Webinar Explores Debates and Issues around Standards of Evidence for Reproductive Health Decision-making
More than 150 researchers, practitioners, and policymakers from over 30 countries participated in a timely webinar entitled, “Standards for Identifying Evidence-based Practices in Reproductive Health,” on July 30, 2015, co-organized by the Evidence Project, STEP UP Consortium, the High Impact Practices (HIP) Initiative, and the Alliance for Health Policy and Systems Research. The webinar was the second in a series hosted by WHO/IBP, UNFPA, USAID and the IBP HIPs Task Team on maximizing family planning investments through evidence-based programming.
Dr. Karen Hardee, Director of the Evidence Project and the webinar’s moderator, introduced the session noting that different program and policy decisions need different kinds of evidence, and that the three presenters would respectively discuss intervention impact and effectiveness, implementation research, and the role of evidence and other factors in decision-making.
Dr. Ian Askew, Director of Reproductive Health Services and Research and co-director of the STEP UP Programme, Population Council, spoke about research designs, the types of evidence they generate, and their value and limitations. While randomized control trials (RCTs) are the gold standard for deciding if a clinical intervention works, Dr. Askew advocated that decision-makers accept and support non-randomized yet rigorous quasi-experimental designs for determining effectiveness of service delivery programs. He also argued that groups that synthesize bodies of evidence, like WHO and Cochrane, should include studies with quasi-experimental designs because they can be as rigorous as RCTs and have the advantage of offering lessons about the real world context within which the intervention was tested.
The topic of implementation research was addressed by Dr. Nhan Tran, Manager, Implementation Research Platform, Alliance for Health Policy and Systems Research, WHO. Dr. Tran emphasized that implementing a new service or program is about change, and change is a process, not a one-time event. Change occurs through learning and research – in this case implementation research – that informs how health systems perform and how they integrate new practices. It should be a continual and iterative process that generates insights and understanding so stakeholders can make better, informed choices.
Dr. Patrick Aboagye, Director, Family Health Division, Ghana Health Service, highlighted the questions policymakers need answers to before they can make evidence-based decisions. These include: “What is the source and weight of the evidence?” “Is the intervention affordable and scalable?” “Are the study’s recommendations politically, socially and culturally acceptable?” The last question, in particular, reveals that while evidence is important, policymakers have other concerns that factor into their decisions.
A key point that cut across the three presentations was the need for more research linked with implementation. “Donors and policymakers need to be aware of the importance of funding to do robust evaluations to prove intervention effectiveness and for implementation research when scaling up or adopting a new practice,” said Dr. Hardee.