Our guiding question for this week is:
Q4. What do you think are the different types of evidence that civil society can provide, that otherwise would not be considered? What are the main drivers and barriers to uptake and use of such evidence?
With regards to the first part of that question, it might be helpful to categorise evidence, and then consider the role of CSOs in generating, highlighting and applying such evidence. Is anyone on HIFA familiar with typologies of evidence? I feel out of depth on this subject but offer a few preliminary thoughts based on my observations of discussions on HIFA.
Notwithstanding there are a few types of evidence where CSOs clearly have a special, and sometimes unique, role. The most obvious is their ability to give voice to the population (whether national, subnational or local community level) or to specific groups within a population. CSOs are well-placed to undertake surveys and to hold public meetings for this purpose. Can anyone give examples?
A government (policymaker, decision-maker) that aspires to evidence-informed policymaking needs to listen to people's voices (and not just the conclusions of international guidelines). CSOs are specially able to assist governments in giving people a voice. Governments *need* civil society for this purpose. Can anyone give examples of governments and CSOs collaborating to give a voice to people?
CSOs also have an important role in highlighting existing evidence and holding governments accountable, often pointing to legal obligations. For example, HIFA pointed out in 2012 that governments have a legal obligation to take steps towards universal access to reliable healthcare information, a message that has fallen on deaf ears to date (with some governments egregiously regressing on this obligation in relation to COVID-19 misinformation). The Treatment Action Campaign (South Africa) has been mentioned and is an excellent example of existing evidence being used by a CSO to effect massive change. Can you describe other examples?
Coming to the second part of the question: "What are the main drivers and barriers to uptake and use of such evidence?". Again, based on our discussions on HIFA, the most obvious barrier is the fact that evidence is indeed only a small part of the reality of policy-making. As HIFA members have said:
"It is usually political expediency rather than objective decision-making that is practiced."
"Superstition, ignorance and refusal to change amongst policy makers constitute a huge hindrance to evidence driven policy making.“
"Challenges include the capacity of policy makers to understand what is evidence, how it is gathered, making sense of what is published, who is publishing it, the hierarchy of evidence and actually applying the evidence in context."
The challenge is to promote the value of an 'evidence-informed policymaking' approach and to support policymakers to move in this direction. Policymaking is messy and there is a lack of easy-to-use tools to guide policymakers.
Lastly (for now) there is the challenge of integrating global and national evidence. Here, the assumption is that organisations such as WHO produce international guidance, which can then be adapted at national level, based on context and local evidence. This is a hugely complex process, even if there is the political will to undertake evidence-informed policy. I would be interested to hear from HIFA members of examples in practice, perhaps describing how CSOs may have played a part.
Best wishes, Neil
Joint Coordinator, HIFA SUPPORT-SYSTEMS
Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org
HIFA profile: Neil Pakenham-Walsh is global coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information.
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