Key lessons learnt from the implementation of the Rapid Assessment Protocol for Insulin Access as a tool for policy change
|
The challenge of Noncommunicable diseases has been recognised by the global community with the United Nations High-Level Meeting on Noncommunicable diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control in Moscow. The World Health Organization’s response has been the development of an “Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable diseases” and a “Prioritized Research Agenda for Prevention and Control of Noncommunicable diseases”.
Highlighting that “research is fundamental to generate knowledge and information for formulating evidence-informed policies and practices in support of global public health and health equity”, the Sixty-third World Health Assembly, in May 2010, in resolution WHA63.21, endorsed the World Health Organization Strategy on Research for Health and established the role and responsibilities of World Health Organization in health research. Within this strategy, the “Prioritized Research Agenda for Prevention and Control of Noncommunicable diseases” was developed to align with this global research agenda. In this context it is important to understand the influences on the decision making process of health systems research and its impact on the policy process. The International Insulin Foundation developed the Rapid Assessment Protocol for Insulin Access recognising the fact that merely increasing insulin supply would not improve the prognosis for people with diabetes, and the root of the problems within the health system needed to be assessed. |
The Rapid Assessment Protocol for Insulin Access is structured as a multi-level assessment tool for health systems research of the different elements that influence the access people with diabetes have to care in a given country. To date the Rapid Assessment Protocol for Insulin Access has been implemented in six countries (representing four World Health Organization Regions) by the International Insulin Foundation: Kyrgyzstan, Mali, Mozambique, Zambia, Nicaragua and Vietnam. The Rapid Assessment Protocol for Insulin Access was able to provide local stakeholders with a clear view of the challenges to diabetes care in their country, but also propose concrete solutions. By doing so the Rapid Assessment Protocol for Insulin Access process was able to bring diabetes care to the forefront and contribute to making the case for resource poor countries to start addressing the issue of diabetes and NCDs.
In order to assess the depth and breadth of the impact of the International Insulin Foundation’s work a multi-stage approach was taken. The first stage included a documentary review including peer-reviewed publications, reports and other published materials, which included results from the Rapid Assessments or reference to the International Insulin Foundation’s work. An online questionnaire was designed and sent to people who had worked with the International Insulin Foundation or used or referenced the International Insulin Foundation’s work in order to get their perspectives of its impact. “Key people” were interviewed using a discussion guide developed based on the results of the documentary review and online questionnaire. These individuals were “key people” in the different countries where the Rapid Assessment Protocol for Insulin Access was implemented, stakeholders from the World Health Organization and International Diabetes Federation and other individuals involved in different aspects of the Rapid Assessment Protocol for Insulin Access process both globally and in specific countries.
The lessons from this project were that the Rapid Assessment Protocol for Insulin Access was viewed as methodologically strong leading to multiple research outcomes including reports and peer-reviewed publications. A strength of the process was the close collaboration between the International Insulin Foundation and the local research team. Both these elements led to the credibility of the research process and findings. Each implementation and research outcome contributed to the overall credibility of the process.
From this research context specific results were obtained and provided an overall view of the situation with regards to access to insulin and diabetes care. Although there was an active use of the results by the International Insulin Foundation and local partners dissemination was viewed as the main weakness of the Rapid Assessment Process. Interviewees highlighted that it was important for dissemination to be done at local, national and global levels.
The recommendations proposed by the International Insulin Foundation were viewed very positively in terms of being targeted, grounded in local data and the local context. Again though a lack of funding for implementation was viewed as a barrier. Overall the impact of the Rapid Assessment Protocol for Insulin Access was on policy and programme implementation, providing situation specific data that was used locally and globally and other parallel/collateral impacts.
As highlighted by other studies looking at research into and a quote from the Global Diabetes Advocate, “it is hard to say which changes in diabetes were due to the Rapid Assessment Protocol for Insulin Access and which were due to changes in other diabetes initiatives.” The policy process and the use of research to inform it are constantly changing and therefore current methods that only enable a snapshot miss vital information. Methods to help gain a clearer overview need to include multiple data sources and approaches. This project attempted to do this using documentary reviews, an online questionnaire and in-depth interviews. It allowed for certain key lessons to be highlighted and show that the Rapid Assessment Protocol for Insulin Access had varying impacts in the countries where it was implemented and globally thanks to strong recognised methods, implemented in collaboration between the International Insulin Foundation and strong local colleagues, generating useful and credible results, that despite problems with dissemination allowed for targeted recommendations to be developed.
In order to assess the depth and breadth of the impact of the International Insulin Foundation’s work a multi-stage approach was taken. The first stage included a documentary review including peer-reviewed publications, reports and other published materials, which included results from the Rapid Assessments or reference to the International Insulin Foundation’s work. An online questionnaire was designed and sent to people who had worked with the International Insulin Foundation or used or referenced the International Insulin Foundation’s work in order to get their perspectives of its impact. “Key people” were interviewed using a discussion guide developed based on the results of the documentary review and online questionnaire. These individuals were “key people” in the different countries where the Rapid Assessment Protocol for Insulin Access was implemented, stakeholders from the World Health Organization and International Diabetes Federation and other individuals involved in different aspects of the Rapid Assessment Protocol for Insulin Access process both globally and in specific countries.
The lessons from this project were that the Rapid Assessment Protocol for Insulin Access was viewed as methodologically strong leading to multiple research outcomes including reports and peer-reviewed publications. A strength of the process was the close collaboration between the International Insulin Foundation and the local research team. Both these elements led to the credibility of the research process and findings. Each implementation and research outcome contributed to the overall credibility of the process.
From this research context specific results were obtained and provided an overall view of the situation with regards to access to insulin and diabetes care. Although there was an active use of the results by the International Insulin Foundation and local partners dissemination was viewed as the main weakness of the Rapid Assessment Process. Interviewees highlighted that it was important for dissemination to be done at local, national and global levels.
The recommendations proposed by the International Insulin Foundation were viewed very positively in terms of being targeted, grounded in local data and the local context. Again though a lack of funding for implementation was viewed as a barrier. Overall the impact of the Rapid Assessment Protocol for Insulin Access was on policy and programme implementation, providing situation specific data that was used locally and globally and other parallel/collateral impacts.
As highlighted by other studies looking at research into and a quote from the Global Diabetes Advocate, “it is hard to say which changes in diabetes were due to the Rapid Assessment Protocol for Insulin Access and which were due to changes in other diabetes initiatives.” The policy process and the use of research to inform it are constantly changing and therefore current methods that only enable a snapshot miss vital information. Methods to help gain a clearer overview need to include multiple data sources and approaches. This project attempted to do this using documentary reviews, an online questionnaire and in-depth interviews. It allowed for certain key lessons to be highlighted and show that the Rapid Assessment Protocol for Insulin Access had varying impacts in the countries where it was implemented and globally thanks to strong recognised methods, implemented in collaboration between the International Insulin Foundation and strong local colleagues, generating useful and credible results, that despite problems with dissemination allowed for targeted recommendations to be developed.
| Key Lessons from the RAPIA |