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

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

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

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

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

The survey – October MPs completed short questionnaire 17 by telephone 10 face to face

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

…receive evidence from reliable, unbiased sources? CIET 2011

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

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

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

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

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 … the use of jargon …difficult wording and statistical data …evidence from government agencies is outdated …inexperienced research officers…lack of researchers for parliament …technical terms are a challenge …access to the information CIET 2011

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

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

Some of participants from 2011

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

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

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

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

The Gizmo dashboard

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

Evaluation of sessions Relevance of content Level of content Presentation (Mean scores out of 5)

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