Fostering access to and use of contextualised knowledge to support health policy-making: Lessons from the Policy Information Platform in Nigeria

Background: Contextualising evidence to inform policy-making is increasingly recognised as key to developing and implementing effective health policies. Creating a one-stop shop for evidence is an approach that can facilitate timely access to the best evidence to inform policy decisions. We report outcomes after implementation of the Policy Information Platform (PIP), a pilot one-stop evidence repository in Nigeria designed to alleviate barriers to accessing policy-relevant knowledge. Methods: This cross-sectional study involved five phases, namely (1) consultation with Nigerian policy-makers to identify priority policy issues, areas of health policy information needs, and challenges and capacity constraints in accessing evidence for policy-making; (2) a stakeholder engagement workshop to formally launch the PIP; (3) extraction of data and other information from scientific articles, policy briefs, evaluation reports, grey literature and health policy documents relevant to policy-making in Nigeria (identified by Google and PubMed searches and by examination of websites of relevant Nigerian government ministries, agencies and parastatals), for use in developing the PIP website; (4) promotion of the PIP in national and state health policy meetings; and (5) evaluation of the PIP using a stakeholder survey questionnaire distributed via email and critical appraisal of the grey literature included in the PIP using the authority, accuracy, coverage, objectivity, date and significance (AACODS) checklist. Results: Priority policy areas identified by policy-makers were disease control and prevention, population health issues and health administration. Challenges identified by policy-makers were a lack of adequate capacity to access policy-relevant evidence and transform the evidence into policy. Policy-makers suggested using systematic reviews, policy briefs and rapid response mechanisms and involving policy-makers in research as ways of increasing evidence uptake for policy. A total of 126 policy-relevant, peer-reviewed scientific articles, 85 health policy documents and 201 policy-relevant grey literature documents were selected for inclusion in the PIP. Of the 195 individuals contacted via email to evaluate the PIP, 31 (15.9%) provided a response. Respondents noted that the PIP facilitated access to information based on local evidence and context-sensitive data. Barriers identified included lack of knowledge about the PIP and limited capacity of end-users to use the data compiled in the platform. Conclusion: An easily accessible one-stop shop of policy-relevant evidence can considerably improve policy-makers’ access to evidence for use in policy-making and practice. This cross-sectional study involved five phases in developing the PIP, as follows: (1) consultation with policy-makers and identification of priority policy issues; (2) a stakeholder engagement workshop, with formal launch of the PIP; (3) extraction of data from policy-relevant publications and development of the PIP website; (4) promotion of the PIP website; and (5) evaluation of the PIP. The PIP was planned to represent a decision-making resource and an actionable repository of knowledge, with its content designed to address key priorities identified at the national level in Nigeria. To determine the priority health policy issues to be showcased within the platform, we engaged with key policy-makers representing various areas of the health sector in Nigeria (Tables 1 and 2). These policy-makers were interviewed during face-to-face discussions or by telephone. We asked them to identify key priorities in the health policy-making process within both the government and the health sector in Nigeria, for which policy-relevant information was needed. Phases of development of the Policy Information Platform (PIP) in Nigeria Key Nigerian policy-makers consulted to identify priority health policy issues that should be addressed by the Policy Information Platform A 1-day stakeholder engagement event was convened in September 2015 at Abakaliki, Nigeria, during which the PIP was formally launched. The purposes of the meeting were to bring together policy-makers, researchers and other stakeholders in the health sector policy-making process (including health practitioners, civil society organisations and media practitioners), to formally present the PIP Nigeria, including the website, and to elicit insights on the implementation and effectiveness of the platform to support health policy-making. A structured questionnaire (Additional file 1) was administered to participants to assess (1) their health policy-relevant information needs; (2) the challenges and capacity constraints they experienced in accessing evidence; (3) the ways in which they utilised evidence in policy-making; and (4) their suggestions of ways and formats in which policy-relevant information could be made easily available and accessible through the PIP. The potential content of the PIP was classified into five main categories, namely (1) scientific articles, (2) policy briefs, (3) evaluation reports, (4) grey literature and (5) health policy documents. A description of the process for extracting data and other information from these publication types is provided below. Scientific publications reporting research done in Nigeria related to policy-making in the field of maternal, newborn and child health (MNCH) were sought. The emphasis on MNCH was a recommendation arising from the stakeholder engagement event. A PubMed search of the MEDLINE database was performed in August 2015, and studies published in English that investigated MNCH in Nigeria in relation to health policy were identified. To be included as scientific articles, these publications had to be original studies and had to contain policy recommendations. Eligible studies were retrieved and indexed in the PIP, with links to the full articles in PubMed. For the purpose of the PIP, a policy brief was defined as a policy document that clarifies a health policy problem, renders the evidence for addressing the problem concise and understandable, explains why the evidence is important, describes evidence-informed policy options that would be suitable actions for policy-makers to take, and provides key implementation considerations [33–35]. A Google search was performed in August 2015 with the keywords ‘policy brief’, ‘health’ and ‘Nigeria’, yielding a total of 313 entries, of which 46 policy briefs were selected. Each selected document fulfilled the following inclusion criteria: (1) must be a policy brief that meets the definition given above, (2) must focus on Nigeria, (3) must focus on the health of the population, and (4) must highlight recommendations relevant to health policy-making. For the purpose of the PIP, an evaluation report was defined as a document that reports a systematic assessment of a health activity, project, programme, policy or institutional performance and that provides evidence-based information relevant to the decision-making processes, to allow an understanding of achievements or the lack thereof [36]. To identify evaluation reports, another Google search was performed in August 2015, with keywords such as ‘evaluation reports’, ‘health policy’ and ‘Nigeria’; this search yielded 363 entries, of which 23 were selected. The selected documents fulfilled the following criteria: (1) must be an evaluation report meeting the definition given above, (2) must focus on Nigeria, (3) must focus on the health of the population, and (4) must highlight recommendations relevant to health policy-making. For the purposes of the PIP, the grey literature was defined as documents produced by all levels of government, academics, business and industry, in print or electronic formats, but not controlled by commercial publishers [19, 21]. The websites of more than 30 health-related organisations were searched for policy-relevant grey literature in August 2015. The websites were hosted by organisations such as the Nigerian health-related government ministries, departments and agencies, non-governmental organisations (NGOs), civil society organisations, and health and professional associations. The materials obtained included policy documents, statistical publications, newsletters, bulletins, fact sheets, working papers, technical reports, conference proceedings, dissertations and multimedia content. The criteria used for the selection were as follows: (1) must be a grey literature document that fulfils the definition provided above, (2) must focus on Nigeria, (3) must focus on health of the population, and (4) must be relevant to health policy-making. Each document from the grey literature was critically appraised using a modified version of the Authority, Accuracy, Coverage, Objectivity, Date and Significance (AACODS) checklist [37] (Additional file 2). This tool considers the following criteria: (1) Authority: Is the document from a reputable organisation or individual author from a reputable organisation? (2) Accuracy: What are the aims of the document? Has it been peer-reviewed or edited? Is the basis for the document clear? Is the document well structured? (3) Coverage: Are any limits clearly stated? (4) Objectivity: Does the work seem to be balanced in presentation? (5) Date: Is the date of the document given? (6) Significance: In the researcher’s estimation, will the document be of interest? The AACODS checklist has been modified by the National Institute for Clinical and Health Excellence (NICE, United Kingdom) and included among that organisation’s checklists for evidence evaluation [38]. We further refined the tool to include grading and a cut-off threshold of three points for inclusion or exclusion from the PIP. Notably, in this study, the modified AACODS checklist was used as a decision-making tool for inclusion or exclusion of grey documentation, but not to provide a scientific quality appraisal per se (e.g. low, moderate or high quality). Of 393 documents assessed, 201 (51.1%) met the threshold for inclusion. We searched for relevant policy documents at the websites of all Nigerian federal ministries that deal, directly or indirectly, with health, including Health and Social Services, Women Affairs and Social Development, Water Resources and Rural Development, Science and Technology, Finance and Economic Development, Environment, Education and Youth Development, and Agriculture and Natural Resources. We also searched the websites of all agencies and parastatals under the Ministry of Health, including the National Health Insurance Scheme and the National Primary Health Care Development Agency. A total of 85 health policy documents were identified and included in the PIP. A presentation about the PIP was made at one national and two state health policy meetings. The national meeting was a stakeholder engagement event on MNCH organised by the West African Health Organization and held in October 2015 in Abuja; 92 participants were in attendance. The two state meetings took place at Ebonyi State University in Ebonyi State, Nigeria, with 32 participants in the November 2015 event and 35 in the April 2016 meeting. Attendees at all three meetings included policy-makers, researchers and other stakeholders. The engagement process involved interaction between policy-makers and researchers on issues related to the research-to-policy interface and the establishment of formal mechanisms for continuous partnership. The PIP was introduced to the participants as a platform that would continue to provide policy-relevant information; contact information was provided so that users could request additional relevant information to address future policy-making needs. To assess the impact of the PIP among stakeholders who had been informed about its existence, we conducted an evaluation survey via email 6 months after the PIP was established. For this survey, 195 individuals were contacted via email. These contacts included individuals who had participated in the national and state meetings where presentations about the PIP had been made. The following questions were posed in the email survey: The written responses to the evaluation survey were analysed according to Giorgi’s phenomenological approach [39, 40]. Qualitative data analysis was conducted by assessing narratives and textual information, identifying all comments that appeared significant, abstracting units of meaning, categorising and summarising the abstractions, and returning to the extracted text to ensure a good fit.