Thanzi la Onse has cultivated an approach to research-to-policy engagement in health and health economics by establishing equitable partnerships between national universities and ministries of health in Malawi, Uganda and throughout the East Central and Southern African region and international research partners such as York, Imperial, UCL and ODI. As TLO looks to its next phase from 2022, we explore our plans for applying this approach to other contexts across Africa.
TLO is built around a core belief that policy-making on resource allocation can best be achieved by combining excellent research, research-to-policy engagement and capability strengthening; leading to population health improvement. This requires researchers to co-produce research alongside policy-makers and implementers and, by combining methods development and applications, to produce generalisable and practical methods/ tools to address user needs. It also requires upskilling and training for researchers and policy-makers to generate, use, critique and apply evidence that is relevant for policy-making.
In the contexts in which TLO operates, the challenges of resource allocation are particularly stark owing to severe shortages in available resources, including budgets and key health care workers. Further, policy decisions are often made with limited relevant evidence that is suitable for the context. TLO has collaborated with national and regional health research and policy communities to establish new engagement platforms through which better and more relevant evidence can be generated, and also supported the uptake of this evidence into policy. We are now exploring how this approach can best be adapted to address the needs of other health systems across Africa.
National units in health economics and policy
TLO supported the set-up of two new Health Economics and Policy Units in Malawi and Uganda in 2018 and 2020. These units sit between the national Ministry of Health Planning Departments and the College of Medicine (Malawi) and Makerere School of Public Health (Uganda), and provide a platform through which policy-makers and health researchers can engage with each other on priority policy challenges and co-design research.
Locating these units at public universities has been important to their success to date, as they can capitalise upon their host institutions’ strong and trusted links with policy-makers but be afforded an independence to carry-out research removed from government politics. As leading national higher education establishments, the host institutions also have capacity to offer training opportunities via the hubs.
Since their establishment, the two hubs have led on major health research projects and contributed towards large-scale public health decisions. The Malawi Health Economics & Policy Unit (HEPU) has hosted frequent Think Tank and Policy Lab workshops (read more here), including hosting the Extraordinary COVID-19 Think Tank in mid-2020. HEPU has also facilitated research into the design of a resource allocation formula to inform geographic resource allocation (read the corresponding paper here), and a health technology assessment framework for Malawi. The Uganda Health Economics & Policy Programme (HEPP) – launched in late 2020 – is leading on developing a benefit package for community health care, adapting and further advancing the methods designed and honed in Malawi by TLO.
The early successes enjoyed by the HEPU and HEPP have generated interest from others in the ECSA and West Africa region to set-up similar initiatives in their contexts. TLO is working with teams in Eswatini, The Gambia, Ghana, Senegal and Zimbabwe on designing plans for new health economics and policy units; the specific demands for health economics capacity in each context, as well as plans for the governance of such units, are detailed in the individual reports linked at the end of this blog.
Regional communities of practice in health economics
In 2018, the East Central and Southern Africa Health Community (ECSA-HC) worked with TLO to establish the ECSA-HC Health Economics Community of Practice (COP). This is a network of academics and health decision-makers from all nine ECSA-HC members who are interested in using health economics to address resource allocation challenges in their contexts. A baseline mapping exercise undertaken with the COP revealed that, among member states, few individuals are trained in health economics and, as such, those who are often feel isolated from others in the field. The COP helps to provide a community to support these specialists to network, learn from and support each other.
The COP meets frequently to discuss common challenges affecting members and to undertake training in health economics topics (identified as being a priority for members). To date, TLO has delivered short courses in health benefit package design and health financing to the COP and, since 2020, ECSA-HC has hosted a webinar series for the COP with regional experts in fields such as refugee health, HTA and digital health (watch previous webinars here). ECSA-HC also co-manages the Global Health Economics Hub (globalhealtheconomics.tghn.org), where training resources are made freely available alongside a private COP discussion forum.
The longer-term ambitions for the COP, including plans for how ECSA-HC could partner with the HEPU and HEPP to evolve the COP into a new ECSA-HC accredited college, are detailed in the report at the end of this blog. ECSA-HC and TLO are also now working closely with the West African Health Organization (WAHO) to design a second health economics COP serving WAHO members.
As the first phase of TLO draws to a close at the end of 2021, we are looking ahead to how we may support the continuation and expansion of these national and regional initiatives. TLO’s existing partners in Malawi, Uganda, the UK and at ECSA-HC are pleased to be joined by new collaborators in Eswatini, The Gambia, Ghana, Senegal, Zimbabwe and at WAHO, to develop the Thanzi la Onse-Africa Partnership. This larger network aims to facilitate the set-up of new health economics and policy units, as well as the launch of WAHO’s health economics community of practice.
The expansion of the TLO network and ECSA-COP approach into West Africa corresponds with a new collaborative initiative with the African Union and Global Fund, working on a strategy for establishing and funding regional health economics units across Africa. This initiative stems from a 2019 African Union resolution to develop five knowledge and training hubs across the continent dedicated to health economics and financing. It is our longer-term ambition that the Thanzi la Onse-Africa Partnership will provide a framework through which these other regional units can be established.
Development of a national Health Economics and Policy Unit in Eswatini | Mr. Dumisani Shongwe | March 2021
The Gambia National Health Economics and Policy Unit: Final Concept Note | Mr Gibril Jarjue; Dr Paul Bass; Mrs Haddy Badjie; Mr Yaya Barjo | April 2021
Opportunities for a Health Economics and Policy Unit (HEPU) in Ghana: a concept note | Dr. Emmanuel Ankrah Odame; Dr. Ama Fenny; Prof. Justice Nonvignon | March 2021
Malawi report (forthcoming)
Senegal report (forthcoming)
Uganda report (forthcoming)
National Health Economics and Policy Unit (HEPU) in Zimbabwe | Prof. Albert Makochekanwa; Mr. Stephen Banda; Mr. Benson Mutongi Zwizwai | March 2021
Advancement of the ECSA Health Economics Community of Practice | Mr. Edward Kataika; Mr. Sibusiso Sibandze | March 2021
WAHO report (forthcoming)
By: Alexandra Rollinger and Paul Revill | March 2021