REPORT OF THE SIXTH EVIPNET EUROPE MULTICOUNTRY MEETING 3–5 SEPTEMBER 2019, ISTANBUL, TURKEY TOWARDS A CULTURE OF EVIDENCE- INFORMED POLICY The Evidence-informed Policy Network (EVIPNet) Europe WHO was established in 1948 as the specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publications programme, seeking to help countries to make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. 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REPORT OF THE SIXTH EVIPNET EUROPE MULTICOUNTRY MEETING 3–5 SEPTEMBER 2019, ISTANBUL, TURKEY TOWARDS A CULTURE OF EVIDENCE- INFORMED POLICY © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/ licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). Towards a culture of evidence-informed policy: Report of the Sixth EVIPNet Europe Multicountry Meeting Document number: WHO/EURO:2020-5547-45312-64854 REPORT OF THE SIXTH EVIPNET EUROPE MULTICOUNTRY MEETING 3–5 SEPTEMBER 2019, ISTANBUL, TURKEY TOWARDS A CULTURE OF EVIDENCE- INFORMED POLICY TOWARDS A CULTURE OF EVIDENCE-INFORMED POLICY EVIPNET EUROPEIV ABSTRACT The Evidence-informed Policy Network (EVIPNet) Europe is an initiative of the WHO Regional Office for Europe. It was established to build and institutionalize capacity in knowledge translation (KT) at the country level through the establishment of knowledge translation platforms (KTPs). To date, EVIPNet Europe has brought together multiple country champions in a series of six multicountry meetings, the last of which was held in Istanbul, Turkey in September 2019. This meeting highlighted recent achievements at all stages of the EVIPNet Europe action cycle – situation analyses, evidence briefs for policy and policy dialogues – across the Network, thus allowing members to share experiences and to gain from lessons learnt. To further develop participants’ abilities in facilitating evidence-informed policy- making (EIP), participants engaged in a series of sessions hosted by the McMaster Health Forum, which sought to guide and facilitate the production of rapid syntheses. Furthermore, Network members were introduced to the concept of the cultural contexts of health (CCH) as a lens through which to better understand and promote health and well-being. Participants also brainstormed in groups on how best to sustain EIP efforts through the setting up of a national KT infrastructure, and develop country EIP workplans. A tool for rapid case study evaluation was presented, as well as feedback on its pilot implementation by three countries. Future goals include moving towards a more systematic consideration of CCH in EIP efforts and working towards institutionalizing KTPs at the country level. A partnership with Cochrane Nordic is in the offing, with Cochrane Nordic planning to organize training in EVIPNet Europe member countries. Group photo © WHO/Mustafa Guzel VCONTENTS ACKNOWLEDGEMENTS......................................................VIII ABBREVIATIONS.......................................................................IX EXECUTIVE.SUMMARY............................................................X 1..INTRODUCTION.......................................................................1 1.1 Background ........................................................................................ 1 1.2 What is EVIPNet Europe?................................................................... 1 1.3 The Sixth multicountry meeting ........................................................ 3 TECHNICAL.SESSIONS............................................................5 2..LESSONS.LEARNT.FROM.EIP.COUNTRY.. ACTIVITIES....................................................................................5 2.1 Case study I: Developing an SA in Estonia ......................................... 5 2.2 Case study II: Developing an EBP in the Republic of Moldova ........... 7 2.3 Case study III: Developing a PD in Slovenia ....................................... 8 3..CONDUCTING.RAPID.SYNTHESES.............................. 10 3.1 Conducting a policy analysis in three days: rapid evidence synthesis .......................................................................................... 11 3.2 Lessons learnt in conducting a rapid synthesis ................................ 13 TOWARDS A CULTURE OF EVIDENCE-INFORMED POLICY EVIPNET EUROPEVI 4...A.PARTNERSHIP.BETWEEN.CCH.AND.EVIPNET. EUROPE....................................................................................... 15 4.1 What is culture and why does it matter? .......................................... 16 4.2 A CCH approach is multidisciplinary ............................................... 16 4.3 Culture is an enabler ........................................................................ 19 5..INSTITUTIONALIZATION.OF.A.KNOWLEDGE. BROKERING.ORGANIZATION.............................................. 21 5.1 Institutionalization EVIPNet KTPs at country level ......................... 21 5.2 KT and its institutionalization through workplan development ..... 24 5.3 A knowledge-brokering success story: the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) ................................................................................... 25 6..DEVELOPING.AN.EVALUATION.TOOL........................ 27 7..CONCLUSIONS.AND.NEXT.STEPS............................... 29 REFERENCES............................................................................30 APPENDIX.................................................................................. 35 VII LIST.OF.TABLES Table 1. A diversity of definitions on culture ............................... 17 Table 2. Types of social science and humanities methodologies used by CCH .................................................................... 18 Table 3. Summary of brainstorming session on institutionalizing KTPs ................................................... 23 LIST.OF.TEXT.BOXES Box 1. A closer collaboration between EVIPNet Europe member countries and Cochrane ...................................... 4 Box 2. Lessons learnt from conducting an SA in Estonia............. 6 Box 3. Lessons learnt from conducting an EBP in Moldova ......... 8 Box 4. Lessons learnt from conducting a PD in Slovenia ............. 9 Box 5. Pioneering a rapid response service in the Americas...... 11 Box 6. AMSTAR and GRADE ...................................................... 12 Box 7. Rapid-learning health systems ...................................... 14 Box 8. From cultural competencies to cultural humility ........... 19 Box 9. The development of a Health Evidence Network synthesis report on CCH and EIP ................................... 20 Box 10. A developing toolbox ...................................................... 26 LIST.OF.FIGURES Fig. 1. Types of KTPs ................................................................ 22 TOWARDS A CULTURE OF EVIDENCE-INFORMED POLICY EVIPNET EUROPEVIII ACKNOWLEDGEMENTS The WHO Regional Office for Europe wishes to express sincere thanks to all participants who contributed to the success of the sixth EVIPNet Europe multicountry meeting. Many thanks are owed to the Cultural Contexts of Health team hosted at the WHO Regional Office for Europe for co- organizing and co-hosting the meeting, as well as for generously providing funding awarded from the Wellcome Trust. Michael Wilson of the McMaster Health Forum (McMaster University, Canada), Mukdarut Bangpan (EPPI- Centre, Department of Social Science, University College of London [UCL]), Adrianna Murphy (London School of Hygiene and Tropical Medicine, United Kingdom) and Felicity Thomas (Exeter University, United Kingdom) added substantially to the major thematic elements of the meeting. We also wish to thank national EVIPNet Europe champions Angela Ivask (Estonia), Polonca Truden (Slovenia), Maja Šubelj (Slovenia) and Marcela Ţîrdea (Republic of Moldova), as well as Evelina Chapman of the WHO Secretariat of EVIPNet Europe, for sharing their lessons learnt. Sincere thanks are extended to Tanja Kuchenmüller (coordinating the WHO Secretariat of EVIPNet Europe) for chairing the meeting, Akbar Suvanbekov for extensive organization and management of the meeting, and Anne-Birgitte Gradman for superb administrative support to the meeting. We thank the Turkish Ministry of Health for hosting the meeting and Pavel Ursu of the WHO Country Office in Turkey for opening it. Lastly, we would like to thank Mustafa Guzel for his photographs of the meeting, Bandana Malhotra for editing and Nadia Scott for being the rapporteur. Ix ABBREVIATIONS AMR antimicrobial resistance AMSTAR A MeaSurement Tool to Assess systematic Reviews CCH cultural contexts of health DFID Department for International Development EIHPM evidence-informed health policy-making EIP evidence-informed policy-making EBP evidence-based brief for policy EHII European Health Information Initiative EPPI-Centre The Evidence for Policy and Practice Information and Co-ordinating Centre EVIPNet Evidence-informed Policy Network GPW General Programme of Work GRADE Grading of Recommendation Assessment, Development and Evaluation HINARI Health InterNetwork Access to Research Initiative IBM International Business Machines KT knowledge translation KTP knowledge translation platform LTCF long-term care facilities OECD Organisation for Economic Co-operation and Development PD policy dialogue SA situation analysis UK United Kingdom UNESCO United Nations Educational, Scientific and Cultural Organization WHO World Health Organization TOWARDS A CULTURE OF EVIDENCE-INFORMED POLICY EVIPNET EUROPEx ExECUTIVE SUMMARY In today’s information age, policy-makers are confronted with an information and evidence overload, challenging their ability to filter relevant information for decision-making. The usefulness of evidence is, however, contingent upon it being applied in policy and practice. To this end, knowledge translation (KT) has been proposed as a discipline that seeks to strengthen the interface between research and policy. The Evidence-informed Policy Network (EVIPNet) was established in 2005 as a global initiative with a mandate to build and institutionalize country capacity in KT. At the end of 2012, EVIPNet Europe was launched in the WHO European Region, under the aegis of the WHO European Health Information Initiative (EHII). EVIPNet Europe fosters through its activities the implementation of the European policy framework Health 2020, the United Nations Sustainable Development Goals and the Action Plan to enhance the use of evidence, information and research for policy-making in the WHO European Region. This regional network provides assistance and capacity-building support to its members, inter alia, through multicountry meetings, webinars, technical advice and networking opportunities to share experiences. The sixth multicountry meeting of EVIPNet Europe took place in Istanbul, Turkey in September 2019. This meeting welcomed two new Member States to the Network. Meeting participants were familiarized with the methods, tools and resources to develop rapid syntheses, bringing together the best available evidence on a specific high-priority health policy issue. Participants were also familiarized with the various methods used in social sciences research and how these complement quantitative methods such as randomized controlled trials. This blending of the quantitative and qualitative is particularly germane with regard to considering the cultural contexts of health (CCH) and how such factors underscore overall health and well-being. In conjunction with these two main foci, participants were encouraged to institute knowledge translation platforms (KTPs) in their home countries, so that the movement towards EIP might become strongly embedded in the working cultures of both researchers and policy-makers. Key outputs of the meeting included finalizing an evaluation tool, completing drafts of national workplans with a focus on EIP, and learning how to complete a rapid synthesis on a country-specific high-priority topic (per country). Participants left the meeting with a growing appreciation that cultural contexts could act as an enabler in KT activities in their respective countries. xI The next steps for implementing EVIPNet Europe’s work is expected to expand greatly over the next year due to new partnerships, including with Cochrane Nordic, whose representatives attended the meeting as observers. As a result of Cochrane Nordic’s attendance at the event, closer collaboration between EVIPNet Europe member countries and Cochrane is expected to be established. This partnership will greatly widen the scope and depth of EVIPNet Europe’s work, strengthen ties and help to deliver meaningful and useful outputs.
1. INTRODUCTION 1 1. INTRODUCTION 1.1.BACKGROUND The establishment of the Evidence-informed Policy Network (EVIPNet) was a direct response to the 2005 World Health Assembly resolution WHA58.34 that urged the Director-General “to assist in the development of more effective mechanisms to bridge the divide between ways in which knowledge is generated and ways in which it is used, including the transformation of health-research findings into policy and practice” (1). Thus, in conjunction with “the global scientific community, international partners, the private sector, civil society, and other relevant stakeholders”, EVIPNet was given the mandate “to strengthen or establish the transfer of knowledge in order to communicate, improve access to, and promote use of, reliable, relevant, unbiased, and timely health information”(1). 1.2.WHAT.IS.EVIPNET.EUROPE? Following the establishment of EVIPNet in other WHO regions of the world, EVIPNet Europe was launched in 2012 by the WHO Regional Office for Europe with the specific aim of building country and regional capacity in knowledge translation (KT). The Action Plan to strengthen the use of evidence, information and research for policy-making in the WHO European Region (2) provides EVIPNet Europe with the explicit mandate to strengthen the evidence-informed policy-making (EIP) capacity of the 53 Member States in the WHO European Region. The new WHO General Programme of Work (GPW) 2019–2023 (3) renews the need for initiatives such as EVIPNet Europe to provide support at the country level for more effectively formulating and implementing health policies in view of achieving the organizational triple billion goals of 1 billion more people benefiting from universal health coverage; 1 billion more people better protected from health emergencies; and 1 billion more people enjoying better health and well-being. "EVIPNet is something we like to do and we want to continue doing it. It is our opinion that we should be using this type of approach more often to further improve our skills. This is very logical.” Polonca Truden (Slovenia) USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE2 EVIPNet Europe promotes EIP that is responsive to local contexts, needs and priorities. Its portfolio of EIP activities at the country level include: • conducting EVIPNet Europe situation analyses (SA) to assess the country context of EIP, the driving factors, barriers and key actors; • developing evidence briefs for policy (EBP), which synthesize the best available research evidence to answer a specific policy problem in a concise way, written in user-friendly, non-expert language and adapted to various stakeholders. EBPs are based on a systematic search and appraisal of the global, regional and local evidence to understand what is known about that policy issue and which policy options effectively address the issue; and • organizing policy dialogues (PD), which are deliberative dialogues during which the tacit (experience-based) knowledge of all key stakeholders affecting or being affected by the key priority issue dealt with in the EBP is collected to guide policy development (4). At the regional level, EVIPNet Europe convenes annual multicountry meetings that serve to promote EIP commitment and enhance KT institutionalization (5), inter alia, through peer support and mentoring of newcomers to the Network by more experienced Member States. It is hoped that such combined initiatives will broker enduring horizontal partnerships and networking between EVIPNet Europe member countries, as well as vertical linkages between the WHO Secretariat of EVIPNet Europe and member countries. Tanja Kuchenmüller,1 leading the WHO Secretariat of EVIPNet Europe, and Ursu Pavel (WHO Representative, Turkey) welcomed the participants, including two new member countries (Austria and Turkey), to the Sixth EVIPNet Europe multicountry meeting. The opening session provided a general overview of EVIPNet Europe, its mandate, tools and activities as well as its progress. As the WHO Regional Office for Europe was the last to launch EVIPNet activities among other WHO regions, this allowed it the distinctive advantage of being able to capitalize upon the experience gained from its counterpart networks in other regions. While 13 member countries met in Turkey for the inaugural multicountry meeting of EVIPNet Europe in 2013 (6), the Network has since grown to comprise 21 member countries and has hosted four further multicountry meetings, which took place in Slovenia (2014) (7), Lithuania (2015) (8), Moldova (2016) (9) and Slovakia (2017) (10). 1 Unit Leader, Knowledge Management, Evidence and Research for Policy-Making, Division of Information, Evidence, Research and Innovation, WHO Regional Office for Europe 1. INTRODUCTION 3 Countries joining the Network can benefit from a community of practice, as well as technical assistance and peer support. EVIPNet has a variety of tools and networks to promote KT in the European Region (see (4)). Beyond capacity-building, the explicit goal of EVIPNet Europe is for countries to promote a culture more favourable to KT at national and regional levels. This requires institutionalization of KT via knowledge translation platforms (KTPs), which are formalized networks of key national actors charged with planning and implementing KT activities and interventions (4). 1.3.THE.SIXTH.MULTICOUNTRY.MEETING MEETING.OBJECTIVES The primary objectives of the meeting were threefold: 1. To build the technical capacity of Network members in conducting rapid syntheses to inform policy-making; 2. To consider the synergies at the interface of CCH and EIP; and 3. To discuss and explore strategies to institutionalize the work of EIP and EVIPNet Europe teams in each member country. ORGANIZATION.OF.THE.REPORT In accordance with these objectives, this meeting report (a) introduces the lessons learnt on EIP country activities; (b) presents an overview of the rapid response synthesis sessions via an in-depth series of sessions facilitated by Michael Wilson of the McMaster University Health Forum, as well as a pilot experience in a country in the Americas; (c) documents the exchange of experiences, lessons learnt and good practices, including the successful experiences of countries; and (d) provides an introduction to the synergies at the interface of CCH and EIP through a new collaboration with the CCH initiative at the WHO Regional Office for Europe. These sessions were led by Nils Fietje, head of CCH, and Felicity Thomas, co- director of the WHO Collaborating Centre on Culture and Health2; (e) discusses the institutionalization of KT via KTPs; (f) presents a new tool 2 Senior Research Fellow at Exeter University http://cultureandhealth.exeter.ac.uk/ “The power of good meetings is the enthusiasm of the chair. Tanja brings out the best in people. The most important part of these meetings is the increased motivation. It’s like returning to school with an inspiring teacher.” Sead Zeynel (North Macedonia) USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE4 for EBP evaluation; and (g) highlights progress on workplans that will be implemented with the support of EVIPNet Europe. BOx 1. A CLOSER COLLABORATION BETWEEN EVIPNET EUROPE MEMBER COUNTRIES AND COCHRANE The.acting.Director.of.Cochrane.Nordic,3.Karsten.Juhl.Jørgensen.and.his.communications.officer,.Dina.Muscat.Meng,. attended.the.EVIPNet.Europe.multicountry.meeting.as.observers..One.of.the.outcomes.of.the.meeting.is.the.closer. collaboration.that.Cochrane.Nordic.will.establish.with.EVIPNet.Europe.member.countries..With.the.ultimate.aim.of. establishing.a.Cochrane.Baltic,.Cochrane.Nordic.is.co-organizing.a.Cochrane.workshop.in.Estonia.that.will.take.place. in.early.2020. 3 The Nordic Cochrane Centre is a regional centre contributing to evidence-based decision-making in health care by producing high- quality independent research and systematic reviews that are free from commercial sponsorship. The Centre is hosted by Rigshospitalet in Copenhagen, Denmark. There are associate centres in Finland, Norway, Poland, Russia and Sweden. (https://nordic.cochrane.org/nordic-cochrane-centre-copenhagen) “Everybody is entitled to health care that is informed by the best available evidence, no matter where you live in the world. The work of EVIPNet Europe to bring evidence into practice and adapt it to local conditions is therefore a cornerstone of optimal health care and resource use.” Karsten Juhl Jørgensen, Acting director, Nordic Cochrane CentreForging a partnership © WHO/Mustafa Guzel 2. LESSONS LEARNT FROM EIP COUNTRY ACTIVITIES 5 TECHNICAL SESSIONS 2. LESSONS LEARNT FROM EIP COUNTRY ACTIVITIES Sharing good practices and lessons learnt among Network member countries is a cornerstone of EVIPNet Europe activities. During this session, three EVIPNet Europe country champions presented their experiences in implementing key EVIPNet Europe KT activities – the conducting of an SA, development of an EBP and organization of a PD (4). 2.1.CASE.STUDY.I:.DEVELOPING.AN.SA.IN. ESTONIA In Estonia, EVIPNet activities started in 2013 with a capacity-building workshop where a number of policy-makers and researchers met to raise awareness on the tools and resources available to health system policy- makers and stakeholders. These would support their use of research evidence, enhance skills in acquiring, assessing, adapting and applying research evidence, and learn how to prepare EBPs. As a result, in 2015–2016, the national team, with the support of the WHO Secretariat of EVIPNet Europe and its partners, prepared its first EBP on the negative health impact of the consumption of sugar-sweetened beverages (11). Since every third child in Estonia is now overweight, this is a significant challenge to health policy-makers in a country that had previously enjoyed one of the lowest incidences of child overweight and obesity in Europe. The experiences from this first EBP showed that there is a lack of relevant structures and experienced specialists that would allow KT and regular preparation of EBPs and thus EBPs could only be carried out case by case. Understanding the usefulness of EBPs in improving policy-making, work on an SA (12) was initiated in January 2018 to identify a suitable mechanism to institutionalize KT work at the country level and to systematize the development of EBPs. Angela Ivask explained that the SA was expected to describe and analyse the local context that potentially enables or hinders USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE6 the EIP process, and to deliver sufficient background information with which to guide deliberations on the organizational form, location and strategic direction for a suitable and sustainable KTP. The core team for Estonia’s SA consisted of five members from the departments of Health Systems Development and Analysis and Statistics of the Ministry of Social Affairs, and one member from the WHO country office. Data collection was carried out between November 2018 and February 2019. Various literature sources were searched, and six interviews and fifteen consultations were carried out via written, face-to-face or phone communications. The final draft SA report was presented at a stakeholder consultation in June 2019 to validate and further deliberate on the findings. All stakeholders expressed their support for the SA and agreed with the findings. In the near future, Estonia seeks to hold a broader political discussion on the findings revealed by the SA (see Box 2), and to further develop proposals on the future structure of a KTP. BOx 2. LESSONS LEARNT FROM CONDUCTING AN SA IN ESTONIA During.the.EBP.process,.a.critical.lack.of.relevant.structures,.experienced.specialists.and.financing.were.identified.as. key.barriers.to.systematically.integrating.EIP.into.Estonian.policy.processes..Similar.challenges.were.observed.during. the.conduct.of.the.SA,.as.well.as.additional.impediments,.including.the.following: •. inadequate.national.guidance.on. the.nature.of. the.evidence. that.should.be.used. in. the.EIP.process.by.policy- makers; •. a.lack.of.time.or.skills.to.find.and.interpret.evidence.among.policy-makers; •. no.formal.communication.platform.for.researchers.and.policy-makers; •. insufficient.financial.resources.for.analyses.and.studies; •. no.structure.or.person.responsible.for.EIP.due.to.staff.turnover; •. underestimation.of.the.amount.of.time.needed.to.conduct.an.SA. To.overcome.these.challenges,.numerous.measures.to.improve.the.EIP.process,.in.general,.were.suggested,.including. the.following: •. dedicating.a.structure.or.person.responsible.for.EIP; •. conducting.training.for.researchers.and.policy-makers.on.EIP.and.its.tools; •. creating.networks.between.researchers.and.policy-makers. 2. LESSONS LEARNT FROM EIP COUNTRY ACTIVITIES 7 2.2.CASE.STUDY.II:.DEVELOPING.AN.EBP.IN. THE.REPUBLIC.OF.MOLDOVA As one of the first countries to join the Network, Moldova presents important progress in the implementation of EVIPNet Europe activities. In this session, Marcela Ţîrdea described her country’s experience in developing an EBP to reduce children’s access to alcohol. Central to the problem of high alcohol consumption by children is a lack of properly implemented regulations, compounded by the consideration of beer as food rather than as alcohol. In support of this topic, the Government of the Republic of Moldova established the Government Programme of Activity to strengthen the control of alcohol regulations (13). To develop the EBP, a working group comprising policy-makers, researchers and civil society representatives (including youth organizations) was formed under the leadership of the Ministry of Health in 2015. Local evidence was sourced from the grey literature, while international evidence was primarily based on systematic reviews. Support was provided by the WHO Secretariat of EVIPNet Europe, which delivered multicountry and country-specific capacity-building training that significantly increased the working group’s ability to access, synthesize and apply evidence. The additional training and technical support on EBP that the team received from the Knowledge to Policy Center, American University, Lebanon, as well as additional assistance provided via two training sessions on Health InterNetwork Access to Research Initiative (HINARI), contributed substantially to the success of the EBP. In 2015, a first draft of the EBP was presented to key stakeholders at a deliberative consultation, where participants recommended that the focus of the EBP should be redirected towards specifically amending the alcohol control legislation, together with the inclusion of additional local evidence and input from those in the non-health sectors. In consultation with the WHO Secretariat of EVIPNet Europe and the WHO Country Office, it was decided that additional support be provided to the working group in the form of mentoring by Dr Fadi El-Jardali of the Knowledge to Policy Center in Lebanon.4 The draft EBP was finalized in 2017 and deliberated at a PD with the participation of stakeholders from the sectors of education, agriculture, 4 https://www.aub.edu.lb/k2p/pages/default.aspx USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE8 tourism, media, etc. The outcome of this long EBP process (see Box 3) was the revision of Moldova’s alcohol control legislation by Parliament. BOx 3. LESSONS LEARNT FROM CONDUCTING AN EBP IN MOLDOVA Key.challenges.identified.by.Moldova.included.the.following: •. a.lack.of.political.stability,.e.g..three.governments.in.2015; •. high.specialist.turnover; •. weak.institutional.capacities.in.EIP.and.information.exchange; •. no.financial.resources.dedicated.to.EIP.and.underfinanced.research.area; •. limited.reliability.of.local.evidence. Countering.these.challenges.was.aided.by.several.mechanisms,.including.the.following: •. sharing. and. using. the. knowledge,. methods. and. tools. acquired. in. the. capacity-building. events. organized. by. EVIPNet.Europe,.as.EVIPNet.Europe.methods.and. tools.provide.support. in.promoting.and.approving. the.most. difficult.public.policy; •. collaborating.and. communicating.between.national. focal. points,.WHO.Country.Office. and.WHO.Secretariat. of. EVIPNet.Europe; •. creating. formal. and. informal. partnerships.with. researchers,. civil. society. representatives. and. colleagues. from. other.public.authorities; •. using.HINARI.to.ensure.access.to.international.evidence.and.to.overcome.the.lack.of.local.evidence; •. using.any.opportunity.to.promote.the.use.of.evidence.in.policy-making. 2.3.CASE.STUDY.III:.DEVELOPING.A.PD.IN. SLOVENIA Polonca Truden and Maja Šubelj reported on Slovenia’s experience in conducting a PD. Previously, her group had completed an EBP on antibiotic prescribing in long-term care facilities (LTCF) for the elderly (14), with the objective of informing antimicrobial stewardship strategies in tackling the growing crisis of antimicrobial resistance (AMR)5 in LTCF (15). Here, their primary objective was to address the lack of monitoring of antibiotic use, particularly the lack of communication between doctors and nurses working in these facilities. To organize the PD, two experts from the National Institute of Public Health were nominated by the Ministry of Health. The WHO Secretariat 5 https://www.who.int/antimicrobial-resistance/en/ 2. LESSONS LEARNT FROM EIP COUNTRY ACTIVITIES 9 of EVIPNet Europe provided continuous guidance, capacity-building and technical support to the PD team, while the WHO Country Office assisted the process by professional encouragement, administrative/logistics and financial support; the National Institute of Public Health (NIJZ) provided organizational support. In terms of tools, in particular, the EVIPNet Europe Policy Dialogue Preparation and Facilitation Checklist (16) as well as the SUPPORT tools (17) and sure Guides (18) were drawn upon to organize the PD. PD facilitators were selected based on their long-standing expertise in and championship of AMR, and high-level role/influence and experience in dialogue with decision-makers, while key stakeholders were selected from a range of sectors, including primary care, infectious diseases, nursing and long-term care, with senior/high-level participants. As a result of the PD (see Box 4), all three policy options are seen as indispensable in Slovenia for improving the prescription of antibiotics in LTCF and are foreseen to be included in the revision of the national AMR strategy. Future recommendations for implementation include: placing AMR even higher on the political agenda while ensuring buy-in from all relevant political decision-makers; promoting strategies to strengthen communication and advocacy, including policy and media tracing, to influence policy formulation to reduce AMR and its implementation in LTCF; building of institutional bridges between ministries and within LTCFs; and encouraging the Ministry of Health to establish a unified approach to long- term care rather than addressing issues pertaining to this area within three separate health directorates. BOx 4. LESSONS LEARNT FROM CONDUCTING A PD IN SLOVENIA Challenges.during.the.PD.process.in.Slovenia.included.the.following: •. too.few.pre-interactions.with.key.stakeholders.prior.to.the.PD; •. insufficient.clarity.on.the.roles.and.responsibilities.of.the.coordination.team.regarding.follow-up.. activities; •. insufficient.institutional.engagement.and.management.support. Conducting.an.effective.PD.resulted.in.the.following.observations: •. Complex.issues.need.a.multilevel.and.multisectoral.approach.as.sociological.and.cultural.factors.play.a.significant. role. •. Local.evidence.should.always.be.integrated.to.propose.the.most.relevant.options. •. Support.and.communication.within.the.working.group.catalyses.work.progress.and.outcomes. •. Participation.of.high-level.stakeholders.throughout.the.process.is.necessary.to.move.the.process.. further. •. The.early.and.ongoing.involvement.of.stakeholders.is.necessary.to.encourage.investment/impact.as.engagement/ liability. USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE10 3. CONDUCTING RAPID SYNTHESES A major focus of the sixth EVIPNet Europe multicountry meeting was on strengthening the technical capacity of Network members in conducting rapid syntheses to inform policy-making. Given that system leaders (policy- makers and stakeholders) have to frequently address urgent health or social system questions, the focus has increased on conducting rapid syntheses as one part of larger efforts to support EIP. A rapid synthesis is a synthesis of research evidence that is produced in a time frame that is aligned with policy-makers’ needs, ranging from several days to a few weeks. As is the case for other KT mechanisms, a rapid synthesis is developed upon the explicit request of policy-makers about a specific, high-priority, health- or social-system question. It can: (i) clarify a problem and its causes; (ii) frame options for addressing it; (iii) identify implementation considerations; or (iv) inform monitoring and evaluation plans. Conducting rapid syntheses should be underpinned by a commitment to being systematic and transparent in identifying and synthesizing evidence and insights for health and social system leaders. In order for such analyses to be completed, good real-time project management is of the essence. Moreover, rapid syntheses should be an important component of support for rapid-learning health systems (see Box 7), which aim to be data-driven, patient-centred and constantly evolving. Such evolvability permits them to be responsive to urgent requests through flexibility in terms of timeline and the types of evidence and insights included. A growing body of literature suggests that rapid syntheses are effective means of increasing the uptake of evidence (19); as such, they have been utilized successfully in several countries, including in the Americas (see Box 5) (20). 3. CONDUCTING RAPID SYNTHESES 11 BOx 5. PIONEERING A RAPID RESPONSE SERVICE IN THE AMERICAS A.success.story.in.EIP,.Evelina.Chapman6.of.the.WHO.Secretariat.of.EVIPNet.Europe.was.instrumental.in.implementing. a.pilot.rapid.response.service.programme.launched.in.Buenos.Aires,.Argentina..Central.to.the.success.of.the.pilot.was. the.development.of. three. types.of. rapid. response. reports.using.methodological.shortcuts,.which.were. found. to.have. increased.confidence.on.evidence.and.communication.with.all.stakeholders.and.decreased.uncertainty.in.the.decision- maker..In.particular,.the.pilot.programme.demonstrated.that.rapid.response.reports.are.especially.valuable.and.effective. when.evidence.is.scarce. Source:. Evelina. Chapman.. Pilot. experience. of. the. Evidence-informed. Rapid. Response. Program. to. support. Health. Management.(PRRIEG)..Ministry.of.Health,.Buenos.Aires,.Argentina..Sixth.EVIPNet.Europe.Multicountry.Meeting..Istanbul,. Turkey,.3.September.2019. 6 Former coordinator of EVIPNet Americas for six years and a former Vice-Minister of Health in Buenos Aires, Argentina 3.1.CONDUCTING.A.POLICY.ANALYSIS.IN. THREE.DAYS:.RAPID.EVIDENCE.SYNTHESIS At the sixth EVIPNet Europe multicountry meeting, a series of sessions hosted by Michael Wilson (McMaster Health Forum) provided participants with the steps needed to systematically and transparently conduct a rapid synthesis on a pressing health system issue of relevance to their country. To enable participants to work on timelines conducive to the needs of often- rushed policy-makers, the goal of this practical session was for participants to prepare a rigorous synthesis of the best available evidence over three business days. The “hands-on” sessions were supported through real-time individualized feedback from the workshop facilitator. The groups were asked to prepare a presentation based on their rapid synthesis using an approach that could be harnessed to brief senior policy-makers in their respective governments. Research topics selected by country teams included interventions to prevent youth alcohol consumption, the efficacy of individual lifestyle counselling on smoking in the general population and a comparison of approaches to increase the uptake of measles–mumps–rubella vaccinations. USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE12 BOx 6. AMSTAR AND GRADE A.high.AMSTAR.(21).score.means.that.the.systematic.review.was.conducted.to.a.high.standard..This.does.not,.however,. mean.that.the.evidence.summarized. in.the.review.is.of.a.high.standard..For. instance,. the.review.may.not.contain.any. eligible.studies.(i.e..it.is.an.“empty”.review)..Alternatively,.the.included.studies.may.be.of.low.quality.(i.e..methodologically. weak)..GRADE,.however,.rates.the.quality.of.the.evidence.(as.opposed.to.the.quality.of.the.systematic.review).(22)..It.is. used.in.some.of.the.user-friendly.summaries.of.systematic.reviews.(e.g..SUPPORT.summaries).that.are.linked.to.one-stop. shops.such.as.Health.Systems.Evidence.(to.see.the.quality.of.evidence,.look.for.a.link.to.a.SUPPORT.summary)..Readers. of.a.systematic.review.will.also.need.to.ask.themselves.whether.the.review.is.locally.applicable. Source:.Michael.G..Wilson,.PhD,.Associate.Professor.and.Assistant.Director,.McMaster.Health.Forum,.McMaster.University.. EVIPNet.Rapid.Synthesis.Workshop.–.Sessions.#11.&.12..“Hands.on”.sessions.about.producing.a.rapid.synthesis;.Sixth. EVIPNet.Europe.Multicountry.Meeting..Istanbul,.Turkey,.4.September.2019. Overall, this session aimed to achieve the following objectives within the constraints of conducting a policy analysis: • to identify where to search for relevant and high-quality evidence when faced with a pressing health system issue; • to develop and refine searches for evidence to include in a rapid synthesis, identify relevant systematic reviews to include and begin data extraction. Some pointers regarding an efficient rapid synthesis process include the following: • soliciting the advice of at least two experts for insights; • formulating questions well, possibly requiring a scoping exercise; • taking into account A MeaSurement Tool to Assess systematic Reviews (AMSTAR) scores (see Box 6), which assess the quality of the review. • incorporating the grey literature; • selecting the most recent systematic reviews in order to avoid double counting of studies; • conducting jurisdictional scans. 3. CONDUCTING RAPID SYNTHESES 13 3.2.LESSONS.LEARNT.IN.CONDUCTING.A. RAPID.SYNTHESIS Attendees were invited to prepare a brief presentation on their rapid syntheses to obtain feedback on the approaches they had applied and the evidence gathered. This feedback session also focused on the identification of key lessons learnt, which included the need for efficient division of labour, good communication, clear questions and the inclusion of all relevant findings, not just the ones that might be politically expedient at the time. Participants expressed great interest in applying their newly acquired skills in rapid synthesis to working on real-world problems when they returned to their home countries. For some, the advantage of rapid synthesis was that they presented an abbreviated format much more applicable to policy- makers’ needs than lengthy reports. Additionally, presenting the rapid synthesis methodology could encourage policy-makers themselves to seek transparency in the briefs that they receive. As rapid synthesis is being recognized as a useful and important tool in view of strengthening EIP at the country level (see Box 7), the WHO Secretariat of EVIPNet Europe will increasingly focus its activities on supporting its member countries in effectively applying this EIP mechanism. This includes providing assistance in setting up national rapid response units for which some member countries have already officially submitted a request. RR session facilitated by Michael Wilson © WHO/Mustafa Guzel USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE14 BOx 7. RAPID-LEARNING HEALTH SYSTEMS At. the.outset,. rapid. learning.health. systems.were.devised. as. a. potential.means.of. filling. knowledge.gaps. through. mass.analysis.of.electronic.health. records. (23)..Today,.however,. their.use.has.shifted. to. rather.encompass.a.data- driven,.product-centred,.system-supported.and.culture-.and.competency-enabled.combination.of.health.systems.and. research.systems. (24)..Here,. the. term.“rapid. learning”.applies. to. the. fact. that.policy. initiatives. require.political.and. social.capital.for.institutionalization.and.are.expected.to.require.small.changes.throughout.the.process..In.other.words,. policy.initiatives.are.a.constant.cycle.of.small.refinements,.with.the.inherent.expectation.that.one.is.unlikely.to.get.them. right.the.first.time,.or.for.the.initiative.to.work.well.all.the.time.. Rapid.learning.health.systems.require.the.following.three.types.of.analyses.(and.evidence.sources): •. policy.analysis.(a.synthesis.of.best-available.evidence.–.systematic.reviews.and.primary.studies.when.needed.–. and.insights.from.key.informants.about.benefits,.harms.and.adaptations.needed.for.policy.options); •. system.analysis.(policy.documents,.websites,.data.and.insights.from.key.informants.about.how.systems.work.and. how.to.do.things.differently); •. political. analysis. (policy. documents,.websites. and. insights. from. key. informants. to. identify. factors. that. affect. government.agenda-setting.and.policy.choices). Sources:. (23,24). &. Michael. G..Wilson,. PhD,. Associate. Professor. and. Assistant. Director,. McMaster. Health. Forum,. McMaster.University..EVIPNet.Rapid.Synthesis.Workshop.–.Sessions.#5.&.6..Importance.of.conducting.rapid.syntheses. to.inform.policy.and.their.importance.for.rapid-learning.health.systems..Sixth.EVIPNet.Europe.Multicountry.Meeting.. Istanbul,.Turkey,.3.September.2019. 3. CONDUCTING RAPID SYNTHESES 15 4. A PARTNERSHIP BETWEEN CCH AND EVIPNET EUROPE Awareness of cultural contexts is vital for effective KT, as successful uptake of evidence in policy is dependent on good understanding of the cultures of study participants, researchers and policy-makers. Today, there is growing appreciation for the myriad ways in which cultural contexts intersect with health (25). Incorporating cultural contexts requires different types of evidence and research methods. These include the use of non-traditional data sources such as qualitative evidence and narrative studies. While culture has always been central to the work of EVIPNet Europe, no specific tools or approaches have yet been developed by EVIPNet Europe in this area. Hosted at the WHO Regional Office for Europe, the CCH project aims to enhance public health policy-making through a nuanced understanding of how cultural contexts affect health and health care in four key areas: nutrition, migration, environment and mental health (15,26). To date, CCH has hosted five expert group meetings and works in collaboration with bodies such as the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Organisation for Economic Co-operation and Development (OECD), the Wellcome Trust and the Robert Wood Johnson Foundation. Today, CCH aims to scale up the implementation of activities at the country- level in Member States. As per the 2018 CCH expert group meeting (27), this move involves a partnership with EVIPNet Europe that integrates CCH evidence into policy-making while enhancing KT mechanisms. CCH panel discussion with country champions © WHO/Mustafa Guzel USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE16 Thus, the meeting in Istanbul was a unique opportunity to explore the interface between CCH and KT. The CCH session was divided into two parts: (a) a general overview presented by Nils Fietje of how cultural contexts affect health and well-being, combined with a panel discussion in which champions discussed their country-level perspectives on including culture in KT activities, and (b) a detailed presentation on the dynamic nature of culture by Felicity Thomas, followed by hands-on work. 4.1.WHAT.IS.CULTURE.AND.WHY.DOES.IT. MATTER? The term culture itself has been subject to a multiplicity of definitions (see Table 1). Culture is not a static set of beliefs and practices but is instead dynamic. Culture is all encompassing and does not merely equate with categorizations of ethnicity or race. Studies of culture and health thus necessitate an understanding of cultural beliefs, values and norms over time and across space, and their impact on health behaviours and outcomes. Experiences of health and well-being are inextricably influenced by cultural contexts that, concurrently, inform the beliefs and actions of people, policy-makers and health-care practitioners (see Box 8). As a consequence, improving health outcomes is dependent upon health providers recognizing and understanding the sociocultural conditions that enable people to be healthy. 4.2.A.CCH.APPROACH.IS.MULTIDISCIPLINARY Understanding cultural contexts requires us to consider a wide range of evidence. Yet even today, health policy and practice continue to often rely on particular forms of evidence at the expense of others, a bias underlain by the predominating view that the humanities and social sciences are less valid than scientific fact due to their focus on opinion and experience. It is necessary to recognize that all forms of knowledge and practice – from the scientific and medical (such as systematic reviews and randomized controlled trials) to qualitative methods (such as narratives) – are duly influenced by culture. Indeed, our understanding of the subjective beliefs “While culture is something that is shared across groups of people, it is not a static set of beliefs and practices, but rather an ever- emerging array of collective values, ethics, assumptions and ideals.” Felicity Thomas “To inform the implementation of Health 2020 adequately, data collections need to be strengthened and new health monitoring approaches need to be explored. These include the use of non-traditional data sources such as qualitative evidence and narrative studies.” European Health Report, WHO 2015 4. A PARTNERSHIP BETWEEN CCH AND EVIPNET EUROPE 17 TABLE 1. A DIVERSITY OF DEFINITIONS ON CULTURE A.DIVERSITY.OF.DEFINITIONS.ON.CULTURE Culture.is.the.set.of.distinctive.spiritual,.material,.intellectual.and. emotional.features.of.society.or.a.social.group,.encompassing.art.and. literature,.lifestyles,.ways.of.living.together,.value.systems,.traditions.and. beliefs. UNESCO.Universal.Declaration. on.Cultural.Diversity,.2001 Culture.is.a.matrix.of.infinite.possibilities.and.choice.. Wole.Soyinka Culture.is.….conventional.understandings,.manifest.in.act.and.artefact. Robert.Redfield,.1941 [Culture.is].the.shared,.overt.and.covert.understandings.that.constitute. conventions.and.practices,.and.the.ideas,.symbols,.and.concrete.artefacts. that.sustain.conventions.and.practices,.and.make.them.meaningful. Napier.et.al.,.2014.(28) Culture.....is.that.complex.whole.which.includes.knowledge,.belief,.art,. morals,.law,.custom,.and.any.other.capabilities.and.habits.acquired.by. man.as.a.member.of.society.. Edward.Burnett.Tylor,.1870 Source: Nils Fietje, PhD, Unit leader, Evidence for Health and Well-being in Context, WHO Regional Office for Europe. Session #4. How cultural contexts of health play a role in EIHPM; Sixth EVIPNet Europe Multicountry Meeting. Istanbul, Turkey, 3 September 2019. and experiences of health, illness and well-being has been limited by a focus on the quantitative, which is based on limited sets of variables that elude the compounding of risk factors that typify our daily lives. In other words, quantitative measures are ill-suited to dealing with complexity. Rather, social science researchers use a range of qualitative methods (see Table 2), such as interviews, focus groups and ethnographic approaches, to compare experiences of health and well-being across and within geographical and cultural settings. Central to the CCH approach is the recognition that all research methods can be useful. Accordingly, the inclusion of different methods and their associated different forms of data serves only to strengthen the evidence base rather than undermine it. USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE18 TABLE 2. TYPES OF SOCIAL SCIENCE AND HUMANITIES METHODOLOGIES USED BY CCH TYPES.OF.SOCIAL.SCIENCE.AND.HUMANITIES.METHODOLOGIES.USED.BY.CCH Participatory.research Commonly.used.in.international.development.as.an.attempt.to.rebalance. power.relations.and.to.inform.action,.participatory.research.involves.a.range. of.methods,.including.mapping,.diagramming,.autophotography,.participatory. surveying.and.budgeting..This.method.can.be.effective.in.reaching.marginalized. groups.and.for.use.in.sensitive.issues. Engaged.research Engaged.research.is.about.researchers.and.stakeholders.such.as.community. members,.civil.society,.policy-makers.and.health.professionals.working.together. throughout.the.research.process,.which.ensures.that.stakeholders.play.a.part.in. shaping.and.directing.the.research..As.this.also.ensures.that.research.is.done.in. a.language.that.is.inclusive.rather.than.exclusive,.it.helps.give.people.ownership. of.the.process.and.any.interventions.that.follow. Historical.studies A.wide.range.of.sources,.such.as.written.records,.oral.history.and.visual.media,. can.be.used.to.investigate.how.social,.cultural.and.economic.factors.have. influenced.developments.in.medicine.and.health.care,.and.shaped.subjective. experiences.of.health.and.disease..These.methodologies.can.help.to.understand. how.cultural.beliefs.and.norms.have.shaped.health.and.well-being.over.time. and.across.the.Region,.as.well.as.show.how.the.collection,.presentation.and. interpretation.of.health.and.well-being.data.have.been.influenced.by.social.and. cultural.factors. In-depth.qualitative.and. ethnographic.studies Narratives.are.the.stories.that.people.tell.to.make.sense.of.their.experiences.. In.comparing.experiences.of.health.and.well-being.across.and.within.settings. and.population.groups,.using.methods.such.as.interviews,.focus.groups.and. ethnography.serves.to.provide.in-depth.insight.into.lived.experience.. Studies.of.cultural. heritage The.analysis.of.literature,.films,.art.and.sites.deemed.to.be.of.historical.or. cultural.significance.provides.insight.into.societal.norms.and.values.that. influence.daily.choices.and.health.behaviour,.as.well.as.factors.that.promote.or. constrain.resilience.and.belonging..It.can.also.enable.an.understanding.of.the. factors.that.promote.resilience.and.a.sense.of.belonging,.and.the.factors.that. exclude.certain.groups.from.this.. Popular.media Popular.media,.e.g..films,.novels,.newspapers,.can.shape.and.reproduce.–.as. well.as.contest.–.cultural.norms.and.values,.including.those.that.impact.on.well- being. Source: Felicity Thomas, PhD, Senior Research Fellow, Exeter University, United Kingdom. Session #21. EIP and cultural context of health; Sixth EVIPNet Europe Multicountry Meeting. Istanbul, Turkey, 4 September 2019. 4. A PARTNERSHIP BETWEEN CCH AND EVIPNET EUROPE 19 4.3.CULTURE.IS.AN.ENABLER. Culture is wide-ranging, dynamic and ever present, affecting our daily interactions, values, aspirations, working practice, and policy and regulation. As a result, culture influences the way that people understand and respond to health and well-being. Further investing into and strengthening the cultural contexts of EIP can only lead to improved health outcomes and better understanding. Much of the CCH work has examined the manner in which cultural factors intersect with social, political and economic circumstances to determine patterns of disease and ill-health and to influence the way people experience well-being. In the context of EIP, creating an understanding of the influence of cultural determinants of health is important for two key reasons: (a) identifying the barriers and facilitators that influence the choice and implementation of evidence-informed policy options, and (b) to better understand the overall EIP culture that prevails in a country and the importance that is attributed to evidence as a means of improving health policy, systems and outcomes. BOx 8. FROM CULTURAL COMPETENCIES TO CULTURAL HUMILITY Until. recently,. the.notion.of.cultural.competencies.was.stressed. in.multicultural.clinical. training.as.achieving. mastery.of.a. finite.body.of.knowledge.on. the.cultures.of.“others”;.however,. this.view.opened.up.possibilities. of.paternalistic.physician–patient.dyads,.as.well.as.creating.power.imbalances.between.clinicians.and.defined. populations.. Cultural. humility. instead. moves. away. from. the. simple. notion. of. mastery. towards. a. lifelong. commitment. to. self-evaluation. and. self-critique. (29).. Central. to. cultural. humility. is. an. appreciation. of. one’s. own.assumptions.and.unconscious.biases.that.is.cognizant.of.multiple.“truths”..In.this.way,.practitioners.rather. recognize. that. others. have. their. own. culturally.mediated.ways. of. knowing,. instead. of. a. perception. that. the. way.we.live.our.lives.is.the.only.or.best.way..While.cultural.competencies.are.goal.oriented.and.view.cultures. as.monolithic. entities. or. stereotypes. based. on. academic. knowledge,. cultural. humility. instead. reinforces. the. perception.that.gaining.knowledge.of.other.cultures.is.a.lifelong.attempt.that.requires.substantial.introspection. and. personal. growth..While. KT. espouses. cultural. competencies. in. EIP. work. such. as. rapid-learning. health. systems.(24),.thus.far.cultural.humility.has.not.yet.been.widely.adopted.in.the.field..However,.as.CCH.considers. cultural.humility.to.be.central.to.their.approach,. it.would.be.worthwhile.for.EVIPNet.Europe.to.move.towards. adoption.of.cultural.humility.as.a.key.practice. Sources:.(24,29) USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE20 BOx 9. THE DEVELOPMENT OF A HEALTH EVIDENCE NETWORK SYNTHESIS REPORT ON CCH AND EIP The. Health. Evidence. Network. (HEN),. initiated. and. coordinated. by. the. WHO. Regional. Office. for. Europe,. is. an. information. service. for.public.health. system.decision-makers. in. the.WHO.European.Region..HEN.synthesis. reports. use.multidisciplinary.and.intersectoral.sources.of.evidence.to.support.policy-making..They.summarize.what.is.known. about.a.policy.issue,.gaps.in.the.evidence.and.areas.under.debate..Based.on.the.synthesized.evidence,.HEN.proposes. policy.considerations. (as.opposed. to. recommendations). for.policy-makers.and.other.stakeholders. to.consider.when. formulating.their.own.recommendations..The.reports.are.indexed.in.the.National.Centre.for.Biotechnology.Information. Bookshelf.in.the.United.States.of.America.and.are.searchable.and.available.via.the.PubMed.archive. In.fact,.the.role.of.culture.within.policy-making.has.increasingly.been.recognized.a.It.is.now.acknowledged.that.policy- making.occurs.in.value-laden,.dynamic.ways.that.vary.in.different.contexts,.including.how.research.and.evidence.are. generated.and.used.b–e.To.better.understand.these.mechanisms.of.the.interplay.between.CCH.and.KT,.which.have.not. yet.been.systematically.studied.we.have.commissioned.a.HEN.synthesis.report.on: What.mechanisms.exist.to. integrate.cultural.contexts. into.the.KT.process.for.health.policy-making?.Considering.the. following.elements.within.the.scope: •. tools,.frameworks.and.models; •. how.CCH.influences.KT;.and •. synonyms.for.tools. Sources:. a.. Oliver. K,. Boaz.A.. Transforming. evidence. for. policy. and. practice:. creating. space. for. new. conversations.. Palgrave. Communications..2019;5(1):1. b.. Strassheim. H,. Kettunen. P.. When. does. evidence-based. policy. turn. into. policy-based. evidence?. Configurations,. contexts.and.mechanisms..Evidence.&.Policy..2014;10(2):259–77.. c.. Muers. S.. Cultures,. values. and. public. policy.. Bath:. Institute. for. Policy. Research;. 2018. (https://www.bath.ac.uk/ publications/culture-values-and-public-policy/attachments/ipr-culture-values-and-public-policy.pdf,. accessed. 20. December.2019).. d..Cairney.P,.Oliver.K..Evidence-based.policymaking.is.not.like.evidence-based.medicine,.so.how.far.should.you.go.to. bridge.the.divide.between.evidence.and.policy?.Health.Research.Policy.and.Systems..2017;15(1):35. e..Cairney.P,.editor..The.politics.of.evidence-based.policy.making..London:.Palgrave.Macmillan.UK;.2016.(https://www. palgrave.com/gp/book/9781137517807,.accessed.20.December.2019). As a result of the CCH session, EVIPNet Europe and CCH will jointly work on identifying existing tools and mechanisms that can further advance the systematic incorporation of CCH into EIP (see Box 9). 4. A PARTNERSHIP BETWEEN CCH AND EVIPNET EUROPE 21 5. INSTITUTIONALIZATION OF A KNOWLEDGE BROKERING ORGANIZATION 5.1.INSTITUTIONALIZATION.EVIPNET.KTPs.AT. COUNTRY.LEVEL EVIPNet Europe aims to go beyond individual capacity-building and institutionalize the systematic and transparent use of evidence in policy decision-making through the establishment of national KTPs. KTPs are core to the work of EVIPNet Europe as they lead and coordinate country KT interventions. They implement or delegate KT mechanisms such as EBPs and PD, rapid response services, clearinghouses and priority-setting exercises. Although many EVIPNet Europe member countries have conducted an EIP SA to identify the institutional niche for establishing a KTP, the next steps towards institutionalization are still under negotiation. During this session, the conceptual information on KTPs and institutionalization was presented. The various forms that a KTP can take are: (i) an independent organization, (ii) a part of an existing organization, (iii) a network with a stable secretariat and an informal network (see Fig. 1). Regardless of form, the WHO Secretariat of EVIPNet Europe empowers KTPs in promoting evidence use. KTP institutionalization session – group work by participants © WHO/Mustafa Guzel USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE22 Fig..1..Types.of.KTPs. Source: Tanja Kuchenmüller, Unit Leader, Knowledge Management, Evidence and Research for Policy-Making. Session #13. Institutionalization of a KTP (theoretical level). Sixth EVIPNet Europe Multicountry Meeting. Istanbul, Turkey, 4 September 2019. Participants worked in four groups (a) to define institutionalization, and (b) to identify the key domains of institutionalization. Participants strove to think not only about the theoretical aspects, but also local applicability and feasibility: how to institutionalize KTPs in their own respective countries. Discussions centred around the different types of KT institutions, the role of the Ministry of Health, the ideal order of steps in the KTP process, the various ways a KTP could be institutionalized, and the pros and cons of tapping into an existing structure versus creating something de novo. These points were reported back in plenary (see results in Table 3) and compared with the preliminary findings of a literature review, which will feed into the framework development of the WHO Secretariat of EVIPNet Europe. More broadly, these efforts will contribute to the wider project that EVIPNet Europe is undertaking with the EVIPnet steering group on creating an institutionalization framework. 5. INSTITUTIONALIZATION OF A KNOWLEDGE BROKERING ORGANIZATION 23 TABLE 3. SUMMARY OF BRAINSTORMING SESSION ON INSTITUTIONALIZING KTPS SUMMARY.OF.BRAINSTORMING.SESSION.ON.INSTITUTIONALIZING.KTPs Group.1 This.team.envisioned.institutionalizing.a.KTP.as.building.a.sustainable.and. stable.structure,.as.well.as.building.long-term.commitments.to.overcome. personal.interests.and.formalize.cooperation.with.key.EIP.actors..This.requires. (i).willingness.by.decision-makers,.e.g..in.the.form.of.commitment.letters.or.laws. supporting.the.work.of.the.KTPs,.(ii).sustainable.resources.(financial.resources,. trained.staff.and.good.lobbying),.and.(iii).continued.support.by.WHO.. Group.2 Institutionalization.requires.being.hosted.in.an.institution,.thus.it.is.not.informal.. For.this,.it.would.require.personnel.in.a.team.with.appropriate.training.in.EIP. and.KT.who.can.form.a.network.of.partners..It.requires.KT.responsibilities.and. partnerships.to.be.established.by.a.regulation.or.legislation..To.establish.the. KTP,.the.process.must.be.planned.in.advance,.with.timelines.and.resources,. a.legal.framework,.dedicated.personnel,.appropriate.training,.good.access. to.databases,.sustainable.funding,.and.commitment.by.policy-.and.decision- makers.to.use.evidence.in.policy.formulation.and.implementation. Group.3 This.team.expressed.the.idea.that.a.KTP,.with.the.mandate.to.bridge.the. research-to-policy.gap,.should.be.situated.“in.the.middle.of.society”,.executing. the.following.functions:.to.produce.policy-relevant.knowledge;.link.agencies. and.EIP.actors;.build.KT.capacity.and.implement.core.KT.activities.such. as.conducting.a.situation.analysis,.developing.EBPs,.communicating.and. advocating.for.its.KT.activities;.as.well.as.monitoring.and.evaluating.its.KT. activities..A.KTP.needs.to.have.its.own.budget,.from.a.combination.of.project. income.and.donor.revenue;.have.trained.human.resources,.and.be.recognized. by.decision-makers.for.its.KT.work;.rely.on.a.network.of.supporting.actors,. including.universities;.and.obtain.continued.support.from.WHO. Group.4 Institutionalization.requires.that.the.KTP.is.hosted.in.a.suitable.institution,. receive.its.mandate.through.special.regulation.protecting.its.work,.human. resources.and.budget,.government.support,.and.knowledge.that.is.channelled. or.sifted.down.to.state.institutions..Institutionalization.was.viewed.as.a.linear. process,.proceeding.from.stakeholder.debates.on.KTP.establishment.and. functioning,.to.the.drafting.of.a.note.by.the.Ministry.of.Health,.which.needs.to.be. passed.to.the.government.where.it.is.amended.and.approved.by.Parliament. USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE24 5.2.KT.AND.ITS.INSTITUTIONALIZATION. THROUGH.WORKPLAN.DEVELOPMENT. Developing a workplan is an important means of identifying the way forward and having a roadmap to strategically and efficiently collaborate with others in achieving joint goals. The purpose of this session was to bring EVIPNet Europe national champions – both experienced and new members – together to reflect on future KT activities and possibilities for institutionalization, and to develop their new country workplans for the 2020–2021 biennium. Prior to the workshop, a workplan template had been sent to the participants to allow them to brainstorm on and draft initial future KT activities at country level with both WHO country offices and relevant government agencies. At the multicountry meeting, participants were exposed to step-by-step explanations on how to fill in the provided workplan template, using examples of the draft workplans submitted by a few countries as a pre- workshop task. Participants learnt to tailor their workplans to the work of EVIPNet Europe, ensuring that the lead persons, timelines and the resources required were identified, as well as how the workplan would contribute to the United Nations Sustainable Development Goals.7 Post-meeting, participants were required to finalize their workplans, to meet with the respective WHO Country Office if necessary, and to send their documents back to the WHO Secretariat of EVIPNet Europe for review and consolidation. 7 Access to all goals at https://sustainabledevelopment.un.org/sdgs An animated brainstorming session © WHO/Mustafa Guzel 5. INSTITUTIONALIZATION OF A KNOWLEDGE BROKERING ORGANIZATION 25 5.3 A.KNOWLEDGE-BROKERING.SUCCESS. STORY:.THE.EVIDENCE.FOR.POLICY. AND.PRACTICE.INFORMATION.AND.CO- ORDINATING.CENTRE.(EPPI-CENTRE) As a practical example of the KT institutionalization process, the EPPI- Centre, part of the Department of Social Science within the University College of London (UCL) Institute of Education, is an internationally recognized research centre that excels in the design and conduct of systematic reviews and research on evidence ecosystem and research use (30). As discussed by Mukdarut Bangpan, the successful institutionalization of the EPPI-Centre (31) owes much to the development of research expertise and staff commitment over the past 25 years. The Centre started as a small group of researchers in the field who sought to organize, collect and synthesize data in a reliable way, with a focus on systematic reviews. At the time, its stated goal was to be the first to develop a database of well- designed evaluations of interventions in education and social welfare. In 1995, it received funding for work on methods of research synthesis. Central to the continued success of the EPPI-Centre is its co-location with academic institutions, which permits easy access to resources such as publications, and an incentive system that recognizes systematic reviews as academic output. Its continued success is also due to sustainable funding and a network of partnerships. In short, two key driving factors of institutionalization could be identified: developing a portfolio of tools and a portfolio of partnerships (Box 10). Sharing experience of EPPI-Centre KT institutionalization facilitated by Mukdarut Bangpan © WHO/Mustafa Guzel USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE26 BOx 10. A DEVELOPING TOOLBOx In.conducting.systematic.reviews,.the.EPPI-Centre.works.with.several.partners,. including.the.Campbell.Collaboration8. and.Cochrane.Reviews.9.The.EPPI-Centre.has.emerged.as.a.key.leader.not.only.in.the.conduct.of.systematic.reviews,.but. also.in.its.study.of.research use..In.line.with.this,.its.information.technology.staff.developed.in-house.software.for.use. by.internal.and.external.teams.on.conducting.systematic.reviews..This.is.complemented.by.published.books.on.policy- relevant.systematic.review.and.evidence.synthesis,10.as.well.as.short.courses.on.a.variety.of.topics..Regarding.a.focus. on.evidence.use,. the.EPPI-Centre.has.developed.an.Evidence.Library,.which. is.a.service. for.users.on.when.and.how. to.use.evidence.for.policy-making,.as.well.as.a.Research.Advisory.Service..Their.overarching.aim.as.an.organizational. knowledge.broker.is.to.not.only.collect.evidence,.but.to.also.develop.methods.and.a.framework.to.work.with.different. types.of.evidence.in.the.field..One.recent.tool.that.emerged.from.the.EPPI-Centre’s.systematic.review.programme.of.work. was.the.evidence.gap.map,.first.described.in.1996.. The.EPPI-Centre.has.been.at.the.forefront.in.developing.and.utilising.technology.for.research.and.evidence.synthesis.. EPPI-Reviewer,.for.instance,.is.an.end-to-end.software.solution.for.conducting.systematic.reviews,.producing.evidence.gap. maps.and.managing.data.from.citation.screening.through.synthesis..In.addition.to.a.long-standing.(20-year).collaboration. with. the.UK.Department.of.Health,. the.KTP.also.has.a. focus.on. international.development. through.partnerships.with. UNICEF.and.the.World.Bank..EPPI-Centre.collaborates.with.the.UK.Department.for.International.Development.(DFID).to. build.capacity.of.international.research.teams.to.conduct.systematic.reviews.in.different.policy.areas. Source:.Mukdarut.Bangpan,.Associate.Professor,.EPPI-Centre,.UCL..Session.#14..The.EPPI-Centre.(practical.level)..Sixth. EVIPNet.Europe.Multicountry.Meeting..Istanbul,.Turkey,.4.September.2019. 8 Access at https://campbellcollaboration.org/ 9 Access at https://www.cochrane.org/ 10 Link to full list of publications (with access) at https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=56 The sessions on institutionalization demonstrated that challenges remain to systematically bringing the two worlds – decision-making and research production – together. While good practice models of organizational knowledge brokers exist, such as the EPPI-Centre, the evidence ecosystems in the middle of these two communities need to be better understood and guidance identified on how countries can proceed in view of institutionalizing their EIP work. The institutionalization framework that the WHO Secretariat of EVIPNet Europe is currently developing with the EVIPNET steering group will soon provide such guidance to Network member countries. 5. INSTITUTIONALIZATION OF A KNOWLEDGE BROKERING ORGANIZATION 27 6. DEVELOPING AN EVALUATION TOOL Evaluation of the EBP development process presents an opportunity for new countries to learn from experienced members. Their valuable lessons should be shared with EVIPNet Europe and the broader community of EIP researchers and practitioners. At the behest of countries at the 2017 multicountry meeting, it was felt to be necessary to develop a tool with which EVIPNet Europe countries could evaluate their EBP process. In this session, Adrianna Murphy (Assistant Professor, London School of Hygiene and Tropical Medicine) presented a pilot tool for rapid case study evaluation that she had designed while on secondment at the WHO Regional Office for Europe. With the aim of developing a tool that would permit a rigorous evaluation and become a standard tool to compare across countries, her specific objectives were to design an approach that would capture the complexity of the EBP process and be scientifically valid, and to pilot this in three EVIPNet Europe countries. It was imperative that the tool be practical, meaning that it could be implemented in a relatively short time period by someone new to monitoring and evaluation. To design the tool, a scoping review was conducted to identify frameworks and data collection approaches to process evaluation; this identified an approach that combined the Medical Research Council Process Evaluation Framework (32) with rapid appraisal methods as being the most appropriate. Invoking the principle of triangulation, rapid appraisal methods provide an understanding of a situation in a more timely and cost-effective manner than standard social research methods and involve collecting data from multiple sources, qualitative interviews with stakeholders and document review. Participants for stakeholder interviews were selected purposively in order to capture the perspectives of as many people as possible who are or were involved, directly or indirectly, in the EBP process. For implementation on the ground, key questions are detailed in the topic guide. Regarding relevant documents, potential avenues of inquiry included terms of reference, workplans, published and in-progress EBPs, situation analyses, lessons learnt reports and other notes from EBP teams. “It is important for everyone to feel that their opinion matters and is channelled back to the organizers. This tool is a great opportunity to reflect on what we have done.” Balazs Barbarczy (Hungary) USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE28 As tool implementation is itself best improved through an evaluative process, the newly designed tool was recently piloted in three countries that had completed an EBP. In this session, the three pilot countries shared and discussed their lessons learnt. Overall, tool implementation was found to be a clear and straightforward process, although best implemented during or just after the EBP process. More specific suggestions surrounded trimming overly descriptive elements in the topic guide, refining the document review and improving objectivity in the process, perhaps by involving someone external to the EBP process to conduct the interviews. Together, these results from the piloting demonstrated that the evaluation approach can provide useful lessons on key factors that might affect the EBP process, such as access to resources, team leadership and a volatile political context. Country teams at work © WHO/Mustafa Guzel 6. DEVELOPING AN EVALUATION TOOL 29 7. CONCLUSIONS AND NExT STEPS The 2019 multicountry meeting was very well received by EVIPNet Europe’s members, covering such topics as (a) institutionalizing KT; (b) conducting rapid syntheses; and (c) considering cultural contexts as intrinsic components of health and well-being. Overall, key outputs and outcomes of the meeting included the following: • improved knowledge and skills of participants to develop rapid syntheses; • a rapid synthesis on country-specific high-priority topics (per country); • increased understanding and commitment of participants to consider CCH in their KT work; • draft of national EVIPNet Europe workplans providing the roadmap for each country for the next 2 years; • input to the EVIPNet Europe KT institutionalization framework that is currently being developed as a new tool for the Network; • input to the finalization of the EBP evaluation tool, with findings to be published in a peer-reviewed journal; • increased Network-wide cohesion, exchange of experiences and identification of good practices. With a growing awareness of the importance of institutionalization, participants are tasked with moving further towards KTP institutionalization. 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London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College; 2016 (https://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20 and%20summaries/Science%202016%20Langer%20report. pdf?ver=2016-04-18-142701-867, accessed 20 December 2019). 31. Oakley A, Gough D, Oliver S, Thomas J. The politics of evidence and methodology: lessons from the EPPI-Centre. Evid Policy J Res Debate Pract. 2005;1(1):5–32. 32. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W et al. Process evaluation of complex interventions. BMJ. 2015;350:h1258. APPENDIX 35 APPENDIx LIST.OF.PARTICIPANTS AUSTRIA Ms.Katharina.Habimana Austrian.Public.Health.Institute BULGARIA Mr.Peter.Atanasov. Head.of.Department,.National.Center.of. Public.Health.and.Analyses ESTONIA Ms.Angela.Ivask. Scientific.Adviser,.Ministry.of.Social.Affairs. . Ms.Eleri.Lapp Chief.Specialist,.Ministry.of.Social.Affairs,. Health.System.Development.Department HUNGARY Mr.Balazs.Babarczy Analyst,.National.Public.Health.Center,. Unit.of.Infection.Control.and.Hospital. Epidemiology Mr.József.Vitrai Head.of.Unit.for.Health.Monitoring,.Public. Health.Department,.Ministry.of.Human. Capacities LITHUANIA Mr.Vincentas.Liuima Acting.Head.of.Division.of.Technology. Assessment,.Public.Health.Technology. Centre,.Institute.of.Hygiene Ms.Ilona.Radvinauskienė Adviser,.Strategic.Management.and. International.Cooperation.Division,.Ministry. of.Health.of.the.Republic.of.Lithuania NORTH.MACEDONIA Ms.Bojana.Atanasova Ministry.of.Health Mr.Sead.Zeynel Ministry.of.Health. POLAND Mr.Jan.Strzeminski Head.Specialist,.Ministry.of.Health.-. Department.of.Analysis.and.Strategy. REPUBLIC.OF.MOLDOVA Ms.Galina.Obreja Associate.Professor,.Department.of.Social. Medicine.and.Health.Management,.Nicolae. Testemitanu.State.University of.Medicine.and.Pharmacy Ms.Marcela.Tirdea Ministry.of.Health,.Labour.and. Head.of.Policy.Analysis,.Monitoring.and. Evaluation.Department,.Social.Protection ROMANIA Ms.Claudia.Dima Chief.of.Service,.National.Center.for. Evaluation.and.Promoting.Health,.National. institute.of.Public.Health Mr.Ciprian.Ursu Primary.Physician.Public.Health.and. Management,.National.Center.for.Evaluation. and.Promoting.Health,.National.Institute.of. Public.Health SERBIA Ms.Farida.Bassioni-Stamenic. Ministry.of.Health. . Ms.Nevenka.Pavlovic Assistant.Director,.Head.of.CDC,.Institute.of. Public.Health.for.Belgrade. SLOVENIA Ms.Polonca.Truden.Dobrin National.Institute.of.Public.Health. Ms.Maja.Subelj Public.Health.Specialist,.National.Institute. of.Public.Health........................................................................... USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE36 TURKEY Mr.Hasan.Hüseyin.Yildirim Director,.TÜSEB.Turkish.Institute.for.Health. Policies. . . Mr.Birol.Tibet Turkish.Institute.for.Health.Policies. ................ TEMPORARY.ADVISERS Ms.Mukdarut.Bangpan Associate.Professor,.University.College. London. . Ms.Adrianna.Murphy. Assistant.Professor,.London.School.of. Hygiene.and.Tropical.Medicine. Ms.Felicity.Thomas University.of.Exeter Mr.Michael.Wilson. Assistant.Professor,.Department.of. Health.Evidence.and.Impact,.McMaster. University. OBSERVERS Ms.Dina.Muscat.Meng. Communications.Consultant,.Cochrane. Nordic lMr.Karsten.Juhl.Jørgensen. Acting.Director,.Nordic.Cochrane. Centre. . . . . . ..................... Ms.Yonca.Özatkan. Expert,.TÜSEB.Turkish.Institute.for.Health. Policies.. RAPPORTEUR Ms.Nadia.Scott Max.Planck.Institute.for.Evolutionary. Anthropology. WORLD.HEALTH.ORGANIZATION COUNTRY.OFFICE Mr.Toker.Ergüder National.Professional.Officer,.WHO.Country. Office,.Ankara,.Turkey. Mr.Pavel.Ursu WHO.Representative,.Ankara,.Turkey REGIONAL.OFFICE.FOR.EUROPE Ms.Tanja.Kuchenmüller Unit.Leader,.Knowledge.Management,. Evidence.and.Research.for.Policy-making, Division.of.Information,.Evidence.and Research.and.Innovation. Ms.Evelina.Chapman Technical.Officer,.Knowledge.Management,. Evidence.and.Research.for.Policy-making,. Division.of.Information,.Evidence.and Research.and.Innovation Mr.Akbar.Suvanbekov Consultant,.Knowledge.Management. Evidence.and.Research.for.Policy-Making,. Division.of.Information,.Evidence,. Research.and.Innovation. Mr.Nils.Fietje. Unit.leader,.Evidence.for.Health.and. Wellbeing.in.Context,.Division.of. Information,.Evidence.and.Research.and. Innovation Ms.Andrea.Scheel. Consultant,.Evidence.for.Health.and. Wellbeing.in.Context,.Division.of. Information,.Evidence,.Research.and. Innovation Ms.Anne-Birgitte.Gradman Programme.Assistant,.Knowledge. Management,.Evidence.and.Research.for. Policy-making,.Division.of.Information,. Evidence,.Research.and.Innovation. LIST.OF.PARTICIPANTS.(CONTD) APPENDIX 37 MEETING.PROGRAMME DAY.1:.TUESDAY,.3.SEPTEMBER.2019 Registration Session.1:.Welcome.and.opening Ministry.of.Health,.WHO.Country.Office,.WHO.Secretariat Session.2:.Introduction.to.EVIPNet.Europe.and.updates. Tanja.Kuchenmüller./.Akbar.Suvanbekov Session.3:.Successful.experiences.on.Evidence-Informed.Health.Policy-making.(EIHPM).in.the.Region. 3.EVIPNet.Europe.member.countries Coffee/tea.break Session.4:.How.cultural.contexts.of.health.play.a.role.in.EIHPM Nils.Fietje./.Andrea.Scheel Group.photo.and.lunch.break Session.5:.Importance.of.conducting.rapid.syntheses.from.a.policy-maker’s.perspective Michael.Wilson./.Evelina.Chapman. Session.6:.Rapid.evidence.syntheses.in.the.context.of.rapid-learning.health.systems Michael.Wilson. Session.7:.Practical.session.on.searching,.finding.and.appraising.systematic.reviews Michael.Wilson Coffee/tea.break.to.be.served.in.the.conference.room Session.8:.Practical.session.on.producing.a.rapid.synthesis Michael.Wilson Session.9:.Wrap-up WHO.secretariat Intensive.skill.building.session.on.evidence.syntheses.(voluntary) Michael.Wilson USING RESEARCH EVIDENCE FOR POLICY-MAKING EVIPNET EUROPE38 DAY.2:.WEDNESDAY,.4.SEPTEMBER.2019 Session.10:.Outlook.on.Day.2 WHO.Secretariat Session.11:.Practical.session.on.producing.rapid.syntheses. Michael.Wilson Coffee/tea.break Session.12:.Practical.session.on.producing.rapid.syntheses. Michael.Wilson Lunch.break Session.13:.Institutionalization.of.a.Knowledge.Translation.Platform.(Theoretical.level). Tanja.Kuchenmüller Session.14:.The.EPPI-Centre.(Practical.level) Mukdarut.Bangpan Coffee/tea.break. Session.15:.Developing.of.a.new.workplan. Akbar.Suvanbekov./.Tanja.Kuchenmüller Session.16:.Wrap-up. WHO.Secretariat. Pick-up.at.the.hotel.. Bosphorus.cruise.dinner. MEETING.PROGRAMME.(CONTD) APPENDIX 39 DAY.3:.THURSDAY,.5.SEPTEMBER.2019 Session.17:.Outlook.on.Day.3 WHO.Secretariat Session.18:.Presentation.and.feedback.on.rapid.syntheses. Michael.Wilson Coffee/tea.break. Session.19:.EVIPNet.Europe.M&E.and.rapid.case.study.evaluation.tool.. Tanja.Kuchenmüller./Adrianna.Murphy. Lunch.break. Session.20:.Session:.EIP.and.cultural.context.of.health. WHO.Secretariat.(EHC). Coffee/tea.break.to.be.served.in.the.conference.room. Session.21:.EIP.and.cultural.context.of.health.continued. WHO.Secretariat.(EHC). Session.22:.Wrap-up.and.closing. World Health Organization Regional Office for Europe UN.City,.Marmorvej.51,.DK-2100.Copenhagen.Ø,.Denmark Tel.:.+45.45.33.70.00...Fax:.+45.45.33.70.01. Email:.euwhocontact@who.int The WHO Regional Office for Europe The.World.Health.Organization.(WHO).is.a. specialized.agency.of.the.United.Nations.created. in.1948.with.the.primary.responsibility.for. international.health.matters.and.public.health.. The.WHO.Regional.Office.for.Europe.is.one.of. six.regional.offices.throughout.the.world,.each. with.its.own.programme.geared.to.the.particular. health.conditions.of.the.countries.it.serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia.and.Herzegovina Bulgaria Croatia Cyprus Czech.Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North.Macedonia Norway Poland Portugal Republic.of.Moldova Romania Russian.Federation San.Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United.Kingdom Uzbekistan WHO/EURO:2020-5547-45312-64854