[Re: https://www.hifa.org/dgroups-rss/africa-evidence-network-evidence-doesnt... ]
Dear Neil and colleagues,
Thank you for sharing this thought-provoking piece and for opening the discussion.
Many of the points raised resonate strongly with my own recent reflections from working within hospital systems in Southeast Asia. In particular, the emphasis on context as a primary determinant of outcomes, rather than a secondary consideration, reflects what we encounter daily in maternal care settings.
In practice, the gap between guidelines and implementation is often shaped less by lack of knowledge and more by resource constraints, staffing realities, and informal systems that evolve to sustain care. These factors are rarely captured in formal evidence frameworks, yet they significantly influence outcomes.
I also appreciate the point on multiple evidence traditions. Frontline experience, operational constraints, and local adaptations often provide critical insights that complement formal research, especially in low-resource environments.
There seems to be a growing recognition that strengthening health systems requires not only better evidence, but also a broader understanding of what constitutes evidence in real-world settings.
Warm regards,
Suren
HIFA profile: Suren Kanayan is the Administrative Manager at Central Hospital in Cambodia. Professional interests: Maternal and Child Health, Obstetrics & Gynecology Clinical Practice, Healthcare System Strengthening in LMICs, Telemedicine and Digital Health Platforms. Email: skan71 AT yahoo.com