Barriers of evidence based policy making in iran's health system

La formation des sociétés fondées sur la connaissance, le progrès de la technologie de communications et un meilleur échange d'informations au niveau mondial permet une meilleure utilisation des connaissances produites lors des décisions prises dans le système de santé. Dans des pays en voie de développement, quelques études sont menées sur des obstacles qui empêchent la prise des décisions fondées sur des preuves (PDFDP) alors que des études similaires dans le monde développé sont vraiment rares. L'Iran est le pays qui a connu la plus forte croissance dans les publications scientifiques au cours de ces dernières années, mais la question qui se pose est la suivante : quels sont les obstacles qui empêchent l'utilisation de ces connaissances de même que celle des données mondiales? Cette étude embrasse trois articles consécutifs. Le but du premier article a été de trouver un modèle pour évaluer l'état de l'utilisation des connaissances dans ces circonstances en Iran à l’aide d'un examen vaste et systématique des sources suivie par une étude qualitative basée sur la méthode de la Grounded Theory. Ensuite au cours du deuxième et troisième article, les obstacles aux décisions fondées sur des preuves en Iran, sont étudiés en interrogeant les directeurs, les décideurs du secteur de la santé et les chercheurs qui travaillent à produire des preuves scientifiques pour la PDFDP en Iran. Après avoir examiné les modèles disponibles existants et la réalisation d'une étude qualitative, le premier article est sorti sous le titre de «Conception d'un modèle d'application des connaissances». Ce premier article sert de cadre pour les deux autres articles qui évaluent les obstacles à «pull» et «push» pour des PDFDP dans le pays. En Iran, en tant que pays en développement, les problèmes se situent dans toutes les étapes du processus de production, de partage et d’utilisation de la preuve dans la prise de décision du système de santé. Les obstacles qui existent à la prise de décision fondée sur des preuves sont divers et cela aux différents niveaux; les solutions multi-dimensionnelles sont nécessaires pour renforcer l'impact de preuves scientifiques sur les prises de décision. Ces solutions devraient entraîner des changements dans la culture et le milieu de la prise de décision afin de valoriser la prise de décisions fondées sur des preuves. Les critères de sélection des gestionnaires et leur nomination inappropriée ainsi que leurs remplaçants rapides et les différences de paiement dans les secteurs public et privé peuvent affaiblir la PDFDP de deux façons : d’une part en influant sur la motivation des décideurs et d'autre part en détruisant la continuité du programme. De même, tandis que la sélection et le remplacement des chercheurs n'est pas comme ceux des gestionnaires, il n'y a aucun critère pour encourager ces deux groupes à soutenir le processus décisionnel fondés sur des preuves dans le secteur de la santé et les changements ultérieurs. La sélection et la promotion des décideurs politiques devraient être basées sur leur performance en matière de la PDFDP et les efforts des universitaires doivent être comptés lors de leurs promotions personnelles et celles du rang de leur institution. Les attitudes et les capacités des décideurs et des chercheurs devraient être encouragés en leur donnant assez de pouvoir et d’habiliter dans les différentes étapes du cycle de décision. Cette étude a révélé que les gestionnaires n'ont pas suffisamment accès à la fois aux preuves nationales et internationales. Réduire l’écart qui sépare les chercheurs des décideurs est une étape cruciale qui doit être réalisée en favorisant la communication réciproque. Cette question est très importante étant donné que l'utilisation des connaissances ne peut être renforcée que par l'étroite collaboration entre les décideurs politiques et le secteur de la recherche. Dans ce but des programmes à long terme doivent être conçus ; la création des réseaux de chercheurs et de décideurs pour le choix du sujet de recherche, le classement des priorités, et le fait de renforcer la confiance réciproque entre les chercheurs et les décideurs politiques semblent être efficace.

The direct-democratic challenge to evidence-based policy making: Questioning the governmental PISA narrative in Swiss school policy

The democratic deficit of evidence-based policymaking and the little attention the approach pays to values and norms have repeatedly been criticized. This article argues that direct-democratic campaigns may provide an arena for citizens and stakeholders to debate the belief systems inherent to evidence. The study is based on a narrative analysis of Program for International Student Assessment (PISA) reports, as well as of newspaper coverage and governmental information referring to PISA in Swiss direct-democratic campaigns on a variety of school policy issues. The findings show that PISA reports are discursive instruments rather than ‘objective evidence’. The reports promote a narrative of economic progress through educational evidence that is adopted without scrutiny by governmental coalitions in direct-democratic campaigns to justify school policy reforms. Yet, the dominant PISA narrative is contested in two counter-narratives, one endorsed by numerous citizens, the other by a group of experts. These counter-narratives question how PISA is used by an ‘expertocracy’ to prescribe reforms, as well as the performance ideology inherent to. Overall, these findings suggest that direct-democratic campaigns may make more transparent how evidence is produced and used according to existing belief systems. Evidence, on the other hand, may be a stimulus for democratic discourse by feeding the debate with potential policy problems and solution. Thus, direct-democratic debates may reconcile normative positions of citizens with the desire to base decisions on empirical evidence.

Evidence-based decision making to strengthen local governance : nutritional health interventions in Bantul and Gunungkidul

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural, and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

The Maori social science academy and evidence-based policy

This paper focuses on recent moves to forge stronger linkages between the Māori social science academy and the policy industry. A critical appraisal of this development is offered, with particular attention given to the desirability of enhancing the academy’s role in the policy process, given the policy industry’s continued privileging of Eurocentric theory and research methodologies within the developing evidence-based environment. The paper ends with a discussion of the possibilities and problems associated with engagement with the policy industry, particularly as these relate to the various roles members can (or are forced to) take; either as ‘insiders’ (such as policy workers and contract researchers), or independent, critical ‘outsiders’. The author concludes that the best that insiders can hope for are incremental, largely ineffective changes to Māori policy, while independent members of the academy are best placed to speak on behalf of Māori, Māori communities, hapu and iwi.

Clinical data warehousing for evidence based decision making

Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.

Evidence-based practice

Introduction This chapter traces the history of evidence-based practice from its roots in evidence-based medicine to contemporary thinking about the usefulness of such an approach to practice. It defines evidence-based practice and differentiates it from terms such as evidence-based medicine, evidence-based policy and evidence-based healthcare. As evidence-based practice is concerned with identifying ‘good evidence’, this chapter will first describe the nature and production of knowledge, as it is important to understand the subjective nature of knowledge and the research process. The chapter considers the necessary skills for evidence-based practice, and discusses the processes of attaining the necessary evidence and its limitations. We examine the barriers and facilitators to identifying and implementing ‘best practice’ and when evidence-based practice is appropriate to use. The chapter concludes with a discussion about the limitations of evidence-based practice and the potential use of other sources of information to guide practice.

Evidence-based practice

This chapter traces the history of evidence-based practice (EBP) from its roots in evidence-based medicine to contemporary thinking about the usefulness of such an approach to public health practice. It defines EBP and differentiates it from terms such as evidence-based medicine, evidence-based policy and evidence-based health care. As EBP is concerned with identifying ‘good evidence’, this chapter will briefly describe the nature and production of knowledge, as it is important to understand the subjective nature of knowledge and the research process. This chapter considers the necessary skills for EBP, and discusses the processes of attaining the necessary evidence and its limitations. We examine the barriers and facilitators to identifying and implementing ‘best practice’, and when EBP is appropriate to use. There is a discussion about the limitations of EBP and the potential use of other sources of information to guide practice, and concluding information about the application of evidence to guide policy and practice.

Evidence-based practice

This chapter traces the history of evidence-based practice (EBP) from its roots in evidence-based medicine to contemporary thinking about its usefulness to public health practice. It defines EBP and differentiates it from ‘evidence-based medicine’, ‘evidence-based policy’ and ‘evidence-based healthcare’. As it is important to understand the subjective nature of knowledge and the research process, this chapter describes the nature and production of knowledge. This chapter considers the necessary skills for EBP, and the processes of attaining the necessary evidence. We examine the barriers and facilitators to identifying and implementing ‘best practice’, and when EBP is appropriate to use. There is a discussion about the limitations of EBP and the use of other information sources to guide practice, and concluding information about the application of evidence to guide policy and practice.

Putting down routes: an examination of local government cultural policy shaping the development of heritage trails

This paper explores the significance of trails within local government cultural strategies by presenting the results of an audit of 1000 trails, content analysis of local cultural strategies and a series of interviews with local government cultural officers. It highlights the growing sophistication of trails as flexible and multi-faceted products promising an array of social, environmental, cultural and economic benefits. However, key issues emerge as challenges for local government cultural officers. These include the need for a realistic assessment of the relative importance of competing rationales, the design of methodologies to enable evidence-based policy making and more effective engagement with commercial organisations.