Resumen
Este articulo analiza el proceso de interaccion entre el equipo de investigacion del Instituto de la Salud Juan Lazarte y el equipo de gestion del Seguro Publico de Salud (SPS) de la Provincia de Buenos Aires, Argentina, durante el diseño y desarrollo de la investigacion‚ Analisis de las Capacidades Institucionales y Evaluacion de Desempeño del SPS. Dada la existencia de distintos espacios de interaccion entre el equipo de gestion del SPS y el equipo de investigacion, su relacion es caracterizada como una aplicacion del Analisis del modelo de interaccion, desde una perspectiva transdiciplinaria. Este abordaje promueve interfases que permiten el desarrollo de procesos de negociacioin y colaboracion entre las comunidades cientificas y politicas. La aplicacion de este modelo de interaccion desencadeno cambios en el marco conceptual y metodologico, y sobre aspectos sustantivos del proceso de implementacion del Seguro Publico de Salud Materno Infantil.
Abstract
This article analyzes the process of interaction between the Instituto de la Salud Juan Lazarte research team and the Buenos Aires Public Health Insurance (PHI) management team during the design and development of the study titled PHI Institutional Capability Analysis and Performance Evaluation, currently underway. From a cross-disciplinary perspective, examining different
areas of interaction between the SPS management team and the research team, the relationship is characterized as an application of the interaction model. This approach promotes the construction of interfaces that allow the development of negotiation and collaboration between the scientific and political communities. Application of this model has produced changes in the
conceptual and methodological framework and in substantive issues during implementation of the SPSMI.
Resumen
A pesar del debate academico acerca de la utilizacion de los resultados de las investigaciones en el proceso de formacion de politicas publicas en salud, existe consenso sobre la relevancia del tema y la necesidad de analizar experiencias que ayuden a clarificar aspectos todavia confusos. Este articulo presenta la experiencia de trabajo conjunto entre investigadores academicos y tomadores de decision, politicos en salud del nivel regional y local. El estudio establecio las condiciones socioeconomicas, el ciclo empleo-desempleo y las caracteristicas del aseguramiento en salud de los trabajadores cesantes en el Area Metropolitana del Valle de Aburra (Antioquia, Colombia) en el año 2005. Con base en los resultados se elaboro una propuesta de intervencion que busca garantizar la sostenibilidad de su aseguramiento en salud y de sus familias. Se analizan las potencialidades y dificultades del proceso de interaccion y se discute la influencia que pueden tener los resultados de la investigacion en la formacion de politicas publicas en salud, como tambien las dificultades que impone la realidad concreta y el proceso politico para la implementacion de la innovacion propuesta.
Abstract
In recent decades there has been an important academic debate on how to transfer research-based knowledge to the health policy-making process. Despite an intensive controversy and various approaches to the problem, there is basic consensus concerning both the academic relevance and the usefulness of further evaluation of concrete experiences that allow conclusions and clarification of what are still confusing issues. The current article discusses a joint research experience by professors and local and regional health policy-makers. The research focused on the socioeconomic conditions, duration of the employment/unemployment cycle, and features of health insurance for workers that lost their jobs in the Greater Metropolitan Valle de Aburra Area (Antioquia, Colombia) in 2005, as the basis for a proposal to guarantee the maintenance of health insurance for these workers. The potentialities and difficulties of the interactive process are analyzed. The article is also intended to elucidate how scientific outcomes influence policymaking in health, as well as the difficulties imposed by concrete reality and the political process for implementing the innovative proposal.
Abstract
This paper discusses the experiences and conceptual and theoretical lessons learned during interaction between researchers, policy-makers, program beneficiaries, and other actors in a research project on social protection, health, and forced displacement in Bogotá, Colombia. The article begins by presenting the methodological approach and a description of interaction between various actors. This experience provides the basis for a conceptual discussion on the
factors and determinants of research use. The article also highlights the need for taking an epistemological view beyond the positivist and rationalist underpinnings of the dominant explanations concerning interaction between researchers and decision-makers.
Resumen
El objetivo de este ensayo es mostrar la experiencia, enseñanzas conceptuales y teóricas del proceso de interacción vivido entre investigadores, tomadores de
decisiones y otros actores en el marco del proyecto sobre protección social, salud y desplazamiento forzado en Bogotá, Colombia. Inicia con la presentación de los elementos centrales del enfoque de investigación-intervención, describe la interacción en el proyecto y muestra que el uso de las evidencias es un proceso que compromete a diversos actores. A partir de la experiencia, plantea una discusión conceptual sobre los factores y determinantes del uso de resultados. Muestra la necesidad de asumir una postura epistemológica sobre
la investigación y la formulación de políticas que supere las limitaciones de los enfoques positivistas, así como de los actores racionales, que hasta ahora han
dominado la explicación de la interacción entre investigadores y tomadores de decisiones.
Abstract
In developing a proposal for the study of the effect of user fees on access to preventive care, a team, comprising researchers and policy-makers, initiated interaction with key policy implementers in the Jamaica’s Ministry of Health to ensure that their perspectives were considered at the preliminary stage. There were many pressing events occupying the minds and energies of the implementers, but the team was able to capitalize on existing good relationships to capture attention. In the interviews that followed, agreement was reached on the necessity for the study, its focus and methodology. The process of consultation achieved notable successes and can be regarded as a model for successful research and policy interaction.
Resumo
Diante da proposta de cobrança aos usuários de atendimentos preventivos (defendida pelos implementadores de políticas-chave do Ministério da Saúde da Ja-maica), uma equipe de pesquisadores e formuladores de políticas apresentou um projeto de pesquisa visando a estudar os efeitos dessa cobrança de honorários pagos diretamente, e solicitaram ainda que os achados
do estudo fossem considerados nesta fase preliminar. Embora a agenda do Ministério da Saúde fosse permeada de muitas questões prementes, a equipe de pesquisa conseguiu potencializar as relações produtivas pre-existentes
e garantir espaço na agenda do Ministério da Saúde. As negociações levaram a um consenso sobre a necessidade do estudo, seu enfoque e metodologia. O
processo de consulta alcançou sucessos notáveis e pode ser considerado um modelo para a interação bem-sucedida entre pesquisa e política.
Abstract
This article analyzes the experience of the relationship between researchers and decision-makers in a study based on the hypothesis that this relationship would favor the incorporation of research results in health policy implementation. The attempt was made to identify elements that affect the relationship according to different policy and research phases, with an emphasis on the appropriation of the results by the decision-makers. It was shown that this research model per se does not guarantee the incorporation of the results, since variables related to the political/institutional context, the decision-makers’ profile, and the forms of relationship played a preponderant role in this case. In
research oriented towards decision-making, the use of the results depends on the decision-making timing, the capacity for dialogue, the policy’s institutionality, and the decision-makers’ place in the overall political context.
Resumo
O artigo analisa a experiência de relação entre investigadores e decisores em uma pesquisa que partiu da hipótese de que tal relação favoreceria a incorporação dos resultados da pesquisa na condução da política de saúde. Buscou-se identificar os elementos que interferem na relação segundo as diferentes fases da política e da pesquisa, com ênfase na apropriação dos resultados pelos decisores. Evidenciou-se que esse modelo de pesquisa não garante por si a incorporação dos resultados da investigação, porque variáveis relacionadas ao contexto político-institucional, ao perfil dos decisores e às
formas de relacionamento exerceram um papel preponderante nesse caso. Em pesquisas orientadas para a decisão, o uso dos resultados depende dos tempos do processo decisório, da capacidade de diálogo, da institucionalidade da política e da forma como os decisores se inserem no contexto político mais geral.
Abstract
This paper assesses the preliminary results of a research funding strategy that alters the structure and process of research by requiring interaction between researchers and policy-makers. The five research teams focused on different aspects of expanding social protection in health in Latin America and the Caribbean. Preliminary results revealed negotiation of the research questions
at the start of the process, influencing not only the project design, but the decision-makers’ ways of thinking about the problem as well. As the projects advanced, turnover among govern-ment officials on four of the teams impaired the process. However, for the one team that escaped re-composition, the interaction has led to use of data in decision-making, as well as a clear recognition by both parties that different kinds of evidence were at play. The process highlighted the importance of stimulating systems of learn-ing in which multiple kinds of knowledge interact. This interaction may be a more realistic
expectation of such initiatives than the original goal of “transferring” research knowledge to policy and practice.
Resumen
Este trabajo establece los resultados preliminares de una investigación sobre estrategia de financiamiento que altera la estructura y proceso de la misma, requiriendo la interacción entre los investigadores y los creadores de políticas. Los cinco equipos de investigación se centraron en diversos aspectos para la ampliación de la protección social en salud en Latinoamérica y Caribe. Los resultados preliminares revelaron la negociación de las preguntas de la investigación al comienzo del proceso, influenciando no solamente en el diseño el proyecto, sino también en las maneras de pensar de los tomadores de decisión acerca de la problemática planteada. A medida que los proyectos avanzaron, los cambios de responsables del gobierno en cuatro de los equipos deterioró el proceso. A pesar de ello, la interacción ha llevado – en el único equipo que logró escapar de la recomposición – al uso de datos en la toma de decisión, así como a un reconocimiento claro por ambas partes que diversos tipos de evidencia estaban en juego. El proceso destacó la importancia de estimular sistemas de aprendizaje en los que múltiples tipos de conocimiento interactúan. Esta interacción puede ser una expectativa más realista de este género de iniciativas que la meta original de la “transferencia” conocimiento desde la investigación a la política y su práctica.
Cinco miradas sobre la relación entre investigadores-decisores en una entrevista realizada a los investigadores principales de los proyectos de investigación que participaron de la Convocatoria Extensión de la Protección Social en Salud (OPS/IDRC).
Con el objetivo de caracterizar y analizar la interfaz entre investigadores y tomadores de decisión en el marco de los cinco proyectos que integran la convocatoria "Estrategias de Extensión de la Protección Social en Salud" (OPS/IDRC), el equipo de investigación del Instituto Lazarte de Rosario, Argentina, realizó una entrevista a los investigadores principales de dichos proyectos.
En la misma se indaga acerca de los siguientes tópicos:
1. El reconocimiento de actores:los investigadores y tomadores de decisión.
2. Caracterización de la relación entre las dos “comunidades”: percepciones, roles y espacios
3. Influencia de la interfaz investigación-toma de decisiones en el campo investigativo y en el proceso político
4. Mapeo de alcances: utilización, utilidad.
5. Logros, dificultades, debilidades y fortalezas de la interfaz investigadores-decisores
A continuación se presentan las entrevistas de los diferentes proyectos:
ENTREVISTA A ERNESTO BASCOLO- PROYECTO DE ARGENTINA (Formato pdf - 34 kb)>
ENTREVISTA A ANA LUISA D'AVILA VIANA - PROYECTO DE BRASIL (Formato pdf - 31 kb)
ENTREVISTA A ALVARO CARDONA - PROYECTO DE COLOMBIA MEDELLIN (Formato pdf - 37 kb)>
ENTREVISTA A WILMA BAILEY- PROYECTO DE JAMAICA (Formato pdf - 24 kb)
ENTREVISTA A AMPARO HERNANDEZ BELLO- PROYECTO DE COLOMBIA BOGOTA (Formato pdf - 151 kb)
El Equipo de Investigación del Instituto Lazarte y el Equipo de Cambio del Seguro Público de Salud de la Provincia de Buenos Aires, en el taller de discusión e intercambio realizado en la ciudad de Buenos Aires, 25 de julio de 2006.
Desde la perspectiva del investigador principal de este proyecto, Ernesto Báscolo, los espacios de encuentro y reflexión con los decisores "generaron condiciones generales para viabilizar el proyecto y para motivar al equipo de decisores a darle factibilidad y sentido a los resultados en función de sus propias necesidades. Sin embargo, creo que es demasiado ambicioso y lineal estar pensando que espacios concretos generaron utilización de resultados puntuales. Creo que el conjunto de estos distintos espacios fueron mejorando la calidad de la interfaz. Sirvieron como parte de una problematización general para revalorizar ciertas problemáticas como la de accesibilidad a los servicios, para revalorizar en nuestro proyecto la cuestión del vínculo entre distintos actores a nivel local (salud-desarrollo) y su importancia, pero no en términos concretos para tomar decisiones o seguir hacia un curso de acción o hacia el otro". (Entrevista sobre la Interfaz Investigación-Toma de decisiones. Agosto 2006).
Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action Shelley Bowen*, Anthony B. Zwi PLoS Med 2(7): e166. Volume 2 | Issue 7 | JULY 2005
The authors of this article propose that an “evidence-informed policy and practice pathway” can help both researchers and policy actors navigate the use of evidence. The pathway illustrates different types of evidence and their uses in health policymaking, and proposes that specific capacities, such as an individual's skills, experience, and participation in networks, influence the adoption and adaptation of evidence in practice.
Full-text article available at: http://dx.doi.org/10.1371/journal.pmed.0020166
“Interacción” y usos de la investigación en las políticas y programas de salud: funciona? - Anita Kothari, Stephen Birch and Cathy Charles - Volume 71, Issue 1, Pages 117-125, January 2005
The objective of this study was to assess if interaction between users and producers of research is associated with a greater level of adoption of research findings in the design and delivery of health care programs. Responses to the dissemination of a research report on breast cancer prevention were compared between two groups of public health units in Ontario, Canada. Although all public health units received the report, only a subset of units was involved in the development of the report, while others were not. Research utilisation was conceptualized in terms of stages, including reading the report, information processing, and application of findings for public health units’ policies and programs. Using a multi-case study design, three units that contributed to the report's production (the interacting units) were compared with three units were not involved in producing the report (the comparison units) on the basis of research utilisation. Data collection involved group interviews and document review. Results demonstrated that interacting units had a greater understanding of the report's analysis and attached greater value to the report. However, interaction was not associated with greater levels of utilisation in terms of application. Both interacting and comparison units used the research findings to confirm that their on-going program activities were consistent with the research findings, and to compare their program performance relative to other units. In conclusion, interaction influenced the understanding of the research, and intent to use the research findings, but applied use was independent of interaction between producers and users of research.
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"Assessing the impact of social science research:conceptual, methodological and practical issues"- Huw Davies, Sandra Nutley, Isabel Walter - Research Unit for Research Utilisation School of Management, University of St Andrews - May 2005
This paper lays out the reasons why it is necessary to examine the difference that research can make. It then explores different ways of approaching this problem, outlining the core issues and choices that arise when seeking to assess research impact. A wide range of key questions are raised in the paper, and consideration of these should help those wishing to develop work in this area.
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La interacción entre investigación y toma de decisiones implica el desafío de generar una relación dinámica entre ‘comunidades’ con lógicas diferenciales que permita construir puentes entre la investigación, la política y la práctica.
En tanto la conformación de ‘Alianzas’ entre investigadores y decisores es un componente transversal de los cinco estudios participantes en esta Convocatoria y la ‘Transferenica de Conocimiento’ un área que cuenta con escasa investigación empírica en contextos específicos, este espacio pretende promover el intercambio de experiencias y reflexiones generados por los distintos equipos acerca de los siguientes tópicos:
¿Cómo generar conocimiento basado en las necesidades de los usuarios?
¿Qué estrategias son más eficaces para transferir y diseminar los conocimientos en los distintos momentos del proceso de investigación?
¿Cómo construir capacidades en los decisores para hacer uso de los insumos y productos de la investigación?
¿Cómo hacer factible la aplicación del conocimiento en contextos específicos?
Interaction between research and policy involves the challenge of the construction of a dynamic relationship between communities with different logics that may build bridges linking Research, Policy and Practice.
As the conformation of ‘Alliances’ is a cross cutting component present in all the studies in this Initiative and an area that has very little empirical research in specific contexts, this section pretends to promote the interchange of experiences and reflections generated by the different research teams about the following topics:
How is it possible to generate knowledge based on user needs?
Which ‘push strategies’ are more effective to transfer and disseminate knowledge throughout the research process?
Which ‘pull strategies’ are more efficient to build capacity for its uptake among decision-makers?
How can the knowledge produced during the research cycle be applied in specific contexts?
"Ethical Guidelines for Managing Conflicts of Interest in Health Services Research" - Academy Health Report - December 2004
Summary: The primary interest of health services researchers is to generate and disseminate valid and reliable research that informs policy and practice and to ensure integrity in the process. A conflict of interest occurs when secondary interests—such as teaching, administration, political advocacy, or financial or avocational pursuits—distort the integrity of judgments regarding the primary interest. AcademyHealth convened an Ethical Guidelines Committee comprising individuals reflecting a range of organizations and disciplines to provide practical guidance to individuals and organizations who struggle with the potential for conflicts of interest in health services research and health policy analysis.
Disponible en /Available atwww.academyhealth.org/ethics/introduction.htm
"Convergent evolution:The academic and policy roots of collaborative research" Editorial. Journal Health Services Research and Policy, Vol 8 Suppl 2. October 2003
In the editorial the authors argue that the current popularity of collaborative research is a convergence between emerging forces and traditions within academia and changing rules and norms within policy and management, particularly the public management of health and social policy. First, they discuss briefly the converging streams of academic work behind collaborative research. Then they describe how the field of policy-making and management, through a commitment to evidence-based decision-making, has developed an interest in collaboration with researchers to produce knowledge. Then they position the papers in this supplement: three introductory case studies from the perspective of the collaborating investigators; three articles that evaluate, from the perspective of the research funding agency, the impact of grant programmes that encourage collaborative research; two papers analysing the impact of collaboration on research domains; and, finally, a review of lessons for
collaborative research from outside health care. Finally, they extract a few lessons that emerge from the collection of papers.
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"Diffusion and Innovations in Service Organizations: Systematic Review and Recommendations" - Trisha Greenhalgh, Glenn Robert et al. - The Milbank Quarterly, Vol.82, No 4, 2004 (pp.581-629)
The article summarizes an extensive literature review addressing the questions, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses 1) a parsimoniousus and evidence-based model for considering the diffusion of innovations in health service organizations, 2) clear knowledge gaps where further research should be focused, and 3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
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"Knowledge translation in health and development. Research to Policy Strategies" International Development Research Centre (IDRC),Coalition for Global Health Research Canada, Institute of Population Health, University of Ottawa. October 2003
There are three notable models that include one or more elements of knowledge
translation: Research utilization model in policy (Hanney, 2003), Knowledge Transfer (Lavis et al., 2003) and Ottawa Model of Research Use (OMRU) (Logan and Graham,1998). The OMRU framework provides a way to organise the potential challenges or barriers to research use and the recommendations for overcoming those barriers. One of the principle recommendations for overcoming the barriers to the use of research by policy makers is to create networks. Networks work to facilitate knowledge sharing, creation and dissemination, build relationships to link and involve researchers and policy makers in the research and policy process and train people in research and policy making skills, as well as knowledge translation skills.
This review showed that a number of networks in both industrialised and Low and Middle Income Countries (LMICs), are active in developing and applying innovations that have important KT potential. However, there are few examples of knowledge translation activities linking researchers and research users to work together in priority setting and research planning. The interviews support the great potential for KT and identify a number of key issues critical
to the success of an initiative focussing upon LMICs.