By Dr Harith Ghassany
At the outset, it is necessary to try to avoid a kind of policy-evidence dualism in a proposal that looks at how a Zanzibari research-to-policy-making institute such as ZIRPP can use evidence to make policy and planning decisions in Zanzibar.
The empirical approach assumes that there is evidence which policy-makers can use to make policy decisions but does not ask if there are policies to guide policy-makers to demand research results.
A government policy statement to support research and its implementation in public policy-making is therefore an important cornerstone in establishing and sustaining the Institute in Zanzibari settings.
Secondly, given the fact that Zanzibari human resources are outside Zanzibar, it is therefore necessary that the constitution of the ZIRPP should be able to accommodate the establishment of an overseas branch or branches of the Institute.
The specific objectives of the ZIRPP may include:
• A description of the work and responsibilities of Zanzibari policy-makers, and understand the types of decisions s/he makes, and/or his/her role in the policy-making process.
• Establish the distinction between a public-policy maker and public-policy-pursuant. What is the criteria of considering someone a public-policy maker within Zanzibari settings?
• Sources of information the person uses to make decisions, examples of how information has been used, and description of the major constraints on using research evidence.
• Exposure to research, the value the policy-maker places on research, and suggestions for how to increase engagement of policy-makers in research.
• Understanding of the types of research evidence policy-makers find most useful in making decisions, and description of ways to increase their use of research findings.
• A specific area of investigation will be the perceived utility of research findings on costs of implementation of interventions and their cost-effectiveness, and findings on the degree to which people with different levels of wealth or economic status derive benefit from public-policy interventions or programs (equity).
• The most important principle that used was to identify decision-makers who were clearly acting at the national level, as the focus of the study is at the national (central/federal) level of decision-making.
1.1 Zanzibari Public-Policy Strategy
Is the Zanzibari public-policy-making strategy guided by the old managerial (process-based) or the strategic (results-based) approach? The results-based (outcomes) strategic approach aims at planning for the future and not just focus on current problems (processes).
A clear assessment is needed of the impact on research and public-policy planning from the managerial process of setting the public-policy agenda to the results-based strategic planning of the public institutions in Zanzibar.
What is fundamental is that Zanzibar is running a “free” of payment public-policy service to all her citizens. To what extent is the results-based strategic planning for free public services in Zanzibar is informed by evidence-based public policy-making? And what is the degree of citizen’s satisfaction with the free public services at their disposal? At the moment the two questions are not linked to provide evidence-based answers.
An important factor here is to consider whether a Zanzibari public policy-maker is first and foremost responding to an external or internal strategic outlook.
1.2 Policy-makers and Research in Zanzibari Settings
Has the Zanzibar Government invested in a highly illustrious group of public-policy professionals?
Who are they and are they in the right institutions at the right time?
1.3 Setting the Zanzibar public policy agenda
How is the national public- policy agenda of Zanzibar decided? What is the criteria for selecting the participants and who votes and who does not and at what levels of responsibility. Table 1 below
highlights the possible methods used in setting Zanzibar’s public-policy agenda.
Table 1: Methods Used in Setting the Zanzibari Public-Policy Agenda
1. Problems as they relate to availability of services.
3. Scoring method.
4. Ministries involved.
5. Social voting.
6. Incidence of public problems, there is no voting.
7. Program director.
8. Decisions made by ministers.
9. No one is neglected.
10. Program director.
11. Program managers.
12. That is actually not clear.
13. All involved.
14. By consensus. Scoring.
We need a needs-assessment survey and sample narratives on how some national public policy-makers perceive the process of setting the national public-policy agenda in Zanzibar:
1.4 Sources of information
Is there a Directorate-General of Planning, Information and Statistics Department which captures routine data from public institutions and is it on a daily, weekly, monthly, or annual basis? Is there a functioning Directorate of Research and Studies? Are there regional data collecting points and to what extent are they decentralized at the operational level? Are there statisticians in all public institutions and at different levels? The regions should ideally collect detailed statistics and information data from all the districts (wilayats) and feeds it to the central level.
Table 2: Sources of Information for Policy Makers in Zanzibar
1. Community-based studies and patients’ health service utilization data.
2. Statistical data.
3. Reports, WHO short-term consultants, our own surveys.
4. Peer-reviewed journals and own research.
5. Surveys, statistics.
6. Personal observations on what is going on in the community, newspapers, radio.
7. Hospital data and our own community surveys.
8. Ongoing surveillance national data which we generate, articles I regional and international journals, information and articles from WHO.
9. Ministry’s annual monitoring reports and international reports.
10. Statistics of hospital attendances.
11. Journal articles.
12. Outpatient service data.
13. Ministry’s statistics.
14. WHO/EMRO, UNESCO, FAO, meetings, internet and reading.
15. We do our own research
According to the interviewees the most effective channels for them to be exposed to current research are presentations at meetings, workshops, and articles. Is research evidence such as equity and costs available to Zanzibari policy-makers.
1.5 Costs and equity.
There is a marked ambivalence among policy-makers towards the importance of considering costs and equity in decision-making.
Lack of evidence-based studies has in some important cases led to inconclusive results and consequently to no or weak policies.
Equity and costs are key issues which are important not just to the public services providers but to the citizens who are using those services. Cost is about the wealth of the country and equity is about how that wealth is distributed amongst her people. Do Zanzibari policy-makers express the importance of having research results on costs and equity but at the moment these two specific items are not present in making their policy and planning decisions.
Generally, do Zanzibari public-policy makers sit with researchers in an official forum or committee for the purpose of enriching policies with research results?
1.6 Official contact between policy-makers and researchers
is there an official contact between policy-makers and researchers through an official forum as expressed in the following responses in table 3 below:
Table 3: Contact between Policy Makers & Researchers
1. There is no regular forum where researchers and policy-makers meet.
2. No, basically because we are a service provider and not a research organization.
3. Oh yes. We have a national committee here in the Ministry of…
4. No. They call us when there is something related to us.
6. It is done but not in formal committees. There is no committee/forum to discuss such issues.
8. There is nothing new in that. Have we evaluated our current research studies from a research point of view?
9. I don’t think we have that.
10. There is a forum but I am not personally involved…I keep motivating them and encouraging them to make more research in the health field.
12. Definitely and it was of value to me.
13. Not really. We don’t have that at all. We do it ourselves. We have our body of researchers here.
14. There is no regular forum here where researchers and policy-makers meet.
Despite the fact that policy-makers and researchers do not sit together, is there a public policy-maker who does not consult research results in planning their decisions?
1.7 The Role of Research in Policy-Making: The Views of Policy-Makers
Policy-makers selectively and invariably use certain sources of information in their decision-making. Is the value of research recognized by the senior policy-maker. Without research a decision can be based on personal views or impressions which may not reflect realities on the ground.
What happens when there is strong awareness of the importance of research in policy-making when research itself is absent?
1.8 Increasing the Need to Promote Your Ideas
Some policy-makers do find it very difficult to sell their decision to those higher in authority. Justifications vary according to the policy-maker and the decision which has to be sold. To a particular policy-maker, what makes it difficult for him to sell his ideas is that senior policy-makers are not sure of the extent of the problem. The argument is that even if a middle management policy-maker provides them with data, the question to top management policy-makers is “is it a real problem or not? It is a problem of awareness and level of understanding and the interference of personal interests in the decision-making.
1.9 The Need for Public-Policy to be Better Informed by Evidence
Regardless of the many factors which may play a role in increasing the need of policy-makers to sell their ideas, the need for Zanzibari public policy-makers to be better informed by research evidence seems to represent a deeper need. This is an area of rich insights that clearly indicates how health policy-makers in Zanzibar view sound policy-making by deepening and expanding research evidence. The recommendations are a combination of a bottom-up approach, proper dissemination of research results to policy-makers, and changing the methods or style of doing research.
2.0 Aspects of Research That Interest Policy-Makers
Zanzibaari public policy-makers are interested in which aspects of research results? There are those who are interested in surveys; doing and reading research results; criticize the methodology; what people think and their attitudes; public statistics; the outcome of research; and the public aspect of research results.
Some policy-makers may be interested in applied/operational research which does not match the motivations of an academician, i.e. academic promotion, etc
2.1 Kinds of Research Policy-Makers Would Like to Commission
Within policy-makers’ circles is a there a conflict in the perception of the kinds of research that they would like to commission?
Table 4 below highlights examples of research demanded by public policy-makers in the area of health.
Table 4: Research Demanded by Policy-Makers
1. Patient safety and performance indicators of the health services.
2. Work stress, injury, and the change in morbidity in the industrial area, the policy of industrialization and its social and health impacts.
3. Economic costs of non-communicable diseases.
4. Community surveys on mental illnesses.
5. Assessment of statistics graduates and the use of computers in hospitals.
6. Lifestyle and the impact of the media and globalization on their behavior.
7. More research on adolescents, women and child abuse, and violence.
8. Health services user satisfaction.
9. Evaluate our services and how they will look like in the next 15 years.
10. How to solve the anemia problem in the country.
11. Equity-based health research.
12. Cost-effectiveness or burden of disease.
13. Human resources and training which will give us the right numbers which will produce better outcomes.
14. Cultural and behavioral aspects of Aids.
15. TB, HIV among certain communities.
As indicated above, the main areas of research needed as per the policy-makers’ responses can be categorized into six main areas which are not in any order of priority.
Patient satisfaction and safety
Cost-effectiveness or burden of disease
Community surveys on mental illness
Human resources development and management: assessment of statistics graduates and the use of computers in hospitals, right numbers and level of training to produce better results
Lifestyle diseases: anemia, TB, HIV, Breculosis, women and child abuse and violence, impact of media and globalization on health
Health impact of work, industrialization, tourism
2.2 The Research-to-Policy Gap
Lack of research capacity which creates a research community in Zanzibar in general remains to be the main deficit. A culture of critical inquiry – research – has to be “introduced into the teachers and students very early on in the educational system and at later stages. Zanzibar does not have that at the moment. You build the capacity while you grow. You don’t expect each and every student to be a researcher but to at least appreciate research. A major part of public policy is how aware the public is about evidence-based research.”
It is not helpful to look at the problem of lack of research capacity as simply a problem of researchers or of policy-makers. There is first the need to create genuine awareness among the few and most senior public policy-makers on the importance of evidence-based policy and convince them to promote an enlightened advocacy among the highest echelons in the country. More than one track approach education to promote research-to-health policy awareness will be needed and various models will have to be studied including the United Nations University Model (UNU) model.
A huge task which requires tremendous political will is to erect health research awareness or at least appreciation throughout the educational ladder. That would be the ultimate aim. Short of that and from a human resource development point of view will be to invest more in researchers at higher education levels. The transfer benefits will go beyond public-policy research if properly trained teachers who combine the best from the East and the West will train the next generation of Zanzibaris to think more critically, and disseminate research appreciation.
2.3 Dissemination of Research Results
A policy-maker complains that research is done and the reports are prepared but policy-makers are too busy to read reports and may be they do not read what is written between the lines. “They need someone to help them” or/and provide them with “better readable materials.” The research results are often written in English or in two or three briefings and not the Kiswahili newspapers. policies.
Policy-makers should not be given the bulk of the research results. They should be given what interests them which should be what they need, and not everything. There should be a strategic marketing plan to decide which research results “end up in seminars, flyers, group presentations, booklets, radio, TV, libraries, bookstores.”
Research must decide how policy-makers and the general population get their information. It is very crucial to establish the reading-per-capita for a country like Zanzibar. In some cases word of mouth may be the best strategy but even this assumption must be based on evidence and reputable media research consultants can provide some good insights to work with.
“Results are not disseminated in the proper way… We don’t read. We need more discussions, more town meetings and media campaign for the public to understand. When they publish results they just put them in the newspapers giving percentages. What sense can an ordinary person make of that?”
Zanzibar’s human resources and financial wealth is disproportionately with the Zanzibaris in the diaspora and therefore it is imperative that an organic link be established between internal and external branches of the Zanzibar Institute for Research and Public Policy.
Clearly, there is a need to address the current research-to-policy gap in Zanzibar. While the organizational make-up or location of such an entity needs to be thought out more carefully, its main remit would be to forge a close working relationship with the mass media to inform the public on research-to-policy findings and related current activities taking place in Zanzibar
A research-to-public policy-driven Institute working out of Zanzibar and overseas needs to invest primarily in the field by bringing together the brains and pockets of Zanzibaris to work together with the Zanzibari communities according to defensible evidence-based strategies and results.