[Re: https://www.hifa.org/dgroups-rss/africa-evidence-network-evidence-doesnt...
https://www.hifa.org/dgroups-rss/africa-evidence-network-evidence-doesnt... ]
Thanks Neil and Nasreen Jessani
We've been practising this approach in IPCRG for many years, so let me agree and respond to each point with illustrations
"1. Uncertainty is evidence's natural state — not its failure mode. We perform certainty for funders and policymakers. But real evidence says: "Here's what we know, with these caveats, in these contexts, for now." That's not weakness. That's honesty that enables action."
Yes, totally agree particularly in primary care which deals with the whole person, not single diseases. It is why we advocate for the importance of real life studies using routine primary care data and produce guidance not guidelines, that draw on primary care colleagues' experience as well as the evidence because primary care absolutely recognises and deals with uncertainty. We produce guidance in the form of desktop helpers: https://www.ipcrg.org/resources/desktop-helpers. We also need the users of knowledge to have more say in what gets researched, so the evidence is more closely aligned with users' needs. eg https://www.ipcrg.org/IPCRG-Research-Prioritisation-2021 We are setting up a Collaborative, in close dialogue with WHO, to address this in the field of respiratory care in LMICs. https://www.ipcrg.org/collaborative
"2. Context isn't noise to filter out. It's signal to amplify. What works in Oslo may fail in Ouagadougou — not because of "poor implementation" but because context matters more than the intervention itself. Yet we still make guidelines first, then add context as afterthought. We have this backwards..but we are seeing some encouraging shifts in LMICS."
Yes, and there's a further layer of complexity here - within one country there may be significant differences. For example, the provision of primary care varies markedly in many countries between rural/remote and urban areas. So, there may be more similarity between two countries' urban areas than within one country. Therefore it is not simply about high, middle and low income contexts. Our approach is "right care" - what is the right time and right intervention for that person in that place. It is also about being clear who creates the evidence, and for whom. Abimbola's "Professors, Engineers, Plumbers and Emancipators" is a great categorisation that we use a lot in our research: we are aiming more for plumbers and emancipators. https://gh.bmj.com/content/6/4/e005802 It is why we invest a lot of time and effort in stakeholder mapping and engagement - eg https://www.ipcrg.org/resources/search-resources/stakeholder-engagement-... and https://pubmed.ncbi.nlm.nih.gov/38216986/
"3. Multiple evidence traditions answer different questions with equal rigor. Clinical trials. Implementation science. Traditional knowledge. Community practice. These aren't competitors. They're complementary. But our hierarchy treats only one or some as rigorous, dismissing others until validated by the dominant tradition."
Agree - there's a very nice WHO paper on this on evidence-informed decision-making. https://iris.who.int/server/api/core/bitstreams/e36259b0-541e-4d9a-bc52-...
"4. Equity isn't optional seasoning you add to guidelines, laws, regulations or guidelines. If your decisions (policies, guidelines etc) works for wealthy urban populations and fails for everyone else, you don't have an equity problem. You have a policy/guideline problem."
True, but I think we need a genuine conversation with colleagues about whether equity is indeed the goal. Of course, everyone says it is, but policies driven by non-health actors can compromise this eg "the growth agenda"; "safety and security."
HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos.
sian.health AT gmail.com