Development of a framework to facilitate malaria research utilisation for policy development in Malawi

Abstract

Background: Malaria has remained a major public health burden in Malawi despite recent global progress in its control. Children under the age of five and pregnant women are among the groups most affected by the disease. Malaria research has been identified to provide vital evidence that contributes to addressing this burden through the development of evidence-based policies. One of the challenges however, is the lack of a systematic mechanism through which malaria research can be fully utilised for policy development. Unless research is commissioned by the government, individual researchers often do not know the pathway through which they can engage with policymakers. While some institutions or elements that promote health research in policy development exist, they remain fragmented and overwhelmed by the totality of health research in the country. This study aimed at developing a framework for promoting the utilisation of malaria research for policy development in Malawi. The framework seeks to encourage the engagement of researchers and policymakers, and to increase visibility and coordination of the existing elements presently promoting research utilisation for policy development. Methods: The study utilised both quantitative and qualitative methods depending on the study objectives. Several specific approaches were employed towards the development of the framework. The first step described the type and amount of malaria research conducted in Malawi, and its related sources of funding from 1984 to 2016. Its approach included an online systematic literature review in the Medline/PubMed database for Malawian publications, and the extraction of approved malaria studies from two Ethical Committees. The second approach assessed the research contribution to malaria policy development and the understanding of policy formulation process in Malawi. This step was done through case studies that adopted systematic literature search, in-depth interviews with key informants and relevant stakeholders, and record review. The third step examined the facilitating factors and barriers to utilisation of malaria research in the policy development process and involved in-depth interview with key informants, and review of records. In addition, the assessment of challenges to the implementation of malaria policies in Malawi was conducted through in-depth interviews with key informants and key stakeholders. The development of the framework was then guided by the lessons from the case studies and findings from the assessment of facilitating factors and barriers while being informed by literature of existing research-to-policy frameworks. In addition, a rigorous iterative approach with stakeholders was conducted for validation and applicability of the framework. Findings: The research revealed that clinical and basic research in the fields of malaria in pregnancy, severe malaria, and vector and/or agent dynamics dominated the publications while morbidity studies, severe malaria, and health policy and systems research dominated the approved studies. The results show that malaria research output increased steadily from 1996 to 2016 and this was attributed to the establishment of the College of Medicine and its research affiliates. However, the major malaria research funding came from external sources. The case studies showed that primary research was instrumental in changing the malaria treatment policies and in some cases Malawi was the first country to adopt these changes. Policy development process was found to follow the established process that involves agenda setting, policy formulation, and policy implementation. Many factors were identified as facilitating the utilisation of malaria research in policy development and these included the government commitment through the ministry of health, by reviving the policy development unit and the establishment of the office for the director of research, the knowledge translation unit, and academic and non-academic research institutions. Specific tools that support these institutions are the national health research agenda, guidelines for policy development and analysis, and guidelines for evidence use in policy-making. Barriers to the utilisation of malaria research included, the lack of knowledge by researchers to involve, collaborate and communicate their research findings to policy makers. Other barriers included lack of platforms for researcher-public engagement, politics, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository. Challenges to the implementation of malaria policies included inadequate resources, unavailability of trained staff, poor supervision and mentorship, politics, parallel implementation of policies, lack of a platform for engagement with communities, top-down approach in policy development, lack of understanding of socio-cultural factors affecting policy uptake by communities, and incomplete stakeholder analysis during policy development. Lessons from the case studies and the assessment of facilitating factors and barriers contributed to the development of a contextual knowledge-to-policy framework which proposes an integrated approach to knowledge translation between malaria researchers and the government, through the Ministry of Health (MOH) and the National Malaria Control Programme (NMCP), which is considered as the main user of research knowledge. Conclusion: Malaria research provides the relevant evidence for policy decision-making to address the malaria burden in Malawi. The developed framework offers a basis for the identified factors and their linkages to promote a coordinated approach to malaria research utilisation in policy making. Its applicability and success would, however, hinge on its wider dissemination and ownership by the government through the NMCP. It is important for the government to support health policy and systems research that seeks to explore bottlenecks in the delivery of health services within the health system. This evidence should provide solutions to challenges of policy implementation.