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Evidence Informed Health Policy in Low and Middle Income Countries: An International Forum Addis Ababa, Ethiopia - August 28th-30th, 2012 Evidence informed health policy initiatives, cross-country experience Sharing EVIPNet Brazil Jorge O.M. Barreto, MSc, PhD(c) EVIPNet Brazil, Consultive Council National Council of Municipal Health Secretaries, Brazil Municipal Health Secretary / Health Evidence Center, Piripiri Brazil Nathan M. Souza, MD, MMedEd, PhD(c) EVIPNet Brazil, collaborator


EVIPNet Brazil Background Experience Results Next steps and potentials Issues

EVIPNet Brazil background 58th World Health Assembly (2005) Global call for EVIPNet project (WHO) Health Agenda for Americas 2008-17 (PAHO, 2007) EVIPNet Americas (PAHO, Jul. 2007) Decision and leadership of Ministry of Health (DECIT/SCTIE/MoH)  Launched of EVIPNet Brasil initiative in partnership with BIREME/PAHO (during 8th CRICS, Rio de Janeiro, Oct. 2008)  Established the Consultive Council, Executive Secretariat and the first brazilian EVIPNet team (May 2009)     

Experience  EVIPNet Brazil Consultive Council:

 Proposed priority issues and problems;  Evaluated and contributed to the development and implementation of the work plan;  Established priorities for improvement and sustainability of the network, and  Monitors and evaluates EVIPNet Brazil’s development

 EVIPNet Brazil Secretariat:  Manages EVIPNet Brazil;  Convenes meetings of the Consultive Council, and  Finance the implementation of all activities

By law, MoH of Brazil, 2009

Experience  EVIPNet Brazil Team:  Launched in Aug. 2009;  Trained on SUPPORT Tools for evidence-informed health policymaking;  Trained on policy briefs production;  SUPPORT Workshop in Chile (2009, 2010);  Federal government support fluctuated throughout changes of directors

Results  EVIPNet Brazil website (launched Set. 2010)

Results  Workshops carried out by EVIPNet Brasil team:  03 workshops for municipal managers and their supporters: 2010, 2011 and 2012 during the National Congress of Municipal Health Secretaries  01 workshop for participants from Portuguese speaking African countries (2010)  01 workshop for health sciences graduate students from University of Brasilia - UnB (Nov. 2010)

Results EVIPNet–ePORTUGUESE Workshop

Workshop in University of Brasilia

Workshops in Annual Congress of National Council of Municipal Health Secretaries 2010



Results  Brazilian Policy Brief (2010)  Focused on Perinatal Mortality;  Linked with National Plan to reduce infant mortality;  Widely publicized

Results  Activity report of EVIPNet Brazil (2011)

Results  Piripiri Evidence Centre:  A municipal/local experience launched in Mar. 2010;  Colateral effect of EVIPNet Brasil;  Evidence briefs and deliberative dialogues with highpriority local health problems;  Workshops with local health workers to promote health evidence use;  Two policy briefs translated to English/Spanish  10 permanent members (five full-time)  Currently developing two new policy briefs


Results  Other forms of dissemination: 1) Peer-review publications:  three articles in Brazilian Journals;  Currently developing two new policy briefs 2) Presentations in Scientific and Policy-oriented events both at national and international level:  03 oral and poster presentations at international;  03 oral and poster presentations at national; 3) Reports in public domain at Piripiri government website

Next Steps  Update and maintain EVIPNet Brazil website content;  Prepare news policy briefs;  Build capacity on how to use SUPPORT Tools;  Promote EVIPNet Brazil and expand its network;  Scale-up Municipal Evidence Centers / VHL Stations;  Hire highly-skilled KT researcher to support activities, and  Monitor and evaluate results (focus at municipal level)

Issues 1. What are the best strategies to promote and implement EIPM when decision-making occurs at multiple levels of government? 2. How can civil society groups engage and strengthen EIPM? 3. How to promote the use of local evidence as special input to define problem and options to address it? 4. How would you evaluate the health impact and the costeffectiveness of our local level KT initiative?

Even if knowledge is global, its use is always local

Thank you 16

Evidence Informed Health Policy in Low and Middle Income Countries: An International Forum Addis Ababa, Ethiopia - Aug 28th-30th, 2012 Evidence informed health policy initiatives, cross-country experience Sharing EVIPNet Brazil Jorge O.M. Barreto, M.Sc., Ph.D.(c) EVIPNet Brazil National Council of Municipal Health Secretaries, Brazil Municipal Health Secretary / Health Evidence Center, Piripiri Brazil Nathan M. Souza, MD, MMedEd, PhD(c) Health Research Methodology Program, McMaster University, Canada EVIPNet Brazil, colaborator Slide 01 Good morning everyone, my name is Jorge Barreto. I was requested to share a Brazilian experience with promoting the use of research evidence to support health policy decision making. I have been working with EVIPNet Brazil since its inception in 2007 and with the Secretary for science and technology of the National Council of Municipal Health of Brazil. I have been also a municipal health secretary since 2005 of a small municipality where resources are scarce and need to be used in the best way possible. This municipality is located in Brazil's poorest region is called Piripiri. This presentation was prepared with collaboration of my Brazilian colleague from MacMaster University, Nathan Souza. Slide 2 We will focus on the following points. Slide 3 The introduction of EVIPNet in Brazil may be explained by some factors that made up an important window of opportunity for health policy. The Brazilian Ministry of Health attended in 2007 WHO and its regional Pan-American Health Organization's calls to develop national evidence-informed health policy plataforms through the use of the best research evidence (both global and local evidence) in health policymaking and meaning exchange and collaboration among academia, government, and organized civil society groups. The EVIPNet Brazil initial team was composed by key representatives of the Department of Science and Technology of the Ministry of Health, the Latin American and Caribbean Center on Health Sciences Information (BIREME), and of the three management levels of Brazilian

Unified Health System, namely the National Council of Municipal Secretaries and the National Council of State Secretaries of Health. Brazil has a Unified Health System, the world's biggest universal healthcare system, where the federal, state and municipal federative levels have autonomous but complementary roles, including financing and governance. The federal government is the biggest funder and decision-maker on national policies, but these policies are implemented at the municipal or local government, the biggest executor. However, local governments may also design and implement health policies and programs, many of which constitute innovations that are later on are scaled-up in other Brazilian municipalities. In these national context and favorable international climate, the Brazilian Ministry of Health launched its National EVIPNet team linked to EVIPNet Americas. A deliberative body of EVIPNet Brazil (Consultive Council) was formed and also included partners of health research and civil society. Its creation was regulated by a legal act of the Minister of Health, which strengthened the institutional commitment with such initiative. Slide 04 EVIPNet Brazil operations are guided by a Consultive Council whose mains mandate is to define themes for the national production of policy briefs. However, EVIPNet Brazil's executive secretariat locates at the Knowledge Management General Coordination, which is part of the Department of Science and Technology of the Ministry of Health. The executive secretariat's main mandate is to secure and manage financial resources intended to support the development of the initiative. Slide 05 EVIPNet Brazil's working groups are composed by members of different health management institutions and invited content experts. The working groups' main task is to produce policy briefs as defined by the Consultive Council. As part of capacity building efforts of the EVIPNet Brazil team, there were three workshops. The first workshop took place in Brasilia in 2009 and help to identify researchers and policymakers interested in learn how to use SUPPORT tools and to develop EVIPNet Brazil's work plan. A working group formed in this workshop was responsible to develop EVIPNet Brazil's first Policy Brief. EVIPNet Brazil team attended two other workshops held in Santiago, Chile, in 2009 and 2010. Federal government support fluctuated throughout changes of directors within the Ministry of Health of Brazil, but EVIPNet core team's good will has kept the initiative alive. Slide 06 Now I will talk about some of EVIPNet Brazil's achievements starting with its website.

This is EVIPNet Brazil website. Here you can find methodological materials, news about EVIPNet activities, policy briefs and other relevant resources to health managers, workers and civil society. This is a user-friendly portal designed for decision makers with little health research training. Its aim is to improve access to relevant research evidence and to promote exchange among academia and decision makers. Slide 07 EVIPNet Brazil's team deployed five workshops to train decision makers to systematically and transparently use of research evidence. We followed the SUPPORT Tools. These workshops were held during annual meetings of the National Council of Municipal Health Secretaries, CONASEMS. They helped to build an important partnership between EVIPNet Brazil and CONASEMS. Their evaluation was published in Portuguese and contains excellent feedback from participants. This year's workshop was held in Maceio (Alagoas) included in addition to municipal managers, members of the Ibero-American Observatory of Health Systems and Policies, hence comprised a more qualified audience of managers and researchers. Another activity was the extremely positive workshop for African participants from Portuguese speaking countries, such as Cape Vert, Guinea Bissau and Mozambique. The format adopted for these workshops was adapted to the Brazilian context, but the objectives remain aligned to SUPPORT Tools. All material used in these workshops are available on the EVIPNet Brazil website, which includes videos. Slide 08 These are some pictures taken during these workshops. Slide 09 This is EVIPNet Brazil's first policy briefs whose focus was on perinatal mortality that affects especially the states of North and Northeast, Brazil's poorest regions. The policy brief presents low cost and cost-effective options to address perinatal mortality mainly through Primary HealthCare interventions. Perinatal mortality was prioritized by EVIPNet Brazil's Consultive Council as it situated in the Brazilian political agenda since when Brazilian Ministry of Health signed the Millennium Development Goals. The goal to reduce child mortality has been achieved in Brazil, but significant regional inequalities still exist. This policy brief was widely disseminated among municipal health managers in regions most affected.

Slide 10 Aiming to promote transparency and accountability, the EVIPNet Brazil prepared and publicized a report with its activities as perits action plan for 2009-2010. Slide 11 Another interesting result of EVIPNet Brazil is the Piripiri Evidence Center. This initiative innovates with experiences with the systematic use of research evidence in local decision-making. As mentioned previously, the Brazilian unified health system has three levels of management, but the municipal level is responsible for policy implementation. Nonetheless, municipalities can also create, adapt, and implement policy options. This allows local governments to clarify not only what can be ‘done’ to improve policy results, but also ‘how to do’ these options as to achieve best effects. The Piripiri Evidence Center was launched in 2010 and was strongly influenced by EVIPNet Brazil. The Piripiri Evidence Center built local government capacity to produce evidence briefs, to conduct deliberative dialogues, and most importantly, help to promote cultural and institutional change towards the use of scientific knowledge as an input in health policy making and implementation. Slide 12 In this slide we highlight Piripiri Evidence Centre and its evidence briefs. Slide 13 EVIPNet Brazil also disseminate their activities and results both nationally and internationally. Articles published in Brazilian journals, participation in scientific meetings and reports in the institutional website of the Piripiri municipality ensure that we achieve to communicate for decision-makers, academics and civil society. Slide 14 Well, EVIPNet Brazil has still much to develop and accomplish. Currently the next steps of EVIPNet Brazil are being designed jointly by various institutional partners. Some approaches must be kept, others represent innovations to be monitored and evaluated. An important step towards its sustainability is for EVIPNet Brazil to expand its supporting network including institutionalization at all levels of management and health research that wish to join the effort to promote the use of evidence through the translation of knowledge produced by health, social and economic research.

We are convinced that for EVIPNet Brazil to florish further, it is fundamental to convince the whole Ministry of Health of the power of evidence-informed policymaking, specially considering the multilayer structure of the Brazilian national health system, the best effects will most likely obtained if the implementers are included among evidence users situated in all levels of government. Thank you all for your attention.

EVIPNet Piripiri Brazil at the EIHP Addis Ababa 2012