title: Knowledge systems in health in sub-Saharan Africa: results of a questionnaire-based survey.
abstract: OBJECTIVE
  To describe the mechanisms and systems of knowledge acquisition, creation, diffusion, application and improvement of knowledge in two layers of the health system: health policy formulation and the provision of clinical services.
  
  
  METHODS
  A questionnaire-based survey.
  
  
  METHODS
  Health research institutions in 46 countries of the World Health Organization (WHO) African Region.
  
  
  METHODS
  Key informants in ministries of health and health care institutions in 39 countries of the Region.
  
  
  METHODS
  Existence of knowledge management infrastructure or components of infrastructure in the countries of the Region.
  
  
  RESULTS
  Central national bodies are always cited as having a major role in policy-setting. Non-national bodies most frequently provide advice and act in monitoring and evaluation, while decentralised entities are strongly involved in dissemination, implementation, and monitoring and evaluation. In general, ministries tend not to have an explicit knowledge management framework and do not map knowledge sources and flows for policy-making. The main sources of evidence are guidelines or recommendations from international or national agencies, although systematic reviews are rarely used. Routine monitoring and evaluation of quality and effectiveness of the process of policy development and its implementation was reported in 19 of the 39 respondent countries. In most respondent countries, electronic medical records were rarely used.
  
  
  CONCLUSIONS
  As systematic reviews are rarely utilised as a source of evidence in policy development and few mechanisms exist to assess the performance of the policies, there are significant opportunities for improving policy development.
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo chris@chriszielinski.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Zielinski
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo.
authors.forename: Derege
authors.initials: D
authors.lastname: Kebede
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo.
authors.forename: Peter Ebongue
authors.initials: PE
authors.lastname: Mbondji
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo.
authors.forename: Issa
authors.initials: I
authors.lastname: Sanou
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo.
authors.forename: Wenceslas
authors.initials: W
authors.lastname: Kouvividila
authors.affiliation: World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo.
authors.forename: Paul-Samson
authors.initials: PS
authors.lastname: Lusamba-Dikassa
keywords: health; health information systems; health research; knowledge management