CONCEPTUAL FRAMEWORK
Stage 3: Interaction
This stage builds upon awareness and communication. It is at this stage that research transfer is at its most effective as the needs, knowledge and skills of the relevant parties are integrated to ensure that both researchers and local health service agencies benefit from a more substantive form of interaction. Shared information is debated and activities negotiated. Over time, awareness is superseded by communication and then interaction, with interaction being the end point in the evolution of an effective research transfer process. According to Anderson et al (1999:1010) the central issue in this model is to determine how best to facilitate awareness, communication and interaction. This cannot be forced upon the researchers or municipalities themselves.
What is required is a systematic approach which provides the opportunity for an exchange to occur.
This model is useful as a tool for self-assessment and to determine how to rate various transfer relationships. It also provides some basic guidelines to develop research transfer linkages further. Anderson et al (1999:1011) assert that a critical and often-overlooked component of the use and transfer of research in the health system is the local health and social service delivery agency. In the case of South Africa, this includes municipalities such as eThekwini Municipality. There is also very little understanding of the extent to which local health agencies conduct research internally to improve their operational capacity. It is more than likely that these local service organisations require research to guide activity in a rapidly-changing health care environment characterised by diminishing health and social service budgets, de- institutionalisation and concomitant increases and a metamorphoses in service demands.
The eThekwini Municipality is currently experiencing this rapidly-changing environment. For instance, after the 2000 local government elections, boundaries were expanded to include more under-resourced areas (amidst budget cuts) as part of national government's fiscal policy; extremely high HIV prevalence and a recent Severe Acute Respiratory Syndrome scare added to the burden.
The three key areas proposed by Anderson et al (1999:1007- 1019) seem to be relevant to the eThekwini Municipality Health Unit and any improvement in these areas will lead to
research committee is the vehicle for such research transfer at the eThekwini Municipality.
2.12.3 THE THREE-WAY MODEL OF COMMUNICATION
The basic premise of the model is that research informs policies and programmes most effectively when there is an extended three-way process of communication linking researchers, decision makers and those communities most affected by whatever issues are under consideration as reflected in Figure 14 (Porter and Prysor-Jones, 1997:1-42). The traditional audience for most researchers is other researchers.
Yet to have an impact outside their own research communities, researchers need to hear other points of view and have other ways of communicating their research findings.
Figure 14: Three-way Process of Communication Linking Researchers, Decision Makers and Communities
Source: Porter and Prysor-Jones, 1997:3
Communication is the Key to Relevance
Research that is relevant to policy/program needs
Researchers
Decisions and actions that are responsive to community needs
Research that is Relevant to ommunity needs
Communities Groups Individuals
Effective communication is a conversation that takes place over time and allows for sharing of interests, needs and concerns on all sides. Communication is often informal as the work of research proceeds, but it is better to plan ways to encourage it systematically from the beginning of the research
research to potential users and improve the chances of research findings being heard and acted upon by both management and implementing officials of the eThekwini Municipality Health Unit. The aim of this model is to facilitate a process of communication at key moments in the research process, from the initial choice of research problems to the presentation of final results. Thus effective communication needs to take place with these key stakeholders throughout the following stages of the research process (Porter and Prysor-Jones,1997:l-42).
> Defining The Question
If the resulting research products are to be useful to health system managers and decision makers (councillors), their information needs must be factored into the research from the beginning. The researcher must engage the potential users directly in helping to define the research question (Porter and Prysor- Jones,1997:).
> Developing The Proposal
If research is to serve as a guide to policy or programme management it must concentrate on those policy and programme variables that can, in principle, be acted upon. Researchers must not develop proposals for academic purposes only. The researcher must clarify, at the outset, what decisions are to be
influenced and who the potential users are (Porter and Prysor-Jones, 1997:13).
> Conducting The Study
Personal involvement in data collection and analysis often turns potential users into active supporters and advocates and also contributes to the capacity building of those involved. The researcher needs to involve managers, local health workers and communities in data collection and analysis.
> Communicating Results
Even the greatest research breakthroughs mean very little unless they are successfully communicated to decision makers. The researcher needs to have a systematic research results dissemination strategy for reaching different audiences of potential users.
Many actors are today entering the health services scene. Governments can no longer be the sole body responsible for the health of the people, so community, non-governmental groupings, non-profit foundations and enterprises all play important roles (Research into Action, issues 15, 1998). The key to the Porter and Prysor-Jones model is active communication among key stakeholders (researchers,
decision makers and communities) throughout the research-policy implementation processes.
2.12.4 THE ENVIRONMENT, MECHANISM AND SKILLS MODEL
The Council on Health Research for Development (2000:7) Working Group's model focuses on three major issues, namely environment, mechanism and skills. These need to be considered for any successful link between research and policy or programmes. These issues gave rise to the environment, mechanism and skills model.
This model is the outcome of the analysis of five case studies conducted in Brazil, Burkina Faso, Indonesia, South Africa and Uruguay.
> Environment
First of all, the environment must be supportive and receptive to the research recommendations. The environment involves the political, economic and social situation prevailing in any of the three spheres of government in the case of South Africa. These, according to the Council on Health Research for Development (COHRED) Working Group, must be favourable or conducive to the health research process.
> Mechanism
A mechanism is needed to link research to
decision making. The main tasks of this co-ordinating mechanism are:
• To monitor the research-to-policy process.
• To ensure that priority research is conducted.
• To monitor the move towards equity in health by conducting and using this priority research.
• To facilitate networking between the various actors and to ensure that actors are aware of research conducted.
• To ensure that the policies developed are embedded in the existing context.
The coordinating mechanism should include the establishment of an inclusive eThekwini Municipality Health Research Forum
> Skills
Researchers and decision makers need to develop specific skills to improve linkage of research to policy.
This includes:
• Partnership-building by including the relevant stakeholders in early stages of the research.
• Communication, advocacy and social marketing.
• Timing of research, in line with the development of policies.
On-going capacity building for all stakeholders especially decision makers is essential.
It is possible to link some of the models dealt with in the previous section to the three phases of policy making i.e. agenda setting, policy formulation and policy implementation. For agenda setting, health research could impact in one of several ways.
Research could demonstrate the existence or extent of a problem through either specific findings or a process of enlistment. Alternatively, it could be that as in the knowledge-driven model, the generation of more findings leads to pressure to act upon new knowledge (Hanney et al, 2003: 10). For example, in the current eThekwini Municipality workplace the AIDS Policy's agenda-setting was a result of corporate human resource reports indicating high rates of sick leave and death among younger employees. The use of research in policy formulation could be in the instrumental or conceptual stage. Another possibility is that it could be
used as briefs to inform arguments as set in the political model of research use.
The implementation of health policies is often widely acknowledged as difficult. At the implementation stage, research could play some part in demonstrating the best way to implement policy and inform decisions. It could be of symbolic use in helping to build support for implementation through assistance with communication or justifying the policy and being used to generate support for it in terms of financial, political commitment and public opinion.
2.13 SUMMARY
This chapter discussed the conceptual framework. The focus was on description of types and levels of policies and the theories of
Policy making. Two different policy-making stages i.e. the four stages of policy making and the functional policy stages were described. Relevant models for health research to policy process linkage were described.
The theoretical, methodological and contexual considerations in research and policy relationship were also explored. Included in this part were:
impediments to research use, sources of potential conflict between researchers and decision makers and strategies for improving the use of research.
The chapter concluded with the presentations of four frameworks for research policy processes which are: Holistic Approach, Model for Research Transfer, Three-way Model for Communication and Environment, Mechanism and Skills Model. Their relevance to the study is also dealt with in this last part of this chapter.
2.14 PROJECTIONS FOR THE NEXT CHAPTER
The next chapter examines the health research systems in local government settings. The main focus is on the eThekwini Municipality, especially the Health Unit. eThekwini is one of the metropolitan municipalities in South Africa.