I am reproducing the LinkedIn post below from the author Nasreen Jessani for discussion on the issues raised. The full piece is available here: https://lnkd.in/ecbNxnh7
"Thank you to Africa Evidence Network for encouraging me to write a blog on my keynote at the JBI Colloquium in hashtag#Kochi. It was a few months ago but there are some things that I continue to discuss amongst hashtag #EIDM circles and colleagues so posting them here for your thoughts:
"1. Uncertainty is evidence's natural state — not its failure mode.
We perform certainty for funders and policymakers. But real evidence says: "Here's what we know, with these caveats, in these contexts, for now." That's not weakness. That's honesty that enables action.
"2. Context isn't noise to filter out. It's signal to amplify.
What works in Oslo may fail in Ouagadougou — not because of "poor implementation" but because context matters more than the intervention itself. Yet we still make guidelines first, then add context as afterthought. We have this backwards..but we are seeing some encouraging shifts in LMICS.
"3. Multiple evidence traditions answer different questions with equal rigor.
Clinical trials. Implementation science. Traditional knowledge. Community practice. These aren't competitors. They're complementary. But our hierarchy treats only one or some as rigorous, dismissing others until validated by the dominant tradition.
"4. Equity isn't optional seasoning you add to guidelines, laws, regulations or guidelines.
If your decisions (policies, guidelines etc) works for wealthy urban populations and fails for everyone else, you don't have an equity problem. You have a policy/guideline problem.
"The room in Kochi wasn't defensive about these observations. There was shared recognition: the evidence system needs transformation. Not tweaking. Transformation.
"Its the the system that is broken. Not evidence — the system that decides what counts as evidence is what needs shifting.
"I've written up the full argument with specific actions for anyone who sits on guideline panels, controls funding, reviews manuscripts, teaches synthesis, or works in policy. What can you, me, all of us do starting Monday?"
Read the piece on the Africa Evidence Network blog:
https://lnkd.in/ecbNxnh7
==
I invite discussion on the issues raised. Please send your thoughts to: hifa@hifaforums.org
I have invited Nasreen Jessani to join us.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org