Research evidence and policy: qualitative study in selected provinces in South Africa and Cameroon.
BACKGROUND
The translation of research into policy and practice is enhanced by policymakers who can recognise and articulate their information needs and researchers that understand the policymakers' environment. As researchers, we sought to understand the policymaking process and how research evidence may contribute in South Africa and Cameroon.


METHODS
We conducted qualitative in-depth interviews in South Africa and focus group discussions in Cameroon with purposively sampled subnational (provincial and regional) government health programme managers. Audio recorded interviews were transcribed, thematically coded and analysed.


RESULTS
Participants in both countries described the complex, often lengthy nature of policymaking processes, which often include back-and-forth consultations with many diverse stakeholder groups. These processes may be influenced by political structures, relationships between national and subnational levels, funding and international stakeholder agendas. Research is not a main driver of policy, but rather current contextual realities, costs, logistics and people (clinicians, NGOs, funders) influence the policy, and research plays a part. Research evidence is frequently perceived as unavailable, inaccessible, ill-timed or not applicable. The reliability of research on the internet was questioned. Evidence-informed health decision-making (EIDM) is regarded as necessary in South Africa but is less well understood in Cameroon. Insufficient time and capacity were hindrances to EIDM in both countries. Good relationships between researchers and policymakers may facilitate EIDM. Researchers should have a good understanding of the policymaking environment if they want to influence it. Greater interaction between policymakers and researchers is perceived as beneficial when formulating research and policy questions as it raises researchers' awareness of implementation challenges and enables the design of tailored and focused strategies to respond to policymakers' needs.


CONCLUSIONS
Policymaking is complicated, lengthy and mostly done at national level. Provinces/regions are tasked with implementation, with more room for adaptation in South Africa than in Cameroon. Research evidence plays a role in policy but does not drive it and is seen as mostly unavailable. Researchers need a thorough understanding of the policy process and environment, how the health system operates, as well as the priorities of policymakers. This can inform effective dialogue between researchers and policymakers, and contribute to enhancing use of research evidence in decision-making.
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa. cenaude@sun.ac.za.
Celeste E
CE
Naude
South African Cochrane Centre, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa. babalwa.zani@uct.ac.za.
Babalwa
B
Zani
Centre for Development of Best Practices in Health, Central Hospital Yaoundé, University of Yaoundé, P.O. Box 87, Yaoundé, Cameroon. pc.ongolo@gmail.com.
Pierre
P
Ongolo-Zogo
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa. charlesw@sun.ac.za.|South African Cochrane Centre, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa. charlesw@sun.ac.za.
Charles S
CS
Wiysonge
Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa. ldudley@sun.ac.za.
Lillian
L
Dudley
South African Cochrane Centre, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa. tamara.kredo@mrc.ac.za.
Tamara
T
Kredo
Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, Merseyside, L3 5QA, UK. paul.garner@lstmed.ac.uk.
Paul
P
Garner
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa. tyoung@sun.ac.za.|South African Cochrane Centre, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa. tyoung@sun.ac.za.
Taryn
T
Young
D035843:Biomedical Research; D002163:Cameroon; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D036301:Qualitative Research; D013019:South Africa; D057170:Translational Research, Biomedical / Q000379:methods