Researchers, knowledge brokers and policy makers urged to bridge the evidence, policy and practice gap
The first-ever National Symposium on Evidence Synthesis for Medicine, Public Health and Social Development (NSES 2019) organised by The George Institute for Global Health, India and the Campbell Collaboration in the Capital concluded on Friday with a clarion call to young researchers, knowledge brokers and policy-makers to work together to usher in the evidence revolution and ensure that the fields of public health, medicine and social development are informed by good science.
Delivering the key note address on “Synthesising and Contextualising Evidence for Medicine and Public Health in India: Need and Way Forward”; Prof Prathap Tharyan, Director, Prof B.V.Moses Centre for Research and Training in Evidence informed Health Care and Health Policy at the Christian Medical College, Vellore said evidence informed health policy requires investments and partnerships between those who generate the evidence, those who disseminate it, those who frame policies and those who implement them. Every policy decision, he said, should have an evidence footprint.
The two-day symposium brought together close to 120 practitioners, policymakers and researchers from 12 States to share and learn the various evidence synthesis methods and its applications across medicine, public health and social development. It included keynote lectures on the power of evidence synthesis for informing or medicine, public health and social development in India. The two day event also saw organised symposia and panel discussions on evidence synthesis in social development, clinical practice guidelines, evidence-informed policy and evidence-informed journalism.
A key highlight of the symposium was oral and poster presentations on evidence synthesis research on various topics of medicine, public health, social and economic development. Over 94 abstracts were received from researchers across the country and 34 chosen presentations were presented in the sessions spread over two days.
The symposium was supported by a several academic partners that include READ-It, Health Systems Global, The Global Evidence Synthesis Initiative (GESI), Independent Council for Road Safety International (ICORSI), Prof B.V.Moses Centre for Evidence-informed Healthcare and Health Policy, CMC Vellore and The Transportation Research and Injury Prevention Programme (TRIPP) at IIT-Delhi.
The session on clinical practised guidelines the NSES 2019 showed the poor quality of Indian guidelines for cardiovascular diseases , obstetrics/gynaecological conditions and a few other conditions (using AGREE II – a tool to assess quality of guidelines which is also used by WHO in their own guideline development process).). Common reasons for low quality of guidelines included, those being not evidence based but opinions, poor focus on implementation of guidelines and opacity and issues around conflicts of interests and funding. Dr Soumyadeep Bhaumik, of The George Institute for Global Health, India presented research that found academic elitism, poor understanding of methodologies for guideline development and what are the implications of conflicts of interests were the reasons behind the poor quality. The lack of use of cost-effectiveness to inform guideline recommendations was also brought into light by Prof, Luke Vale of NewCastle University, UK.
In a resource limited country, adapting existing high quality guidelines to the local context might be the way forward, particularly when there is lack of high quality local evidence. “Adaptation of guidelines also saves resources that are required for de novo development of guidelines, and makes the guidelines available for informing practice” said, Dr Abdul Salam, The George Institute for Global Health, India.
One of the highlights of the two-day symposium was a discussion on evidence-based journalism. Researchers are pushed to communicate their work, and journalists are often gatekeepers of the research that finds its way into the public realm. Each side faces a slew of challenges, but with a growing disconnect between what the evidence presents, and what the news media eventually offers in a story. One reason for this could be because researchers and journalists do not often define ‘evidence’ in the same way. There are two errors in journalism -- publishing stories without enough evidence and not publishing stories which have enough evidence, said Mr. Sukumar Muralidharan, Associate Professor, Research at the Jindal School of Journalism and Communications, who chaired the panel discussion.
Barriers such as the lack of time or knowledge about how to interpret the relevance of research questions, the significance and application of findings, or the quality of analyses, remain a larger question for journalists working on deadlines. Conversely, researchers must strip away the density of their data stories, and communicate their results simply and clearly to further an understanding of the relevance of their work. Panelists said researchers and Journalists clearly need to talk more, to bridge the gap in evidence-based journalism.
Another session on evidence-based policy chaired by the Health Secretary, Kerala, Rajiv Sadanandan, said policy-makers are often pressurized by lobbies that distort the available evidence and therefore, they must be cautious when weighing the available evidence. In certain cases, there is lack of good evidence and often times there is a pressure to take decisions quickly without waiting for the complete evidence to emerge. Panelists said that conflict of interest often works against applying the right decisions to policy-making and often when we consider equity and the good of all, the way we generate evidence is as important as evidence itself.
Talking about the history and journey of the evidence synthesis movement, Dr Howard White, Chief Executive Officer, Campbell Collaboration said the ‘last thirty years have seen an evidence revolution which has unfolded in fours waves: (1) the results agenda as part of New Public Management in the 1990s, (2) the rise of impact evaluations, notably randomized controlled trials (RCTs) since the early 2000s, (3) increased production of systematic reviews over the last ten years, and (4) moves to institutionalize use of evidence through the emergence of knowledge brokering agencies, most notably the What Works movement in the United States and the United Kingdom.
Prof Prathap Tharyan, Director, Prof B.V.Moses Centre for Research and Training in Evidence informed Health Care and Health Policy at the Christian Medical College, Vellore, who delivered the key note address on Thursday on “Synthesising and Contextualising Evidence for Medicine and Public Health in India: Need and Way Forward” said evidence informed health policy requires investments and partnerships between those who generate the evidence, those who disseminate it, those who frame policies and those who implement them. Every policy decision, he said, should have an evidence footprint.
Tracing the history of the Cochrane collaboration in India, Prof Tharyan said it was during the Asian tsunami of 2004 that the first organised attempt to use evidence synthesis in terms of what works in the area of post-traumatic stress disorders was made. “We have come a long way since then. But we still need young people to champion the evidence revolution and I am glad that this symposium has attracted a lot of young researchers who are interested in evidence synthesis.”
Dr Anju Sinha, Deputy Director General, ICMR, said evidence synthesis was critical in influencing policy and practice and can move us closer towards universal health coverage and sustainable development goals.
The symposium witnessed participants tracing the science of evidence syntheses which has rapidly evolved in the last decade and now inculcates a host of methodologies like systematic reviews, rapid reviews and evidence gap-maps with an increasing focus on knowledge translation supporting government guidelines in the larger scheme of things. There was a focus on systematic reviews which are a rigorous evidence syntheses product that comprehensively captures all relevant evidence but their robust conduct is resource intensive.
Attention was also drawn to rapid reviews, which, are more tactical in nature to support evidence-informed policy and systems decision-making within the pragmatic constraints of resources. Newer methodologies like evidence gap maps present the spectrum of evidence available on a given topic thus identifying gaps in research and prevent research waste.
The symposium concluded with the organisers the Campbell Collaboration – committing themselves to setting up an India network of evidence synthesis stakeholders. The George Institute committed to build national capacity in methodologies aimed at strengthening the evidence synthesis and rapid reviews. Together the host- institutions reiterated their commitment to usher in the evidence informed movement in India in broader domains of medicine, public health and social development with a bid to contribute to the achievement of sustainable development goals.