A case study from Botswana
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Transcript of A case study from Botswana
Building capacities of elected national representatives to interpret and use evidence for health-related policy
decisions:
A case study from Botswana
Neil Andersson, Mokgweetsi Masisi, Lehana Thabane, Anne Cockcroft
Rationale
• Elected representatives make decisions and allocate funds
• They lack skills to interpret evidence on health-related topics
• It is possible to build such skills
Usually:
• Training for MPs covers mechanics and ethics of role
• Training in use of evidence targets technical officers
Can we bridge the gap?
The opportunity
• Debate about national HIV/AIDS policy in Botswana parliament in 2011
• Invited by government – to survey MPs about their needs for
evidence and training in its use– to provide training about evidence use
• Working with Office of President, National Assembly Office, NACA
The Botswana parliament
61 members
57 elected4 appointed
16 ministers
9 assistant ministers
The survey – October 2011
27 MPs completed short questionnaire 17 by telephone
10 face to face
As a parliamentarian do you feel you need more evidence, from research, about HIV and AIDS?
2
25
0 5 10 15 20 25 30
No Yes
CIET 2011
…receive evidence from reliable, unbiased sources?
4
12
11
0 2 4 6 8 10 12 14
DK No Yes
CIET 2011
…know enough about what to do about evidence?
11
16
0 5 10 15 20
No Yes
CIET 2011
…have had enough training in how to make the best use of evidence?
19
8
0 5 10 15 20
No Yes
CIET 2011
Do you think it could help your work if you felt better equipped to use evidence?
2
25
0 5 10 15 20 25 30
No Yes
CIET 2011
How would it help your work?
It would boost my confidence…decisions would be based on facts
We would have actual facts and knowledge to pass to our constituents
…help in effective policy making
We would discuss issues in a well-informed way
…could assist us to make positive changes
CIET 2011
What difficulties do you face in using evidence in your work as a parliamentarian?
…the use of jargon
…difficult wording and statistical data
…evidence from government agencies is outdated
…inexperienced research officers…lack of researchers for parliament
…technical terms are a challenge
…access to the information
CIET 2011
The training sessions
“Parliamentarians and evidence-based decision making”
Oct/Nov 20112 x ½ days
Nov 20122 x ½ days
Material Material
Some dropped, some added
Parliamentarians
Coverage
36 MPs 7 ministersDeputy speakerLeader of oppositionChair of HIV/AIDS cttee
Director HIV/AIDS MoHNACA personnel
Some of participants from 2011
Evidence for planning
• Evidence on impact, coverage and costs• Contrast (counterfactual evidence)• Describing evidence: population link• Value of different evidence sources:
contrast, ability to deal with other factors
The language of evidence
AnalysisAssociationInferenceInteractionContrastConfounder
Relative RiskRisk DifferenceGainsNumber needed to treat
AccuracyErrorBias
Randomised Controlled TrialRandomised Cluster Controlled TrialSystematic reviewMeta analysis
Statistical significanceP valueConfidence intervalStudy size
IncidencePrevalenceHyperendemic countriesBaseline measurementIngredients of a questionnaireUpward trajectory of costsConcomitant increase
Questions to ask about evidence
Discussed summaries of real, published evidence:
• Lacking or weak contrast
• Bias or confounding
• Different setting
• From small or single study
HIV prevention in Botswana
• Remaining 1.5% annual HIV incidence• About 14,000 new cases per year• Highest incidence in young women
• Calculating impact of prevention investment• Increased prevention investment needed• Current programmes not the answer
The Gizmo dashboard
What could you do in your constituency?
• MPs as exemplars, champions• Target poverty alleviation to young
women• Community discussions of “morality”• Sessions for school children• Involve traditional leaders
Measure impact on new cases
Evaluation of sessions2011 2012
Relevance of content 4.25 4.5
Level of content 4.15 4.3
Presentation 4.2 4.0
(Mean scores out of 5)
Would it work elsewhere?
• Timing was right (AIDS Policy debate)• Champion (minister is ADAPT fellow)• Botswana has functional parliament• Sought and incorporated perceived
needs of the MPs• Content direct and relevant