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A case study from Botswana

A case study from Botswana

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A case study from Botswana

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  1. 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

  2. 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

  3. Usually: • Training for MPs covers mechanics and ethics of role • Training in use of evidence targets technical officers Can we bridge the gap?

  4. 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

  5. The Botswana parliament 61 members 57 elected 4 appointed 16 ministers 9 assistant ministers

  6. The survey – October 2011 27 MPs completed short questionnaire 17 by telephone 10 face to face

  7. As a parliamentarian do you feel you need more evidence, from research, about HIV and AIDS? CIET 2011

  8. …receive evidence from reliable, unbiased sources? CIET 2011

  9. …know enough about what to do about evidence? CIET 2011

  10. …have had enough training in how to make the best use of evidence? CIET 2011

  11. Do you think it could help your work if you felt better equipped to use evidence? CIET 2011

  12. 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

  13. What difficulties do you face in using evidence in your work as a parliamentarian? …the use of jargon …difficult wording and statistical data …technical terms are a challenge …inexperienced research officers…lack of researchers for parliament …evidence from government agencies is outdated …access to the information CIET 2011

  14. The training sessions Parliamentarians Oct/Nov 2011 2 x ½ days Nov 2012 2 x ½ days Material Material Some dropped, some added “Parliamentarians and evidence-based decision making”

  15. Coverage 7 ministers 36 MPs Deputy speaker Leader of opposition Chair of HIV/AIDS cttee Director HIV/AIDS MoH NACA personnel

  16. Some of participants from 2011

  17. 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

  18. The language of evidence Relative Risk Risk Difference Gains Number needed to treat Analysis Association Inference Interaction Contrast Confounder Statistical significance P value Confidence interval Study size Accuracy Error Bias Incidence Prevalence Hyperendemic countries Baseline measurement Ingredients of a questionnaire Upward trajectory of costs Concomitant increase Randomised Controlled Trial Randomised Cluster Controlled Trial Systematic review Meta analysis

  19. 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

  20. 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

  21. The Gizmo dashboard

  22. 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

  23. Evaluation of sessions (Mean scores out of 5)

  24. 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