Introduction and Overview to the Global Coalition

This webinar is the first episode of the WHO series that aim to support the routine use of evidence during the policy-making. Focusing on the recently developed WHO checklist, this webinar marked the launch of the Global Coalition for Evidence by the World Health Organization in January 2025. This coalition aims at better collaboration, coordination, and consultation to boost the use of evidence in decision-making and strengthening local leadership to have global influence. A working group has also been formed for institutionalizing the use of evidence. Webinars will be organized during the year on tools and their uses in different countries in order to understand evidence support systems. The next one will be on governance, scheduled for February 25, 2025.

The speakers in this webinar were Tanja Kuchenmuller from the World Health Organization, Mukdarut Bangpan from University College London, and Songphan Choemprayong from Chulalongkorn University, talking about the tools and their use in Thailand.

Background of Institutionalization Work

The institutionalization work started with the WHO Evidence-Informed Policy Network (EVIPNet). Working for nearly two decades, this global network has aimed at strengthening systematic and transparent use of evidence within more than 50 countries. In a nutshell, the network empowers the member countries through the enhancement of local knowledge and skills development in the use of different forms of evidence to bring improvement in the health systems. EVIPNet thus aims at institutionalizing these capacities through support to the establishment and operation of multidisciplinary research advisory bodies called Knowledge Translation Platforms, KTPs. The KTPs create institutional bridges for the continuous and routine use of evidence in policymaking.

The initial focus was to establish organizational structures which would enable sustainable processes, making the use of evidence a routine activity for policymaking. In 2017, a Situational Analysis Manual was developed to guide member countries through the process of getting an understanding of their status in evidence-informed decision-making. The manual helps analyze local contexts, including structures, processes, and conditions that enable or hinder knowledge translation and evidence-informed policymaking. The aim was to identify the institutional position for creating a knowledge translation platform. However, this guide fell short in providing sufficient clarity regarding the establishment and sustainability of KTP operation.

Critical Interpretive Synthesis and Definition of Institutionalization

A critical interpretive synthesis was conducted in 2022 to arrive at a common understanding of the process of institutionalization. In this regard, institutionalization represents both a process and an outcome of recreating, maintaining, and reinforcing norms, regulations, and standard practices based on the collective meaning that underlines those values, actions, and resource allocations, thereby legitimizing health policymaking self-evident with time. Indeed, institutionalization is an iterative process to be conceptualized as having a number of different stages: a triggering event; pre-institutionalization; semi-institutionalization; and institutionalization. It also requires continuous reinforcement to maintain the change and is both a process and an outcome. Legitimacy and self-evidence are essential aspects. Legitimacy is the public belief in the appropriateness and acceptability of an institution's actions, and self-evidence means maintaining social order through routine behavior.

Institutionalization Frameworks

Two frameworks were developed in this synthesis:

1. Process Framework: This framework outlines the various stages of institutionalization.
2. Domain Framework: This framework includes six domains embedded in the context, organizational domain, and external environment:
   1. Governance: Governance mechanisms, regulations, and organizational structures enhance the visibility and stability of knowledge translation.
   2. Standards and Routine Processes: Assure the development of trustworthy, high-value products from knowledge translation and reduce reliance on key individuals.
   3. Partnerships and Collective Actions: Increase flexibility through participation and involvement across the domain of the organization.
   4. Leadership and Commitment: The process should be sustainable through constant influence in the adoption of evidence-based policies.
   5. Resources: Financial, material, human, and informational resources.
   6. Culture: Values, assumptions, and beliefs that consider evidence-based decision-making morally correct and important.

Each domain interacts with another, and the balancing of the system depends on the context of each country.

WHO Checklist

The WHO checklist is based on the critical interpretive synthesis and its frameworks. Its goals are:

1. Conduct a situational analysis to understand the evidence ecosystem.
2. Understand institutionalization domains and processes.
3. Provide a set of actions for each domain to strengthen the institutionalization process.

The aim of this checklist is to raise awareness of the need for the use of evidence, assist countries to institutionalize evidence, and support the reform of evidence mechanisms in policymaking. This checklist also provides step-by-step guidance within each domain through suggested activities linked to the particular maturity stage of a country or organization.

Pilot and Academic Studies

This checklist has drawn the attention of member countries and the research community. Pilot studies in Tajikistan and Trinidad and Tobago, financed by the Geneva Science-Policy Interface (GSPI) and the Special Programme for Research and Training in Tropical Diseases (TDR), are in process. Academics also aim to expand the knowledge and research gaps, like how the domains of institutionalization interact.

Research Project and Checklist Application

A research project will investigate the nature of evidence ecosystems and support the routine use of evidence in policymaking processes based on the checklist in Trinidad and Tobago, Tajikistan, and Thailand, with the potential to expand to China in collaboration with local research teams. The objectives of the study are to:

1. Understand the nature of evidence ecosystems and evidence-based policymaking in the selected countries.
2. Establish the stage of institutionalization and identify main barriers and enablers.
3. Create a checklist of core activities or pathway that countries might use to support the strengthening of their evidence-to-policy processes.
4. Test the usability, efficiency, and effectiveness of the checklist.

This study adopts a case study design incorporating situational analysis, primary research, and participatory workshops of mature methodological diversity.

Checklist Application in Thailand

The checklist is being implemented in the health and education sectors in Thailand. A scoping exercise and literature review have been completed, and a participatory workshop is planned to gain insights and feedback from situational analysis and develop a roadmap.

Challenges and Opportunities

The challenges include:

1. Conceptualizing key terms like "evidence" and "institutionalization" across sectors.
2. Balancing the precision with the practicality of the checklist.
3. Accounting for various scales of application such as institutional, social and national.
4. Teamwork; it involves a multidisciplinary set of expertise
5. Interpretation of this checklist requires time and considerable effort due to complex understanding regarding domains.
6. Identifying the indicators/evidence of the phenomenon of institutionalisation
7. Checklists may not be appropriate for objective measurement.
8. Checklist items may fall short of capturing all the complexity and shades of grey of the different domains.

However this checklist is very useful in:

1. Institutionalization from different points of view.
2. Team building and the realization of the aspects that need strengthening.
3. Awareness and capacity building in the team and stakeholders.
4. Comparison with other sectors.
5. Accountability, shaping conversations.

The second webinar will take place on February 25, 2025 at 1pm (GMT) and will be focused on a deep-dive in the Governance domain as experienced by two countries. Pre-register here!