Challenges in Linking Health Research to Policy: A Commentary on Developing a Multi-Stakeholder Response to Orphans and Vulnerable Children in Ghana

"Our experience has shown that if the context within which researchers, policy makers and stakeholders work were better understood, the links between them were improved and research were communicated more effectively, then better policy making which links across different sectors may follow."

This paper explores the experience of researching orphans and vulnerable children (OVC) to illustrate how the Research and Development Division (RDD) of the Ghana Health Service (GHS) has used an intersectoral approach to engagement with HIV policy actors. Addressing the Balance of Burden in AIDS (ABBA) was a Department for International Development (DFID)-funded project aiming to improve HIV/AIDS policymaking in Africa. A central objective of the ABBA partnerships was to influence poverty reduction and the achievement of the Millennium Development Goals (MDGs) by tackling and reducing the causes of vulnerability through improving HIV/AIDS policymaking.

As detailed here, from the outset, RDD set the research agenda in collaboration with policymakers and stakeholders with whom contact was maintained through facilitative intersectoral discussions and forums up until the reporting stage:

• In 2007, the RDD hosted a set of consultative stakeholder meetings including policymakers, people living with HIV/AIDS, and orphanage managers at national and regional levels. The discussions at the workshop highlighted gaps in understanding on OVCs in Ghana and, in particular: the lack of knowledge and awareness of policy guidelines for OVCs; the need to better identify OVCs in communities and consider changes to how interventions are implemented; and the need to build awareness of organisations and services provided for OVCs.
• The RDD undertook a research study (2008-2010) to assess the state of HIV-affected OVC in households and orphanages. The study questions arose from the consultative meetings, RDD developed the study design, and stakeholders were able to comment on cultural sensitivities, ethics, and community entry. The aim was to develop the research project with all known stakeholders involved with OVC support and work with them to disseminate the results so that a collaborative response could be developed. In-depth interviews were conducted with key personnel from 11 governmental and non-governmental organisations that provide HIV/AIDS services to OVC in the Central region of Ghana. In-depth interviews were also conducted with 3 caretakers of orphanages and 19 household heads that have HIV/AIDS OVC in their care. In short, the study found that all OVC in orphanages appeared to have an advantage in terms of education, nutrition, and health care over children living in the community because they could be easily reached for support interventions.
• Preliminary findings were presented to all stakeholders, who were given an opportunity to ask questions and provide input into the process. "At this stage, the main dissemination was a formality because the key stakeholders had been part of the process and were already aware of the key findings of the research project. The dissemination forum therefore focuses more on the possible actionable points and who should do what rather than just telling the story of the results. This approach makes policy makers and end users of research outcomes pay attention and become more involved in the research process."
• Based on the research engagement, in 2010, a documentary film was commissioned by RDD with the intention of disseminating key findings to a wider audience and spreading awareness of the plight of OVCs using easily an understandable format and language. This was a response to stakeholders' suggestion that dialogue and wider recognition of the issues was necessary and social empowerment was an important strategy. The film was a "docu-drama" that told the story of an orphaned child living in the community. It featured interviews with high-ranking government officials. The RDD links to government were such that it could negotiate that the film was aired at low cost on primetime television across the 3 national networks over the Easter holiday weekend. The documentary reportedly "prompted widespread discussion and demands for the government to act. As a response to the RDD research, the Ghana AIDS Commission expressed commitment to creating an index of OVC in Ghana to assess what services are being delivered. The links facilitated by RDD in these examples highlight the potential of intersectoral working within HIV activities."

The paper presents lessons learned from the OVC research project, such as:

1. Continuous stakeholder engagement was essential for the effective translation and dissemination of research evidence.
2. The complexities of HIV in the community context necessitated transactional, dynamic approaches of applied research rather than a traditional scientific linear approach.
3. Translating research evidence into practice has not yet been possible due to institutional resource constraints; however, engagement with policy actors allowed these limitations to be identified and action to be taken to rectify them.
4. Intersectoral engagement was time-consuming and labour-intensive, and effective dissemination to different professional cultures (academia, clinical practice, policymakers, and the community) required the adaptation of research reaching the general population using national television as a channel of communication to stimulate and initiate fruitful discussions on the issue.
5. The positionality of the RDD (as a research organisation nested within the government infrastructure) meant that it was able to make links between research and policy and bring together relevant government departments and researchers to ensure that research evidence is digested and responded to.