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We conclude that due to the contextual realities of the study countries, there is need for greater focus on policy implementation than on developing additional policies.


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Government institutions should play a central role in all stages of the policy process, and should ensure implementation of defined policies. Strong mechanisms, including financing, that strengthen the position and role of government in policy coordination and the oversight of the policy process will help increase efficient and impactful implementation of research and innovation for health policies.

The important roles played by research and innovation in health delivery cannot be over-emphasised. Policies are put in place to provide a framework for attainment of multiple and often competing socio-economic objectives. According to the research system for health framework [ 2 ] of the Council on Health Research for Development COHRED , policies, priorities, and management make up three critical pillars of a research and innovation system. A number of authors agree that without good policies it will be difficult to provide guidance to any research and innovation system [ 3 - 5 ].

There is increasing academic, policy, and practice interest in how to attain such effective policy implementation [ 6 ]. Seeking to understand implementation of research and innovation for health policies requires an attempt to delineate and discuss what national research for health systems are. This helps to clarify important aspects of health policy implementation such as the scope of health, the individual and institutional stakeholders involved, the resources being allocated to the task, and the impact being made by policy implementation [ 4 ].

A policy defines a vision for the future, establishes targets and points of reference for the short and medium term, outlines priorities and the expected roles of different groups, and builds consensus and informs people [ 7 ]. This paper reports on a study that reviewed existing policies supporting research and innovation systems for health in Mozambique, Senegal, and Tanzania. Further, the rationales for the inclusion of these countries in the R4HA programme are also appropriate bases for inclusion in this study.

These were to include a diversity of experience and context through including a good spread of countries with different research for health systems influenced through their respective colonial histories , and ensuring a good geographic spread by selecting countries with membership of three different Regional Economic Communities. In this study, innovation is defined broadly as the creation and use of new, better, more effective, and more acceptable products, technologies, processes, and ideas [ 8 ]. Innovation systems require deliberate development and embedding within country-specific institutional and technological contexts [ 11 , 12 ].

The WHO framework for health research systems acknowledges that health research systems overlap with health systems and other research systems to varying extents depending on the context [ 14 ]. Policy implementation can be considered as the process of carrying out a government decision [ 6 ]. In defining policy implementation, many scholars have found it useful to make the conceptual distinction between the policy implementation process and policy outcomes, even though these are interactive in practice [ 15 ].

The implementation process involves action on behalf of the policy, whereas policy outcomes refer to the ultimate effect on the policy problem. Implementation is an iterative process in which ideas, expressed as policy, are transformed into behaviour, expressed as social action [ 6 ]. The social action transformed from the policy is typically aimed at social betterment and most frequently manifests as programmes, procedures, regulations, or practices. Implementation has long been recognised as a distinct stage in the policy process, unique for representing the transformation of a policy idea or expectation to action aimed at remedying social problems [ 15 ].

Reflecting a process involving change over time, implementation is characterised by the actions of multiple levels of agencies, institutions, organisations, and their actors and is influenced by context throughout. Understanding the policy implementation process is important in part because many social programmes are publicly funded, and they are initiated and influenced by public policy.

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Assessing policy or programme implementation is also important for informing on-going decision making and exploring the extent of achievement of targets as well as how things can be done differently in more effective and impactful ways. There is a growing body of evidence on developing country research for health systems in general and African research for health systems in particular. For empirical insights in Africa see, for example, Kalua et al.

They divert from the conceptual model of a linear process where evidence is generated, findings are made available, and eventually decisions are influenced. In reality, the process of evidence translation into decision-making within government or other institutions is rather more complex [ 5 ].

However, with a few exceptions, such as that of Mugabe [ 3 ], the majority of the studies and documents focus on the policymaking process itself. They study how policymaking is influenced by such a non-linear process characterised by negotiations among multiple actors, with their impact on knowledge uptake.


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  • This paper focuses specifically on the implementation of research and innovation for health policies unpacking, among others, the role of national and institutional contextual factors, policy content, and approaches. It does not seek to judge the content of the policies or propose alternative ones, but rather focuses on the process and context of successful policy implementation.

    We used both qualitative and quantitative methods to generate insight on policy availability and implementation and reviewed documents and reports. We gathered stakeholder insights, perceptions, and awareness of barriers to and facilitators of policy implementation through questionnaire-led interviews. Thematic analysis guided by themes emerging from the findings was employed for interrogating and analysing the data [ 23 ]. Between April and July , a total of 34 questionnaires were emailed to the R4HA programme partners and other stakeholders who were not only a convenient sample, but are strategic and key actors in the health arena in the study countries.

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    These are people who are either tasked with policy implementation or directly affected by such implementation. The mix of interviewees enabled views of different aspects of the policy process to be received. The successful uptake or implementation of policies was based, rather than on key indicators, upon the perceptions and subjective experiences of this group of interviewees. Twenty-one respondents acknowledged receipt of the study questionnaire and expressed willingness to participate in the study.

    Finally, 16 respondents took part in the study, with 9 self-completing the questionnaire, while telephone or Skype interviews guided by the questionnaire were held with 7 respondents. The literature search resulted in a number of key documents on research for health and innovation in the three countries.

    A variety of policies and strategies were identified in areas such as industry, higher education, science, technology and innovation, and information and communications technology, all of which can have an impact on health. The table also lists the national constitutions, which have a provision for the right to health, though the extent to which health is covered varies per country.

    Reasons given include lack of adequate financial and human resource support; the reactive nature in which activities are implemented; limited attention to evaluation of the systems; information overload and asymmetries; and problems with managing overlaps and how to move from silos to systems. One respondent from Mozambique summed it up as:. While some respondents felt the implementation problem was a result of poor policies and strategies being crafted in the first place, the general argument appears to be that, if there is adequate preparedness and facilitation to implement, better outcomes can be obtained.


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    • Better implementation of policies is more likely to have a bigger impact on other components of the process which as one respondent from Tanzania remarked:. Policy adoption was also rated as receiving a fair amount of attention. On the other hand, policy evaluation, like policy implementation, was said to be poor for reasons including lack of dedicated resources for policy evaluation and limited direct usage of results from evaluation activities.

      Half of the respondents identified this state of affairs as problematic, stating that accountability and transparency trustworthiness, openness, and confidence in the systems accruing from evaluation were significantly important for all stages of the policy process, including having the potential to stimulate better policy implementation. Meanwhile, the source of the resources for the different stages of the policy process was said to have a major bearing on the extent to which the policies got implemented. In Mozambique, resources from the government and other local sources were said to be more effective in implementation of long-term capacity building for both their health sector strategic plan and the science, technology, and innovation strategy than external donor resources.

      Contextual realities are important for policy implementation efforts.

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      The contextual issues relating to the policy process have at best remained the same, but in most cases, they have worsened. Stakeholder engagement and political leadership in policy processes is said to have improved over the last few years in all three countries, but as respondents from Senegal and Tanzania noted, this has not necessarily resulted in increased budget allocations.

      Policy coherence synergy and mutual reinforcement between policies was said to have decreased over the same period. Stakeholder involvement in policymaking processes has increased. This is particularly true for the policy development stage, where across the three countries, government departments, external donors, academic institutions, civil society organisations, and even private companies appear to play active roles.

      The number of actors was said to decrease at stages such as financing, implementation, and evaluation of policies. Coordination and ensuring an even spread of players along the policy process were said to be weak, leading to incoherencies and dissipation of resources. While different organisations and people, including consultants, were said to play roles in coordination of implementation of policies, there was consensus that governments should be central in this so that alignment to overall national development goals can be ensured.

      According to one respondent from a government agency in Senegal:. In addition to strengthening of government policy oversight capacity, governments are also said to be in need of stakeholder support that is consistent and long-term. Openness and Transparency - Timely sharing of lessons learned and results - whether the project achieved its expected results or not - informs other initiatives and will help to drive the diffusion and scaling of innovation initiatives system-wide.

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      In this regard, we are committed to be open and transparent in all that we do so that others can benefit from our successes and leverage the lessons that we are learning along the way. Primarily grants and contributions policies and programs and other government initiatives that may benefit from IIU interventions.

      Initiatives involving departments and agencies interested in co-creation efforts with other departments and external organizations such as other levels of government, the private sector, social enterprises, non-profit organizations, and Canadian citizens. You will not receive a reply. Skip to main content Skip to "About government". Introduction Our Vision Transforming the design and delivery of government policies, programs and services for greater and more sustainable impact on the lives of Canadians.

      The Context: Challenges Addressing persistent, complex and pressing policy issues in new ways: Conventional approaches to addressing challenging public policy issues have not always achieved the results expected. Growing sentiment in Canada and worldwide that governments can and should produce better and more lasting outcomes for citizens. Governments have an imperfect understanding of the full impact of its spending on achieving results.

      Changing citizen expectations of government with a desire to be more engaged and effective: There is a growing call by stakeholders from across all sectors for government to evolve from its traditional role of funder to that of an engaged partner and collaborator. Integrating new tools and technologies for public benefit: There are new tools and technologies emerging that can improve problem analyses, more effectively support collaboration, assess investment opportunities and spending decisions, and improve the productivity of the public service hence improving the quality of service to Canadians.

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      These tools have been underutilized to date. The Context: Opportunities Global advances in public policy innovation and outcomes-based policy approaches: A number of countries have put in place mechanisms e. Growing interest across all levels of government in outcomes-oriented approaches and strengthening evidence-based decision making: At federal level, the IIU is one of a number of players that is advancing and supporting experimentation, more rigorous approaches to evaluation, and examining barriers to the implementation of innovation and outcomes-based policy approaches.

      Opportunities identified in budget announcements, mandate letters, and other stated priorities in support of innovation and experimentation: Departments and agencies must devote a fixed percentage of program funds to experimenting with new. The Minister of Indigenous Services is mandated to work with the IIU and across government to co-create new and meaningful partnership models with Indigenous communities and civil society partners.

      What is a Theory of Change? Image credit: Sidney Harris. Theory of Change Overview Changing the way government designs and delivers policies, programs and services. Our Approach to Realizing Change The IIU's Theory of Change combines four major efforts to help the federal public service develop, use and learn from outcomes-based policy approaches: Engaging public service leadership and supporting the development of competent, knowledgeable and motivated public servants will help grow the design and delivery of outcomes-based policy approaches and other relevant innovations.

      Showcasing excellence in co-creation design approaches and collaborative implementation will help grow and direct interest in outcomes-based policy approaches as well as encourage replication and scaling of successful initiatives. Additionally, the program holds a range of research workshops and seminars and invites eminent researchers and practitioners, current policy administrators, politicians, and corporate representatives, among others.

      In the first year, students are required to undertake course work and earn a minimum of 17 credits from the courses and seminars. In the second year, students are expected to pass the Qualifying Examination QE. After completing QE, students can start writing a dissertation to complete it by the end of the third year.