016. id=3422%3Aevipnet-news&Itemid= 40301& ncbi.nlm.nih.gov/pubmed/23920602 35. Cochrane Collaboration. Review manager lang=es Accessed on 30 January 2017. Accessed on 15 July 2016. (RevMan). Copenhagen: The Nordic 21. El-Jardali F, Lavis J, Moat K, Pantoja T, 28. Makkar SR, Gilham F, Williamson A, Cochrane Centre, The Cochrane Ataya N. Capturing lessons learned from Bisset K. Usage of an online tool to help Collaboration; 2011. evidence-to-policy initiatives through policymakers better engage with research: 36. O’Mara-Eves A, Thomas J, McNaught J, structured reflection. Heal Res Policy Syst. Web CIPHER. Implement Sci. 2015; Miwa M, Ananiadou S. Using text mining 2014;12(1):2. Available from: http:// 10(1):56. Available from: www.implemen- for study identification in systematic re- health-policy-systems.biomedcentral. tationscience.com/content/10/1/56 views: a systematic review of current ap- com/articles/10.1186/1478-4505-12-2 Accessed on 15 July 2016. proaches. Syst Rev;4(1):5. Available from: Accessed on 15 July 2016. 29. Boyko JA, Lavis JN, Abelson J, Dobbins M, www.systematicreviewsjournal.com/con- 22. Tsertsvadze A, Chen Y-F, Moher D, Carter N. Deliberative dialogues as a tent/4/1/5 Accessed on 15 July 2016. Sutcliffe P, McCarthy N. How to conduct mechanism for knowledge translation and 37. Elliott JH, Turner T, Clavisi O, Thomas J, systematic reviews more expeditiously? exchange in health systems decision- Higgins JPT, Mavergames C, et al. Living Syst Rev. 2015;4(1):160. Available from: making. Soc Sci Med. 2012;75(11):1938–45. systematic reviews: an emerging oppor- www.systematicreviewsjournal.com/con- Available from: http://linkinghub. tunity to narrow the evidence-practice tent/4/1/160 Accessed on 15 July 2016. elsevier.com/retrieve/pii/S027795361 gap. PLoS Med. 2014;11(2):e1001603. 23. Polisena J, Garritty C, Kamel C, Stevens A, 2005114 Accessed on 15 July 2016. doi:10.1371/journal.pmed.1001603 Abou-Setta AM. Rapid review programs 30. Ongolo-Zogo P, Lavis JN, Tomson G, 38. Moat KA, Lavis JN, Clancy SJ, El-Jardali F, to support health care and policy decision- Sewankambo NK. Climate for evidence Pantoja T. Evidence briefs and deliberative making: a descriptive analysis of pro- informed health system policymaking in dialogues: perceptions and intentions to cesses and methods. Syst Rev. 2015;4(1):26. Cameroon and Uganda before and after act on what was learnt. Bull World Health Available from: www.systematicreviews- the introduction of knowledge translation Organ. 2014;92(1):20–8. Available from: journal.com/content/4/1/26 Accessed platforms: a structured review of govern- http://dx.doi.org/10.2471/BLT.12.116806 on 15 July 2016. mental policy documents. Heal Res Policy Accessed on 15 July 2016. 24. Maharaj R, Raffaele I, Wendon J. Rapid re- Syst. 2015;13(1):2. Available from: www. sponse systems: a systematic review and ncbi.nlm.nih.gov/pubmed/25552196 meta-analysis. Crit Care. 2015;19(1):254. Accessed on 15 July 2016. Available from: http://ccforum.com/con- 31. Rosenbaum SE, Glenton C, Wiysonge CS, tent/19/1/254 Accessed on 15 July 2016. Abalos E, Mignini L, Young T, et al. 25. Hartling LPT, Guise J-M, Kato E, Anderson Evidence summaries tailored to health MRPJ, Aronson N, Belinson S, et al. EPC policy-makers in low- and middle-income Manuscript received on 1 February 2016. Revised methods: an exploration of methods and countries. Bull World Health Organ. version accepted for publication on 20 September context for the production of rapid 2011;89(1):54–61. Available from: www. 2016.

Rev Panam Salud Publica 41, 2017 7 Special report Mansilla et al. • Evidence-informed policymaking in Chile

RESUMEN Para los sistemas de salud a nivel mundial se ha vuelto cada vez más importante contar con la mejor evidencia disponible como información para el proceso de formu- lación de políticas de salud. Las plataformas de traducción del conocimiento, como la Red de Políticas Informadas por la Evidencia (EVIPNet, por su sigla en inglés) de la La Red de Políticas Organización Mundial de la Salud, son estrategias reconocidas para vincular la inves- Informadas por la tigación a la acción. En este informe se describe la experiencia de la utilización de EVIPNet en Chile, sus Evidencia (EVIPNet) en objetivos, estructura orgánica, estrategia, actividades y resultados principales de su Chile: enseñanzas evolución en el curso de su primer año. Se incluyen asimismo las enseñanzas extraídas. extraídas en un año de De las actividades iniciadas por EVIPNet en Chile, el servicio de respuesta rápida resultó ser un buen punto de partida para interesar a los responsables de las políticas. esfuerzos coordinados También fueron exitosos los talleres que se llevaron a cabo sobre creación de capacidades y los diálogos de política con los interesados directos pertinentes. Además, EVIPNet en Chile elaboró un modelo para invitar a instituciones académicas a participar en el proceso de formulación de políticas por medio de una red centrada en la preparación de resúmenes de datos científicos. Se encontraron también varios retos, como el cambio de métodos para producir síntesis rápidas de datos científicos. Este modelo de aplicación de plataformas de traducción del conocimiento, ubicado en un Ministerio de Salud, podría contribuir al desarrollo de iniciativas similares en otros sistemas de salud.

Palabras clave Políticas, planificación y administración en salud; políticas públicas de salud; formu- lación de políticas; Chile.

RESUMO Fundamentar o processo de formulação de políticas de saúde com as melhores evidên- cias científicas disponíveis tornou-se indispensável nos sistemas de saúde em todo o mundo. As plataformas de tradução de conhecimento, como as Redes de Políticas Informadas por Evidências (EVIPNet) da Organização Mundial da Saúde (OMS), são A Rede de Políticas parte de uma estratégia comprovada para vincular a pesquisa à ação. Informadas por Evidências Este informe descreve a experiência de implantação da EVIPNet no Chile: dos objetivos, estrutura organizacional, estratégia, atividades e principais resultados à (EVIPNet) no Chile: evolução ao longo do primeiro ano de atividade. As lições aprendidas são também lições aprendidas com um apresentadas. ano de esforço Das atividades iniciadas pela EVIPNet-Chile, o Serviço de Resposta Rápida mos- trou ser um bom ponto de partida para atrair a participação dos formuladores de coordenado políticas. Os seminários de capacitação e os colóquios sobre políticas com os interessa- dos relevantes renderam bons resultados. Além disso, a EVIPNet-Chile elaborou um modelo para atrair a participação das instituições acadêmicas na formulação de políti- cas com uma rede dedicada ao preparo de resumos de evidências. Um dos muitos desafios identificados é modificar os métodos para produzir sínteses rápidas de evi- dências. Este modelo de implantação da plataforma de tradução de conhecimento sediado em um ministério da saúde poderia contribuir para a elaboração de iniciativas semelhantes em outros sistemas de saúde.

Palavras-chave Políticas, planejamento e administração em saúde; política de saúde; formulação de políticas; Chile.

8 Rev Panam Salud Publica 41, 2017