The role of scientific advice and public
engagement for better policymaking during the pandemic
Prof Karen Hofman 15 April 2021
Finding the Balance: Public Health and Social Measures for COVID-19 in the DRC and South Africa
Role and importance of scientific evidence
• Evidence crucial and policymaker engagement is essential but
experience in SA shows that the evidence is only part of the landscape - mostly about the political economy
What does this mean
• Political economy is the term used to describe multiple actors who compete for finite resources and power who assess which policies will provide the most beneficial results
Who are the actors
• Government, academia, industry, civil society, international agencies
2
Role and importance of scientific evidence
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In addition to vested interests in SSA we have certain conditions in place that sometimes prevent good policies for health from being implemented even in the face of strong peer reviewed evidence For example:
• Regulatory capture and industry funded research
• Lack of policy coherence between public health goals and economic growth
SA specific lessons/ global lessons
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• Established Ministerial Advisory committee and subcommittees
• SA Academia advised the MAC including economists, virologists, epidemiology and public health
• Publication of manuscripts and clinical trials of
vaccines
BUT new info coming out all the time
• Pace of research unprecedented –
challenges associated with translation of fast accumulating evidence for
policymakers and communities – many of whom not well versed in health
• Preliminary results have made news headlines without usual peer review process
Complementary value of scientific advice and public engagement
• COVID-19 difficulty in setting priorities decisions in resource- constrained setting
• Trade-offs may impact individuals’ health, finances, national economy, nutritional consequences and growing inequalities
• Covid-19 crisis requires unprecedented social buy-in PUBLIC ENGAGEMENT
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Need for public engagement
SA’s public health approach to COVID-19 has been largely scientifically driven which bolstered public trust in some interventions
But lack of transparency and engagement driving context specific decision making
Processes need to be deliberately informed by legitimate priorities that are ethical and reflect public values, even if they cannot be wholly
determined by them 6
Reasons to engage the public
Democratic imperative to involve those affected
(Abelson et al. 2003)
Reinforces legitimacy and acceptability
Moral importance of transparency and engagement- reflect values of the people
Inform difficult decisions about priority setting &
resource allocation–
context of COVID-19
Reflects communities’
health needs + barriers and facilitators (Oladeinde
et al. 2020)
Manages community expectations (Scuffham et
al. 2014; Caddy and Vergez 2001)
Tugendhaft et al, 2020 7
Type of engagement matters…
Non- deliberative
• Limited person to person dialogue/debate
• Surveys, focus groups, feedback meetings, information gathering
Deliberative
• Deeper engagement and consideration of competing views
• Fosters debate
• Setting where values and moral claims can be challenged
• May provide richer data on public attitudes and values
• Educates participants about issue in question as it is being discussed
• Public hearings, community meetings, public panels, deliberative forums, citizens juries
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Value of COVID-19 food assistance from the perspective of HIV+ women
• Low levels of access to parcels (9%) and covid-19 grants (30%) among participants
• Perceived food parcels to be nutritionally inadequate in quality, insufficient in quantity, inefficient in delivery
• Preference to receive vouchers or cash to food parcels
• Early public engagement could have helped to mitigate adverse effects
PRICELESS, 2021, Technical Report 9
During COVID-19 decisions had to be made fast and the public were excluded, especially the most
vulnerable
• PRICELESS gathered insights into how the pandemic and related measures impacted vulnerable groups and what the social barriers and facilitators were of COVID-19 measures
• We investigated policy responses to COVID-19 in the food space (food parcels, extended grants, food supply chain)
• Lived experiences of women living with HIV
PRICELESS, 2021, Technical Report 10
CHAT - Choosing All Together
method of deliberative public engagement
• Simple to use like a game
• Distribute a limited number of stickers (budget) on a board to select intervention options
• Choose priorities
• Modified successfully in rural SA and India, now being tested in Burkina Faso and Ghana
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CHAT SA in rural Bushbuckridge
Tugendhaft et al, 2020
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CHAT helps
• Citizens
• understand that not every service can be provided – choices need to be made
• identify their own priorities
• understand how choices impact them and others when they can't choose everything
• Researchers learn what is most important to communities
• Ensure that priorities reflect the values and preferences and meet the
needs of the communities 13
During crisis, quick engagement methods necessary, supplemented with more meaningful engagement
• Under normal circumstances, decision-makers may have time to
undertake a deliberate process with the benefit of data and scientifically rigorous information
• BUT allocation of resources during times of crisis does not have the benefit of time and perfect processes.
• Existing tools can be used and modified during crisis
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Key messages for scientists
• Policy makers have different expertise to scientists
• Do your homework – they have little time so make the best of it
• Get to the point but don't oversimplify
• Be persistent and patient – don’t be discouraged
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Academy of Science of South Africa (ASSAf)
ASSAf Research Repository http://research.assaf.org.za/
B. Academy of Science of South Africa (ASSAf) Events I. Other
2021
Finding the balance: public health and social measures for COVID-19 in the DRC and South Africa
Academy of Science of South Africa (ASSAf)
Academy of Science of South Africa (ASSAf); Académie Congolaise des Sciences (ACCOS)
Academy of Science of South Africa (ASSAf), (2021). Finding the balance: public health and
social measures for COVID-19 in the DRC and South Africa. [Online] Available at: http://hdl.handle.net/20.500.11911/207 https://youtu.be/CfHsLuWEluc
Downloaded from ASSAf Research Repository, Academy of Science of South Africa (ASSAf)
