5 lessons on how to influence policy: insights from a researcher turned policymaker in Nigeria
In this blog, Dr Onoka offers rare insights from his experiences working in both academic and policy fields, about how to increase use of health systems research in policy and practice.
Over the past 15 years I have been working in the field of health policy and systems research in Nigeria. Health policy research is ultimately intended to make concrete changes towards strengthening the health system and making services more equitable. Often, however, policy processes remain opaque and there are many contextual barriers that inhibit the use of evidence in policy that we as researchers are yet to fully understand.
Since 2017, I have had an opportunity to gain first-hand knowledge of the policy environment by working as a technical advisor at the National Primary Health Care Development Agency (NPHCDA) - the national organisation for primary health care policy development and implementation. Being part of the policy making process, I’ve learned a lot about how and why evidence is, or is not, used by policymakers, and seen first-hand the challenges of evidence translation in complex health systems.
In this blog, I hope to share some of the lessons I have learned with other researchers, so that they can better conduct, communicate and stimulate the use of research in policy.
1. Conduct research that solves policy problems
Research is more likely to be used when it addresses a policy problem and is considerate of real-world contexts than if it is based on theory. This means that when researchers set their agendas, they must be open-minded about what research questions to ask, consult widely with stakeholders and pay close attention to issues that are important to policy.
In Nigeria, policymakers are often presented with research that is based on economic models, for example to estimate funds or numbers of health workers required for an intervention. These estimates are of limited use to policymakers as they do not take into account the realities on the ground. Instead, policymakers within the health sector need information about how much funding is available, or what the government is currently contributing (also known as gap analysis by economists), as this information will help them to make an argument for additional government funding.
2. Identify policymakers or influencers with shared interests and agendas
The use of research evidence in policy can be relatively straightforward if it supports policymakers’ agendas and priorities - but this is rare. More commonly in Nigeria, the people that occupy health policy positions are not subject specialists; they do not have a clear agenda or particular interest in the research.
Rather than expend efforts to directly reach these policymakers, it may be more useful for researchers to identify people or organisations that have an interest in the subject and influence. For example, in Nigeria, policymakers often listen to development partners as they bring with them funding. Working through organisations such as DFID or the World Bank, can be an effective way to raise issues and influence policymakers’ agendas.
The importance of making connections with influential groups cannot be emphasised enough, and these relationships can help more towards research use than other factors such as how the research is packaged (although very short policy briefs have their uses).
3. Create spaces to bring together researchers and policymakers
Before now there have been few opportunities to bring researchers and policymakers together to discuss health systems research in Nigeria. This motivated me, as a researcher, to organise a health summit for states in South East Nigeria in 2015, involving a range of stakeholders including health care providers, policymakers, NGOs and citizens. At the summit, participants were able to ask questions and to challenge policymakers, as well as learn from experiences across states. The thematic areas explored at the event were a product of policy-relevant research, for which there was appetite in the public space.
More recently, RESYST has held a research dissemination and knowledge synthesis workshop on health financing and governance, which similarly sought to bring together academics and policymakers. We need to organise more events like these that create space for interaction, discussions and mutual learning.
Conversations do not always have to be in person. Nowadays many policymakers also use social media and actively engage in conversations on twitter. They respond well to short bites of information.
4. Be responsive, flexible and set aside funds for stakeholder engagement
From a researcher’s point of view, the cost and time required to attend policy meetings can be a significant barrier to effective engagement with stakeholders. This is especially the case in a large country like Nigeria with policymakers operating at Federal and State levels. Opportunities to attend meetings with policymakers can occur at any time (not necessarily when the research is finished) and with little forewarning.
Given the importance of face to face engagements, researchers need to be responsive to opportunities, and prepared to discuss research before it is completed – this may mean developing clear statements about why the research is relevant and what policy problem it intends to solve. Researchers should also set aside funding so that cost isn’t a barrier to participation.
5. Researchers that are embedded in the policy system are best placed to influence change
Finally, from my experience, the most effective route to influencing policy is when researchers are embedded in policymaking processes, for example, working formally or informally as technical advisors or participating in policy committees. When I attend policy meetings, I am able to draw on my knowledge of the evidence to help guide discussions as much as possible, while paying attention to contextual situations.
Recently policymakers at the NPHCDA have been involved in discussions about the Basic Health Care Provision Fund – a new fund that aims to increase the amount of spending to primary health care facilities in Nigeria. Many of the meetings have been dominated by discussions about the amount of funding available rather than how funds will reach PHC facilities with little wastage. During these meetings, I have raised several practical issues, e.g. how prepared facilities are to use the money or how they can be supported to improve infrastructure, human resources with Universal Health Coverage goals in view.
Having gathered experience from working in both the academic and policy field, I now feel better placed to support evidence-informed policy making that will lead to a strengthened health system in Nigeria. Global targets such as Universal Health Coverage are unattainable without first bridging the gap between research and policy. I hope that these lessons can support researchers and policymakers in multiple settings to overcome this divide.
Chima Onoka is a public health physician and health economist with a PhD from the London School of Hygiene & Tropical Medicine. After several years working as a researcher for the Health Policy Research Group in Nigeria, he took on a role as technical advisor to the Executive Director/CEO at the National Primary Health Care Development Agency in 2017. The organisation is responsible for developing Nigeria’s primary health care policy and supporting states and local authorities to implement it.
Health Policy Research Group, is a member of RESYST research consortium, conducting research on health systems financing and governance issues that are relevant to the Nigerian context. The group has a long history of interacting with policymakers and contributing to policy processes at the State and Federal levels in Nigeria.