Sultana Al Sabahi1, Kamila Al-Alawi2, Alaa Hashish2, Jean Jabbour2
1Centre of Studies and Research, Ministry of Health, Muscat, Oman (Correspondence: S. Al Sabahi:
Abstract
Background: Policy-makers do not just consider the general question about what works; they also consider whether it will work in their context, and take into account social values such as affordability, acceptability, equity, equality, and human rights.
Aims: To explain the importance of having a system to govern evidence to inform policies, and reflect on the efforts of the Omani system to support evidence-informed policy-making. Methods: We reviewed the literature and analysed local documents.
Results: Because of the political nature of policy-making, good evidence for policy is judged by its relevance to the policy issue at stake.
Conclusion: Evidence-informed policy-making should focus on building a system for the good governance of evidence to ensure that rigorous, systematic, and technically valid evidence is used within policy-making processes.
Keywords: evidence-informed decision-making, evidence-informed policy-making, good governance, Oman
Citation: Al Sabahi S, Al-Alawi K, Hashish A, Jabbour J. The evidence governance system in Oman: what is it, why is it needed, and the current situation. East Mediterr Health J. 2023;29(8):xxx-xxx http://doi.org/10.26719/emhj.20.xxx Received: 28/09/22, Accepted: 22/12/22
Copyright: © Authors; licensee World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Introduction
It is recognized that for any action and decision, information is needed to determine whether the stated goals have been achieved or to guide the selection of potential options to achieve those goals. Evidence is what provides this information. Evidence-informed policy-making refers to using the best-available evidence to inform policies systematically and transparently (1). Despite the vast amount of evidence, which varies between personal experience, tacit knowledge, and the more systematic findings from organized professional research, advocates of evidence-informed policy-making have only promoted scientific evidence as the form best suited to guiding policy-making (2). However, the concept of evidence-informed policy-making has evolved to better address the political aspects associated with decision-making (e.g. interest groups, public opinion, economic situation, and role of institutions). This article aims to: (1) clarify the difference between evidence-based medicine and evidence-informed policy-making; (2) explain the importance of systems to govern evidence to inform policies; and (3) reflect on the efforts of the system in Oman to support evidence-informed policy-making. This is crucial to countries in the process of bringing evidence-informed policy-making into operation, and it is timely for Oman as the Government announced on 13 November 2022 establishment of a decision-making support unit under the General Secretary of the Council of Ministers (3).
Evidence-based medicine versus evidence-informed policy-making
Evidence-based medicine focuses on research to evaluate the effectiveness of interventions (4). There is a hierarchy of research evidence, with meta-analyses and randomized controlled trials considered to be the gold standard (5). The value placed on evidence-based medicine and its perceived success have provoked application of its basic principles to policy development (4), and there have been increased calls to use scientific evidence in policy-making (6).
Policy-makers need to consider whether their policies will work in their particular context (7). Various social factors may not be feasible for experimentation; for example, affordability, acceptability, equity, equality, and human rights (8). While good evidence in medicine is judged by its hierarchy, good evidence for policy-making is judged by its relevance to the issue at stake and then by its methodological quality (9). This is because evidence hierarchies were originally designed to judge the effectiveness of interventions rather than reflecting policy importance or relevance (8). Despite the difference in the approach to selecting what is considered good evidence for medicine and policy-making, evidence-based medicine and evidence-informed policy-making emphasize the importance of selecting, assessing, and synthesizing evidence systematically and transparently (10).
A system to govern the use of evidence in policy-making
To understand the need for a system to govern the use of evidence in policy-making, we need first to understand the political nature of policy-making. Politics is about who gets what, when, and how (11). Allocating scarce resources and setting priorities are the main concerns with policy-making (12). Hence, policy-making involves trade-offs between multiple, potentially competing social values, and it is considered to be a political process (12). This feature differentiates policy decisions from technical exercises, which have, in most circumstances, a single agreed outcome. In contrast, society has no consensus about which social outcomes are paramount or how to judge their particular value. The lack of agreement in the desired outcomes creates the potential for misuse or bias in using evidence to inform policies. The political bias in utilizing evidence might occur during: (1) evidence creation (e.g. manipulation of studies, or strategic design to achieve a desired outcome, even if the research is conducted in rigorous and valid ways, bias might occur in selecting which issues to research, how to study them, and what questions to ask within a study) (13); (2) evidence selection (e.g. ‘cherry-picking’ and strategic review of data to justify a predetermined position) (14); or (3) evidence interpretation (e.g. interpreting methodological rigour as an indication of policy relevance, or judging the quality of evidence based on the method alone) (15).
Evidence-informed policy-making should not focus on merely acquiring more evidence. Instead, it should focus on building a system to enhance the governance of evidence to inform the policy-making process in a systematic, rigorous, and technically valid way (8). These processes should be inclusive of, representative of, and accountable to the multiple social interests of the population served (8). Institutionalization of evidence-informed policy-making through a governance system is important to ensure system-wide and deeply rooted change in utilizing evidence. It should also avoid limitations associated with strategies that focus on individuals (e.g. connecting policy-makers and researchers, providing decision-makers with evidence, or providing training to individuals to broker knowledge) who might, over time, change roles or leave their positions (16).
In many countries, such a system has been created through building organizations that work to enhance the utilization of evidence in policy-making. These organizations can exist in different settings (e.g. as independent organizations, within universities, and as part of government departments) and have been called different names (think tanks, government-support organizations, and research centres) (15). It is important to note that institutions are no longer limited to simply being the administrative bodies or physical structures within a system. Currently, institutions are presented in the practices they embark upon, the rules by which they function, and the discursive narratives by which their work is comprehended (17). Therefore, creating a system to improve evidence utilization could be through construction or changing the existing structures that are concerned with evidence utilization, or by introducing changes to the principles by which those institutions function (8).
Components of evidence governance system in Oman
In Oman, the government has shown increasing interest in research and innovation in the last few decades. Several health centres in the health and non-health sectors have been established (e.g. Centre of Studies and Research at the Ministry of Health and the Medical Research Centre at Sultan Qaboos University). The Research Council (which is currently under the Ministry of Higher Education Research and Innovation) was established to be the funding body for research and innovation. The Government has reflected its interest in utilizing research findings through the Oman 2040 Vision, which emphasizes the importance of achieving their goals through sound and positive guidance and systematic evidence-based planning, and the importance of a knowledge-based economy (18). The Ministry of Higher Education Research and Innovation announced for 2022 a research funding programme that will target priority areas at the Ministry of Health and Ministry of Agriculture, Fisheries, Water, and Water Resources. This programme mandates the involvement of policy-makers in selecting priories, priority research to be funded, and developing a plan to implement the research findings. The Government of Oman has reinforced its interest in evidence-informed policy-making through its intention to establish a unit to support decision-making (announced 9 November 2021 and officially established on 13 November 2022) (3).
Oman has some institutional structures to support the utilization of evidence. For instance, the Ministry of Health has tasked its policy advice officers and technical advisors with planning, providing policy options, or commenting on proposed policies. These strategies may provide direct and well-integrated channels for expert advice, yet the appropriate capacity and capability remain challenging for such bodies. Another challenge is the lack of clarity in the mandate for utilizing evidence and limiting the scope of subjects for which such bodies can function. On other occasions, the Government convenes expert panels or technical working groups (e.g., Supreme COVID-19 Committee and Oman 2040 Vision Committee) to inform specific decisions, giving such groups different levels of autonomy.
There is evidence that policy-makers recognized the importance of evidence and used it to inform policies (19). However, it was not clear how that evidence was selected and synthesized, and in what way it informed policies. It is unclear which social values guided the policy decisions and whose voices were heard. These rules, norms, and procedures are important to achieve the core principle of evidence-informed policy-making (i.e. transparent and systematic utilization of evidence to serve the social values of the population). By institutionalization of the practice of evidence-informed policy-making in such approaches, we can envision how systems will mature and how evidence utilization will be improved.
Conclusion
Evidence-informed policy-making is the practice of informing policies with the best available evidence in a systematic and transparent manner. Policy-making is a struggle over different ideas and social values; therefore, scientific evidence and social values have both to be considered. Unlike evidence-based medicine, scientific evidence cannot be merely judged by its rigorous methods to inform the policy-making process. Instead, relevance is more important. As a result of the political nature of policy-making, bias in creating, selecting, or interpreting evidence can occur and affect achievement of the intended social goal. Therefore, efforts to support evidence-informed policy-making should be shifted from focusing on individuals to institutions. The institutions should consider the physical structure as well as the rules, norms, and regulations that mandate the good use of evidence in policy-making. Oman has shown interest in utilizing evidence to support policy-making. Different bodies have been working on different rules to support evidence-informed policy-making; however, the Government of Oman needs to create the mandates, rules, and regulations that ensure the institutionalization of good practice in utilizing evidence in policy-making. Besides establishing formal structures, the Government of Oman should focus on creating procedures, norms, rules, or even laws that reduce bias or improve reasonable scientific practice in policy-making. If the Government of Oman takes into consideration the points raised in this article when bringing into operation a decision-making support unit, it will help it take robust steps towards achieving its goal of informing public policies with the best-available evidence.
References
1. Annual Report 2017. EVIPNet Europe. Towards a world in which the best available research evidence informs policy-making (http://www.euro.who.int/__data/assets/pdf_file/0004/368833/Annual-report-2017-for-EVIPNet-Europe.pdf?ua=1, accessed 28 March 2023).
2. Iphofen R, O’Mathúna D. Ethical evidence and policymaking: interdisciplinary and international research. Bristol: Policy Press; 2022.
3. To amend the organizational structure of the General Secretariat of the Council of Ministers 2022. Oman: Ministry of Justice and Legal Affairs; 2023 (https://www.mjla.gov.om/legislation/gazettes/details.aspx?Id=626&type=G, accessed 20 March 2023).
4. Sheldrick RC, Hyde J, Leslie LK, Mackie T. The debate over rational decision making in evidence-based medicine: implications for evidence-informed policy. Evid Policy. 2021;17(1):147–59. https://doi.org/10.1332/174426419X15677739896923
5. Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017 Jul 22;390(10092):415–23. https://doi.org/10.1016/S0140-6736(16)31592-6 PMID:28215660
6. Godziewski C. Evidence and power in EU governance of health promotion: discursive obstacles to a “health in all policies” approach. J Common Market Stud. 2020 Sep;58(5):1307–24. https://doi.org/10.1111/jcms.13042
7. Cairney, P., & Oliver, K. (2017). Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?. Health research policy and systems, 15(1), 1-11.
8. Parkhurst J. The politics of evidence: from evidence-based policy to the good governance of evidence. Routledge; 2017.
9. Parkhurst JO, Abeysinghe S. What constitutes “good” evidence for public health and social policy-making? From hierarchies to appropriateness. Soc Epistemol. 2016;30(5–6):665–79. https://doi.org/10.1080/02691728.2016.1172365
10. Shaw L, Nunns M, Briscoe S, Anderson R, Thompson Coon J. A “Rapid Best‐Fit” model for framework synthesis: using research objectives to structure analysis within a rapid review of qualitative evidence. Res Synth Meth. 2020 May;12(3):368–83. https://doi.org/10.1002/jrsm.1462 PMID:33006277
11. Bhan T. Deserving poor in public sanitation: tracing the policymaking processes of who gets what, when, how, and why in Delhi. Environ Plan B Urban Analyt City Sci. 2022;49(8):2151–67. https://doi.org/10.1177/23998083221089325
12. Woods B, Rothery C, Revill P, Hallett TB, Phillips AN, Claxton K, editors. Setting research priorities in Global Health: Appraising the value of evidence generation activities to support decision-making in health care. York: Centre for Health Economics; 2018.
13. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2017 Feb 16;2(2):MR000033. https://doi.org/10.1002/14651858.MR000033.pub3 PMID:28207928
14. Schoofs EL, Fode M, Capogrosso P, Albersen M, Group ftEAoUYA. Current guideline recommendations and analysis of evidence quality on low-intensity shockwave therapy for erectile dysfunction. Int J Impot Res. 2019 May;31(3):209–17. https://doi.org/10.1038/s41443-019-0132-0 PMID:30911110
15. Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K. Examining and contextualizing approaches to establish policy support organizations – a mixed method study. International J Health Policy Manag. 2021 Aug 7;11(9):1788–800. https://doi.org/10.34172/ijhpm.2021.86 PMID:34380206
16. Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K, Vélez M. Examining and contextualizing approaches to establish policy support organizations – a critical interpretive synthesis. Int J Health Policy Manag. 2022 May 1;11(5):551–66. https://doi.org/10.34172/ijhpm.2020.181 PMID:33008260
17. Lowndes V, Roberts M. Why institutions matter. The new institutionalism in political science. Bloomsbury; 2013.
18. Oman Vision 2040. Moving forward with confidence. Oman: Ministry of Finance; 2020 (https://www.mof.gov.om/pdf/Vision_Documents_En.pdf, accessed 20 March 2023).
19. Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K. Insights from system leaders about operationalising a knowledge translation department in the Oman Ministry of Health. Evid Policy J Res Debate Pract. 2021;18(1):85–107. https://doi.org/10.1332/174426421X16123709152129
