Pakistan floods: innovations and guidance for the response.

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The clerk schedules appointments for the patients at Nuzha Health center, Amman. Credit: UNRWA 2016 / Photo by Mohammad Magda

Over the last couple of months, I think we’ve all been going through a process of grappling with the implications of COVID-19 on our work and our personal lives. For those of us involved in promoting use and uptake of research evidence in humanitarian health policy and practice, the situation presents specific challenges.

First, because it is a general principle that conscious, dynamic engagement with the context for policy-making and decision-making is critical for achieving uptake of research evidence. COVID-19 obviously affects this context – and therefore the process of influencing policy or practice with research evidence – in significant ways. (More general insights at ‘On Think Tanks’ : being constructive and relevant in the pandemic’.)

The humanitarian context in particular, however, already holds multiple challenges for knowledge brokers seeking to inform policy and practice, even before a pandemic (these challenges are explored by ALNAP here, Tufts here, and Evidence Aid here). Since COVID-19, these challenges feel like they have multiplied exponentially. Recently, I consulted the R2HC’s informal working group of ‘research uptake focal points’ (all individuals with ‘knowledge broker’ roles working with research evidence in the humanitarian sector), and we identified the impacts of COVID-19 emerging in our respective roles and working contexts.

Impacts of COVID-19 on humanitarian evidence use and research uptake

  1. Widespread and rapid programme and staff adaptation by humanitarian responders, along with changes to funding and programme priorities, are affecting the production and use of research evidence in humanitarian settings. Due to impacts such as data collection staff being redeployed to the response, researchers are pushing back study timelines. Uptake and dissemination activities for grant-funded research projects will be squeezed — if they can be delivered at all (see #4).
  2. In-person knowledge sharing and dissemination events are off the table. New and different ways of engaging stakeholders in research evidence are needed, in some cases requiring the rapid development of new skills, and adoption of new technology.
  3. Research teams and their partners are pivoting towards COVID-19 relevant work, pausing other studies. This is constructive, but also means that other important evidence gaps on critical humanitarian issues cannot be addressed, with potential long-term consequences for the evidence needs of stakeholders. (A recent Guardian article, for example, quoted tuberculosis campaigners who fear TB vaccine research will be neglected).
  4. Humanitarian actors don’t, at present, have much capacity to absorb evidence, to engage in knowledge sharing activities or events, read communications materials, and so on. As I was told by a working group member, “it’s hard to engage in a conversation about uptake and communications of past results that aren’t to do with COVID-19.”
  5. Communications materials and policy messaging in development for completed studies will need to adapt to retain relevance in the changed context.
  6. Changes in relationships between institutions and researchers, and in the attitudes of policymakers to research, was also noted. More widely, we are seeing increased demand for expert guidance, with a new-found public appetite for research evidence. (Though as this piece ‘Pandemic Science Out of Control’ warns, we need to be equally cautious about the quality of such evidence and how rapidly ‘bad evidence’ can spread.)

This list of impacts can feel overwhelming and even worrying.

At Elrha, we’ve been working to understand what individual study teams, who we fund through our R2HC programme, need from us at a time like this, and to respond flexibly and supportively. But it’s clear that the challenges for humanitarian evidence use are likely to be more significant than can be addressed at this one-on-one level. Faced with such challenges and considering the list of impacts above, I have found personally (and heard in other discussions with those in ‘knowledge broker’ roles externally) that it is tempting to adopt one of two modes: panic ‘rapid action’ mode (trying to produce ‘rapid outputs’ which we hope will respond to the perceived need for COVID-19-relevant evidence). Or, conversely, paralysis mode: thinking that we have nothing useful to contribute.

There is a risk in ‘panic or paralysis’.

Many humanitarian response organisations have worked hard to establish internal research expertise and to build strategic, high-level support for formal research uptake pathways. A culture has been growing around the need to ‘understand what works’, of carefully monitoring and evaluating, of developing robust evidence to underpin programme decisions. Though it is easy to use urgency as an excuse to put good practice on hold, this could be damaging long-term.

For those of us with capacity to do so, there’s value in taking a pause, and reflecting how competencies in translating research evidence into knowledge, policy and practice can best contribute in the changed humanitarian environment. Thinking about context more systematically could help. For example, reviewing a context model, like this one provided by Politics of Ideas and INASP, and asking yourself: what’s changed for the institutions I interact with and the way they use evidence? What’s changed in the flow of information between key actors? How can I adapt accordingly? (If you’re like me, you might have to break off to attend to caring responsibilities or play Lego with a 9 year old- but do what you can.)

Doing this type of thinking also highlights how drastic the impacts of COVID-19 may be for our work promoting evidence use, in our sector and more widely. Even the ‘macro-context’ for uptake- the underlying and normally fixed political, economic and societal structures — may be at a ‘critical juncture’ for change, as Duncan Green has argued. But there may also be opportunities arising from the pandemic for positive changes in the humanitarian sector too.

Pathways for knowledge brokers

To move forward, we are probably looking at two choices: dive in, or step back.

  1. Dive in. If you conclude you can do it well, pivot towards sharing knowledge and evidence to support the immediate, rapid COVID-19 response. (If you can do this, you are probably already doing it- but there’s no harm in reflecting whether this truly meets stakeholder needs).
  2. Those who conclude otherwise may choose to step back. Rather than ‘do nothing’, this means taking a long, wide or conversely, very specific view; perhaps producing commentary or analysis relating to your expertise and context, linking your skills and competencies with new policy-making needs. Evidence linking different types of contextual data, information and knowledge- and which is relevant, specific and timely- is critical to inform humanitarian decisions but is often in short supply. It may be especially important once panic mode subsides and policymakers grapple with bigger, long-term implications of the pandemic for wider humanitarian concerns and priorities.

Whether diving in or stepping back, best practice principles still apply:

  • Identify focal points in the new context, not only for decision-making, but also those who are brokering, coordinating and collating relevant knowledge (information, research) to ensure effectiveness and reduce duplication.
  • Seek feedback from key stakeholders at all stages on what evidence is needed in that context. Understand the quality of evidence required for decision-making. Ask how, when and in what formats evidence is needed.
  • Ensure openness and accessibility of evidence, preferably in useful summary formats which can be easily used by policymakers.

Be compassionate

These are unprecedented and challenging times for humanitarian partners, so be compassionate in interactions with operational stakeholders. In project conception and design, think about sensitive allocation of the ‘heavy lifting’ (financially, operationally, administratively, intellectually) in the co-production and sharing of knowledge.

The humanitarian context is changing, and work at the intersection of research evidence and decision-making- ‘knowledge brokering’- is changing with it. But assuming we are safe, well and able, a systematic assessment of context and stakeholder needs can help knowledge brokers adapt so that responders can still access much needed evidence and expertise.

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