Reflections on Experiences in Doctoral Training and Its Contribution to Knowledge Translation in an African Environment

2019 Reflections on Experiences in Doctoral Training and its Contribution to Knowledge Translation in an African Environment 0 This report is submitted as the final report covering the extension period for: IDRC project number: 104519-008 IDRC project title: Turning health research into policy Project Leader: Nelson K. Sewankambo, MBChB, MMed, MSc, FRCP (IDRC Research Chair / IRC) IDRC International Research Chair in Evidence-Informed Health Policies and Systems Makerere University College of Health Sciences, New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Rd., Kampala, Uganda Country/region: Burkina Faso, Cameroon, Centrafrique, Ethiopia, Mozambique, Uganda, Zambia Mijia Murong and Allen Nsangi. Reflections on Experiences in Doctoral Training and its Contribution to Knowledge Translation in an African Environment. 9 May 2019. Makerere University, Uganda. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA. 1 Contents Introduction 4 Background 4 Objectives 5 Context of doctoral training programs in KT 6 Methodologies 7 Key informant interviews: 7 Focus group interviews: 7 Activities and outputs inventory analysis 8 Findings 8 Respondents’ background 8 Objective 1: To describe the perceived benefits, shortcomings, and suggestions for improvement of the program from the perspective of the PhD candidates, administrators, and supervisors 10 Effective aspects of the program 10 Ineffective aspects of the program 12 Challenges experienced by candidates 12 Suggestions for improvement 13 Objective 2: To document the major outputs of the program 15 Other outputs 29 Objective 3: To describe the perceived outcomes of the program 30 Student- centered outcomes 30 Field-Centered Outcomes 31 Program Impacts 32 Discussion 35 Statement of principal findings 35 Strength and weakness of the study 36 Conclusion 42 Appendix 1: Tables characterizing other doctoral training programs in KT 43 Appendix 2: Activities and outputs inventory form 45 Appendix 3: PhD students semi-structured interview guide 47 Appendix 4: End-users semi-structured interview guide 49 Appendix 5: Initiation focus group discussion guide 50 Appendix 6: Exiting focus group discussion guide 52 2 3 Introduction Background Knowledge Translation (KT) is the process of ensuring that research evidence is scientifically and systematically incorporated into policy and practice. It is often described as the effort to close the “know-do gap” between knowledge creation and policy formulation. The idea of KT emerged in the 1990s, as an outgrowth of evidence-based medical practices. In 2005, WHO reported that for the last 20 years, there has been an unprecedented effort to use evidence in policy and decision making for health systems. As a part of this effort, many strategies and KT platforms have emerged, particularly from high-income countries. Despite of this growing body of evidence-based decision-making initiatives, there is still inadequate KT work and capacity in low- and middle-income countries (LMICs). In sub-Saharan Africa, policies are often made in the absence of research evidence, and when such evidence accumulates it is rarely used by policy-makers. For instance, of the research carried out by post-graduates in the health fields at Makerere University in a ten-year period from 2001 to 2011, only 4% of the research outputs were cited in policy-related documents. Recognizing that the burden of disease and health inequities in (LMICs) can be addressed by existing research knowledge, it is especially important to introduce KT mechanisms in these settings. Efforts to introduce KT mechanisms in Africa have been contributed to through initiatives such as EVIPNet Africa (in Burkina Faso, Cameroon, Central African Republic, Ethiopia, Mozambique, Zambia) and the REACH Policy Initiative (in Uganda), both of which are WHO and International Research Development Center (IDRC) supported KT platforms respectively. They are designed to improve the use of research evidence in policy decisions about health systems through partnerships with policymakers, researchers, and civil society. In addition in 2009, the European Commission’s 7th Framework Programme funded a 5-year project, the Supporting the Use of Research Evidence (SURE) for Policy in African Health Systems, which brought together seven African countries, two European , and one Canadian institutions to strengthen, support, and evaluate the SURE work in those African countries. Among many outputs, the SURE 4 collaboration has produced Evidence briefs, policy dialogues, rapid response services, and national clearinghouses. To address the need for capacity building in knowledge translation, the IDRC provided funding for an International Research Chairs in Evidence-Informed Health Policies and Systems program co-chaired by Dr. Nelson K. Sewankambo and Dr. John N. Lavis. The program began on 28 June 2009, with the objectives to pursue both research and capacity-building. The latter objective states the following: To provide four graduate students from the participating African countries and three graduate students from Canada (who are committed to long-term collaborative research with African partners) with a unique training experience in the area of knowledge translation for policy that includes: exposure to our multi-method approach, joint supervision by us (and others as appropriate), reciprocal training opportunities, a dyad- or triad-arrangement with other graduate students, and the opportunity to pursue their doctoral thesis an in-depth examination of a KT platform in a single country or a single area of inquiry (such as the formative evaluation of policy dialogues) across countries. The capacity building efforts targeting the students from African countries is the focus of this report. Five doctoral students were registered in in Uganda at the Makerere University PhD program between the years 2010-2012. As one of the first PhD training program of its kind in Africa, it was imperative that as part of the educational program a critical reflection or self- evaluation of the experiences and lessons learned from its implementation is carried out and the findings shared widely. Objectives The objectives of this self-evaluation are: 1. To describe the perceived benefits (including contribution to the field of KT), shortcomings, challenges in program implementation and suggestions for improvement, of the program, from the perspective of the PhD candidates, administrators, and supervisors 5 2. To document the major outputs of the program 3. To describe the perceived outcomes of the program Context of doctoral training programs in KT A review of existing peer-reviewed literature discussing doctoral training programs in KT found that several doctoral programs addressing capacity building in KT exists globally and, to a limited extent, in Sub-Saharan Africa. (Table 1) in Appendix 1 shows that the majority of the programs identified exist in high income countries, with 8 operating in Canada, 2 in each the US and the UK. In the LMICs we found programs in Brazil, South Africa, and Nigeria that included KT related skills training as part of different doctoral training initiatives; most of these are hosted in conjunction with a Canadian institution. Unlike the IDRC Research Chairs (IDRC RC) program, most of the other capacity building programs in KT discussed in peer-reviewed literature did not focus solely on KT as the individual field of study. Instead, they provided KT training in conjunction with another field of study. (Table 2) in appendix 1 shows that only 2 of the 13 programs that we found centered KT-science as their main area of focus. Most doctoral programs we identified provided KT training adjacent to training at different academic levels. (Table 1) in Appendix 1 shows that the PhD accreditation stream is often hosted in conjunction with undergraduate, masters, or post-doctoral program offerings. In order to contextualize our doctoral training program, we cross-referenced its components with that of other programs in (Table 3) of appendix 1. In general, there are few KT programs in the African context that simultaneously offer co-supervision by a joint effort between supervisors/mentors from high income and LMIC institutions. Co-supervision provides the opportunities for trainees to study from two different academic institutions, to learn and work within a cohort of students with similar interests, and to work within different functioning KT initiatives. Meanwhile, these features function as the main pillars of our program offering. This is one of the unique approaches to our doctoral training in KT. 6 Methodologies We used a multi-method evaluation approach involving mainly Key Informant Interviews, and complimented by Focus Group Interviews, and an activities and outputs inventory analysis. Each evaluation method used is discussed in detail below. Key informant interviews: A set of semi-structured interviews were conducted to address select components of all four objectives previously discussed. One interview guide was used for interviews of all the 5 PhD fellows from the African countries while another guide was used to interview all 5 end-users who were identified by the fellows as having engaged with the trainees’ KT fieldwork. These end-users include policy analysts, policy makers and district health officers in various Uganda

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