Editorial by Azmal Hossain (MD)
In today’s public health doctrine and as far as knowledge transfer is concerned, we tend to focus on scientific knowledge. We are mainly trying to learn from research conducted in artificial contexts. We call these research findings ‘scientific’ because they follow some predefined rules, regulations and research ethics.
Bangladesh, like many other so called resource-poor countries, is fertile land for research and civil society. It has become a big laboratory for not only public health researchers but also for all other civil society activities. So, there is a lot of research happening but unfortunately, in many cases the findings are not applied in the field. The obvious question is: why? Is it because the policy makers are reluctant to apply them? Are the policy makers beyond our reach? Are they too conservative? Are they driven by their political agenda only? I will simply say ‘No’. This is happening because researchers often care more about their research career than about using their research as an advocacy tool for policy change. Researchers’ duties do not end with the publication of their research; rather along with many things they need to bring their evidence to the policy makers’ table and make it happen in practice. They need to frame their findings in a way that policy makers find them relevant and easy to align with their own political agenda. That is one of the short-cuts to push the research as a means of knowledge translation.
Now, let us have a closer look at the political and policy context inBangladesh. After the country became independent (in 1971), it did not have a coherent health policy for three decades. In the absence of a formal health policy, all health related planning and programming were guided by the health sector components of successive Five Year Plans. The first National Health Policy of Bangladesh was approved by the Parliament in 2000. The second policy (formulated in 2008) is still to be enacted although it was approved by the cabinet of ministries in 2011. In 2011 a third health sector strategy called “Health, Population and Nutrition Sector Development Program” (HPNSDP) was formulated.
So did this HPNSDP strategy come about? Was it formulated only by the clinicians in the ministry of health? No, many actors and sectors including the donors and/or development agencies were responsible for developing this policy. In the technical committee responsible for drafting this HPNSDP strategy, apart from the representatives from the ministry, there were people from WHO, World Bank, DFID, USAID,… In a country where more than 60% budget of this strategy implementation is coming from development partners, how could it be that only the political view of the government would be reflected in the policy?
On the contrary, I would be happy to see that all the political commitment regarding health is reflected in health related policies and strategies. Policies are basically derived from the politics. Policies are the result of political will and power. But the irony is that the “big fishes” in the pond —the donors, development partners, politicized civil society groups, etc. – often rely on their evidence to put pressure on theBangladeshgovernment. In other words, they try to push their own agenda, using and abusing evidence (as the research is sometimes flimsy). Yes, in a few exceptional cases like the issue of community clinics or the operational integration of health and family planning activities, public health history was marked by clearly (domestic) political decisions. But are only the political party in power or the politicians of the two main political parties to blame? No. Many power games are being played. Civil society, bureaucrats, and politicized professional groups, particularly the doctor communities are equally responsible.
Yes, evidence is obvious. Research is inevitable. But in order to have it reflected in the policy and/or strategy, evidence should be gathered in the real world, not in an arranged setting. Research should be driven by proper planning. I am saying this because there are far too many NGOs piloting their pet project and doing their action and operation researches in a somewhat artificial setting. They invest a lot of resources, logistics and time, and the project magically becomes successful. But these pilots are often not replicable in the real world (where the government lacks human resources, for example).
Knowledge Transfer does not only involve the exchange, synthesis and application of knowledge based on research. It needs to consider the complex interaction between researchers and users. More importantly, the application should fit a particular setting. If research in a natural setting is combined with the political will of policy makers and the experience and professional knowledge of health professionals, we will be more able to accelerate and capture the benefits of research in the form of knowledge translation.