Building capacities of elected national representatives to interpret and use evidence for...
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Building capacities of elected national representatives to interpret and use evidence for health-related policy decisions: A case study from Botswana Neil
Building capacities of elected national representatives to
interpret and use evidence for health-related policy decisions: A
case study from Botswana Neil Andersson, Mokgweetsi Masisi, Lehana
Thabane, Anne Cockcroft
Slide 2
Rationale Elected representatives make decisions and allocate
funds They lack skills to interpret evidence on health-related
topics It is possible to build such skills
Slide 3
Usually: Training for MPs covers mechanics and ethics of role
Training in use of evidence targets technical officers Can we
bridge the gap?
Slide 4
The opportunity Debate about national HIV/AIDS policy in
Botswana parliament in 2011 Invited by government to survey MPs
about their needs for evidence and training in its use to provide
training about evidence use Working with Office of President,
National Assembly Office, NACA
Slide 5
The Botswana parliament 61 members 57 elected 4 appointed 16
ministers 9 assistant ministers
Slide 6
The survey October 2011 27 MPs completed short questionnaire 17
by telephone 10 face to face
Slide 7
As a parliamentarian do you feel you need more evidence, from
research, about HIV and AIDS? CIET 2011
Slide 8
receive evidence from reliable, unbiased sources? CIET
2011
Slide 9
know enough about what to do about evidence? CIET 2011
Slide 10
have had enough training in how to make the best use of
evidence? CIET 2011
Slide 11
Do you think it could help your work if you felt better
equipped to use evidence? CIET 2011
Slide 12
How would it help your work? It would boost my confidence
decisions would be based on facts We would have actual facts and
knowledge to pass to our constituents help in effective policy
making We would discuss issues in a well-informed way could assist
us to make positive changes CIET 2011
Slide 13
What difficulties do you face in using evidence in your work as
a parliamentarian? the use of jargon difficult wording and
statistical data evidence from government agencies is outdated
inexperienced research officerslack of researchers for parliament
technical terms are a challenge access to the information CIET
2011
Slide 14
The training sessions Parliamentarians and evidence-based
decision making Oct/Nov 2011 2 x days Nov 2012 2 x days Material
Some dropped, some added Parliamentarians
Slide 15
Coverage 36 MPs 7 ministers Deputy speaker Leader of opposition
Chair of HIV/AIDS cttee Director HIV/AIDS MoH NACA personnel
Slide 16
Slide 17
Some of participants from 2011
Slide 18
Evidence for planning Evidence on impact, coverage and costs
Contrast (counterfactual evidence) Describing evidence: population
link Value of different evidence sources: contrast, ability to deal
with other factors
Slide 19
The language of evidence Analysis Association Inference
Interaction Contrast Confounder Relative Risk Risk Difference Gains
Number needed to treat Accuracy Error Bias Randomised Controlled
Trial Randomised Cluster Controlled Trial Systematic review Meta
analysis Statistical significance P value Confidence interval Study
size Incidence Prevalence Hyperendemic countries Baseline
measurement Ingredients of a questionnaire Upward trajectory of
costs Concomitant increase
Slide 20
Questions to ask about evidence Discussed summaries of real,
published evidence: Lacking or weak contrast Bias or confounding
Different setting From small or single study
Slide 21
HIV prevention in Botswana Remaining 1.5% annual HIV incidence
About 14,000 new cases per year Highest incidence in young women
Calculating impact of prevention investment Increased prevention
investment needed Current programmes not the answer
Slide 22
The Gizmo dashboard
Slide 23
What could you do in your constituency? MPs as exemplars,
champions Target poverty alleviation to young women Community
discussions of morality Sessions for school children Involve
traditional leaders Measure impact on new cases
Slide 24
Evaluation of sessions 20112012 Relevance of content4.254.5
Level of content4.154.3 Presentation4.24.0 (Mean scores out of
5)
Slide 25
Would it work elsewhere? Timing was right (AIDS Policy debate)
Champion (minister is ADAPT fellow) Botswana has functional
parliament Sought and incorporated perceived needs of the MPs
Content direct and relevant