Nearly half of the countries had evidence collation and synthesis mechanisms and knowledge translation platforms to foster the uptake of evidence in policy development and implementation. No single source of evidence can provide comprehensive options to a policy question, and as such evidence from routine systems, several research studies and evaluation reports must be synthesised to provide timely and comprehensive answers. Knowledge translation platforms have been instrumental in improving the uptake of evidence [14]. El-Jardali et al. [14] emphasise that these must be integrated and institutionalised within the policymaking processes. This implies that they must be part of the health sector structures bringing together policy actors and researchers to facilitate synthesis, interpretation and uptake of evidence on the one hand and, on the other hand, the policy questions then informing future research (policy-informed evidence generation). Rwanda presents a best practice that can be emulated by other countries where knowledge translation was mainstreamed into routine health sector performance review.
The absence of such presents a missed opportunity to realising evidence-based dialogue and decision-making on one hand and waste of resources on the other. Generation of evidence is not an end in itself, and as such, its use in improving service delivery needs to be viewed as a return on investment. El-Jardali et al. [14] highlight the role of KT platforms in the COVID-19 response as important platforms in providing timely evidence to guard against misinformation and political interest and bridge the science and policy and implementation gap.
Where KT platforms existed, there was an inherent weakness that may impact negatively on their functionality—for example, being institution-based limits the extent to which stakeholders can be involved because of the limited convening power of national research institutes. Being annual events does not offer much benefit, given the fact that decision-making is an ongoing process. Worst still, several of these annual events had been missed due to the lack of funding. The poor synthesis and presentation of research results, as was reported in Tanzania, negatively impacts the uptake of evidence. This situation reinforces the need to strengthen individual and institutional capacities in not just research but also policy-oriented evidence synthesis and science communication.
Amongst the barriers to uptake of evidence is the lack of appreciation of each other’s world of operation between policymakers and researchers [15]. To this end, we note the initiative undertaken by Senegal to address this gap through an institutionalised capacity building programme on KT, which could be an incentive for researchers and policymakers to work together.
Regarding dissemination of evidence, the approaches employed predominantly were sharing reports, scientific publications and presentation in meetings. Such approaches do not offer much reach for several reasons; access to scientific publications is a challenge because of limited access to the Internet and journal that are not open access. This is compounded by the poor reading culture, which is a documented barrier [16]. The limited use of the media presents a missed opportunity given their capacity to mobilise communities to demand policy evolution [12]. There was no mention of the use of knowledge brokers and personal communication which have proven to be effective [3, 17]. Scholars emphasise the importance of effective dissemination of evidence making reference to simplified messages tailored to different audiences and employing multiple approaches [2, 3]. Amongst noted effective strategies are demand-driven approaches (where researchers respond to policy-makers demand for evidence), and these have been employed in some settings with success.
Although KT structures are still suboptimal, there is documented evidence of the improved quality of health policies underpinned by concrete context-appropriate evidence in Zambia, Uganda, Cameroon, and Ethiopia where KT platforms played an integral role [8]. In these success stories, the contribution of development partners in establishing evidence and collation synthesis mechanisms has been immense. In the case of Zambia and Senegal, high-level interest and support from the government have ensured sustainability beyond the start-up support from development partners.
Study limitations
Our assessment focused on the extent to which structures are in place to foster the uptake of evidence in countries of the WHO African Region. We did not undertake an in-depth assessment of the functionality of these structures and possible solutions to address identified challenges. We, however, believe our findings provide valuable information that can spur action in improving the uptake of evidence. In as much as the functionality of such structures is important, these must be in place in the first place.