Author interview: Dr. Ejemai Eboreime - Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria

In this interview, we discuss with Dr. Ejemai Eboreime, co-author of the article: Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria.

Ejemai Eboreime, Department of Psychiatry, University of Alberta, Edmonton, Canada

Congratulations on your paper, and thank you for choosing the PAMJ to publish your research.

Can you tell us a little bit more about yourself and your areas of practice or research?

I am a public health physician with interests in implementation science, global mental health, and health policy and systems research. I hold a PhD in implementation science, following a WHO/TDR fellowship, which enabled me to be the pioneer PhD holder in the field of implementation science in Africa. I am currently a research associate with the department of psychiatry, University of Alberta. I previously worked with Nigeria’s National Primary Health Care Development Agency where I was involved with primary healthcare policy planning, disease control, as well as operational research.

Can you explain your choice to explore this particular subject? What were the major motives?

As an actor in both the knowledge-producing and the knowledge-consuming communities, I have had concerns that health policies are often made by speculation or anecdotal evidence. I have seen several policies and programmes fail simply because those who designed the policy or those who implement these policies lack the capacity to appraise evidence to inform their work. This has led to policy failure on two levels. First defective design, which I consider as design without evidence backing. The second is defective implementation. Observing these two levels of policy failure, I considered it important that stakeholders across the knowledge production to consumption spectrum interact effectively to harmonize and contextualize evidence-based policy priority areas to streamline funding accordingly.

Your paper explores a very complex subject in filling, or shortening the gap from research evidence to translation/uptake/practice. What are the key challenges and opportunities? Who are the major actors needed here?

Our study sought to understand gaps in knowledge translation for policymaking in Nigeria, and opportunities to improve these gaps. The key gaps we identified are:

1. The communication gap between researchers and policymakers
2. Poor community involvement in evidence generation (research) and policymaking processes. People, rather than being at the center of both processes, often remain at the periphery and are considered objects of both policy and research processes
3. Very limited funding for research. This may not be unconnected with the notion in many low and middle-income countries, that research funding is politically wasteful for election purposes. But this is not correct. Research can point politicians to fund or design high-impact interventions which can garner political scores. Besides, the younger African electorate is more educated today than previously, and can easily demand and/or recognize even intangible but highly impactful evidence-informed health policies.
4. Inequalities: our study highlights inequalities in three dimensions
   1. Financial: policy decision-making is largely top-down. Given that it is often the very wealthy class that occupies the key decision-making space, policies are often skewed in Fell of the privileged
   2. Gender: socio-culturally, women are considered primarily as homemakers rather than decision-makers in Nigeria. This systemic sexism often makes it hard for women to rise into the policy space. The unfortunate irony is that women are more aware of the health needs of most Nigerians, yet they are often excluded from contributing to research (as evidence generators) or policy (as decision makers). Rather, they are most times relegated to objects of research to be studied, or recipient of policy decisions made on their behalf.
   3. Transgenerational: the average age of the Nigerian population is 18 years. But the majority of this class are either unemployed or underemployed. The policy space is rather dominated by people who are either near retirement or even retired.

To address these gaps, it is essential that the people (particularly women and youth) are put at the center of the policymaking processes. The bottom-up approach to research and policy design needs to be normalized.

Can you summarize for our nonmedical audience the findings of your study?

My response to the last question may be considered a lay summary

Were you surprised by some of the findings of your study?

From a bird’s eye view, I was not surprised, considering that some of these issues have been discussed over and over again by researchers and policymakers. However, it was quite a surprise that these findings were elicited mostly from the ordinary person.

Previously, people were not very conscious of their role in research and health care decision-making. But this is rapidly changing. Young people are today more enlightened and are making demands that they be included as partners in policymaking processes. This, I believe, is what makes this study unique. It is not so much about what was said as it is about who said it. Previously, such information would not have easily come from the general public, but today the population is fast becoming knowledgeable about their needs and their roles. And are more capable of being partners in research and policy, rather than merely objects to be studied or decided for.

Publishing in a medical journal is the first step. How do you intend to further disseminate the findings of your study?

As indicated in the article, a road map to improving inclusive evidence-based health policymaking has been developed and disseminated to key stakeholders. But there is more to do. We intend to continue to engage with various key actors to improve the way policies are made. We will do this by organizing more policy dialogues, participatory action and embedded research, as well as other context-sensitive strategies.

What are your next steps in steps of advancing research on this subject?

Described above

How would you like policymakers to use the findings of your paper?

For a long time, policymakers have been known to only talk about these issues. I think it is time to walk the talk. That is why we developed a roadmap in simple language, which we hope will make it easier for busy politicians to absorb. It is time to increase funding for research. It is also time to make policymaking, not just evidence-based, but also inclusive.

What motivated you to publish in the PAMJ?

Though our study was carried out in Nigeria, we strongly believe that these issues are similar in other African countries. Thus, lessons learned can benefit the entire continent.

PAMJ is the leading medical and healthcare journal in Africa. We believe that PAMJ is the right platform to document and disseminate the findings, not only to researchers but to lay persons as well. Considering that PAMJ has reached out to us to do this blog, we are confident that we made the right decision.

Any final words to researchers thinking of publishing African based research findings?

PAMJ is the right journal for African research. The editorial team is not alien to the unique issues in Africa.  Further, the cost of publication is minimal and suitable for Africans while still maintaining a rigorous review process.