R ES E A R C H Open Access
The challenge of bridging the gap between
researchers and policy makers: experiences
of a Health Policy Research Group in
engaging policy makers to support
evidence informed policy making in Nigeria
Benjamin Uzochukwu
1,3,4*
, Obinna Onwujekwe
2,3,4
, Chinyere Mbachu
3
, Chinenye Okwuosa
3
, Enyi Etiaba
3,4
,
Monica E. Nyström
5,6
and Lucy Gilson
7
Abstract
Background: Getting research into policy and practice (GRIPP) is a process of going from research evidence to
decisions and action. To integrate research findings into the policy making process and to communicate research
findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in
a Nigerian university when seeking to ‘do’ GRIPP, and the important features and challenges of this process within
the African context.
Methods: In-depth interviews were conducted with nine purposively selected policy makers in various organizations
and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected
joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and
experience of the methods and processes used by the HPRG to generate research questions and research results; their
involvement in the process and whether the methods were perceived as effective in relation to influencing policy and
practice and factors that influenced the uptake of research results.
Results: The results are represented in a model with the four GRIPP strategies found: i) stakeholders’ request for
evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders
seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the
research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research
findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and
policymakers.
The challenges to research utilization in health policy found were to address the capacity of policy makers to demand
and to uptake research, the communication gap between researchers, donors and policymakers, the management
of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research
funding and the resistance to change.
(Continued on next page)
* Correspondence: bscuzochukwu@gmail.com
1
Department of Community Medicine, College of Medicine, University of
Nigeria, Enugu-campus, Nigeria
3
Health Policy Research Group, College of Medicine, University of Nigeria,
Enugu-campus, Nigeria
Full list of author information is available at the end of the article
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Uzochukwu et al. Globalization and Health (2016) 12:67
DOI 10.1186/s12992-016-0209-1
(Continued from previous page)
Conclusions: Country based Health Policy and Systems Research groups can influence domestic policy makers if
appropriate strategies are employed. The model presented gives some direction to potential strategies for getting
research into policy and practice in the health care sector in Nigeria and elsewhere.
Keywords: Getting research into policy and practice, Nigeria
Background
The importance of getting research evidence into policy
and practice (GRIPP) is widely acknowledged in litera-
ture [1–5]. Over the recent years there has been a prolif-
eration of literature focusing on knowledge utilization
and how health policy and practice can be better in-
formed by evidence [6–8]. Two broad issues are involved
in the GRIPP process namely; engaging the stakeholders
and using evidence in decisions [1]. The goal of GRIPP
is to ensure knowledge translation, knowle dge transfer,
knowledge exchange, research utilization, implementa-
tion, diffusion, and dissemination [9]. Other studies have
noted that when the public is adequately engaged, there
may be increased research uptake especially when civil
society organizations, mass media and consumers are in-
volved [10–15]. Adequately engaging the public is only
one conclusion of the literature and experience on this
topic and not the only solution to the problem.
Several factors have been identified to influence get-
ting research into policy. In addition to linkages between
researchers and practitioners, others include attributes
of the research (in terms of cost, flexibility, complexity,
reversibility , relative advantage, risk, reversibility and
comparability), the characteristics of the researcher,
practitioner characteristics and the method of dissemin-
ation of researc h results [16].
There are an increasing number of ways to enhance
the use of research in health [17]. However, the greatest
challenge influencing the use of research in policy mak-
ing is that research is only one of the inputs to be con-
sidered by policy makers amongst many other legitimate
inputs [18]. This includes the interest of the actors or
decision makers in the policy process which influences
the direction of the policy and this poses threats to
decision makers’ use of research evidence in taking de ci-
sion. Other authors have also highlighted best prac-
tices in promoting the use of research e vidence in
policy [1, 19]. Key factors include the timeliness and
relevance of finding s; th e production of credible and
trustworthy report s; close personal contacts with pol-
icy makers and summaries of findings that present
key actionable recommendations.
Despite these best practices , the gap between re-
search and policy and practice is still very wide, es -
pecial ly in low and middle-inc ome countries (L MIC ).
The failure of take-up of high-quality research
evidence by decision makers ha s been called the gap
between research and policy. Researchers have de-
voted much time and energy to talking about bridg-
ing the gap between research and decision making,
yet significant gaps still exist between the two. Four
misunderstandings between theevidenceproduction
and the policy-making effort have been identified.
The first point is that researchers and policy makers
consider each other’s activity as generating products
instead of engaging in processes; se cond, s cientific
research attempts to focus the question so that a
clear and crisp answer can be provided whereas
policy ma king t ake other variables such as interests,
ideology, values, or opinions into account. Third,
decision makers are not sensitive to the incentives
that drive researchers like attracting grant money
and publishing in peer-reviewed journals and not
responding to a current issue before the government
policy makers. Fourth, resea rchers rarely take into
account the different audienc es that would be audi-
ences for their research [20].
Other researchers have also stated that one of the rea-
sons for the gap is because policy makers rarely convey
clear messages about the policy challenges they face in
their specific context to allow for tim ely and appropriate
research agenda s and researchers on the other hand
often produce scientific evidence that is not always
tailor-made for application in different contexts [21].
Other common obstacles in this regard are centralized
decision making and a policy making culture that gives
little importance to e vidence based [22].
In Nigeria, the use of research findings by policy
makers and communities has been described as very
limited and challenging and can be explained by the lack
of communication between researchers and policy
makers, and the lack of involvement of policy makers
and the community in determining the research to be
done [23]. Also, the research-to-pol icy linkages have
been generally described as weak [24]. Some factors have
been cited for the low uptake of research by Nige rian
policymakers including the lack of high-quality research,
generally weak and unreliable research institutions and
think tanks and apparent disconnect between re-
searchers and policymakers [25]. There is little inter-
action between policymakers and researchers, thus
meaningful discuss ion of available research findings,
Uzochukwu et al. Globalization and Health (2016) 12:67 Page 2 of 15
their suitability to policy-related problems, and identifi-
cation of other policy areas requiring research attention
is severely lacking [25].
There is also dearth of studies or development in
Nigeria that promote evidence-informed policy making
involving meetings between researchers and po licy
makers. Although an innovative effort has bee n made to
bridge the gap between researchers and policy makers
[26], such effort concentrated on organizing a 1-day
evidence-to-policy forum/workshop and the effect of this
intervention on their practice and actually getting
research into practice is yet to be evaluated.
Research organizations serve a useful function of link-
ing policy makers, yet the .work of these organizations is
sometimes not fully appreciated by policymakers either
because researchers do not fully understand the policy
process or do not know how to communicate effectively
their research findings to policymakers. Therefore, how
can country Health Policy and System Research (HPSR)
organisations and groups seek to engage policy mak ers
over time and across projects and experiences, and
sometimes in collaboration with others? The wider lit-
erature focussed on projects because so much of the
thinking is linked to donor-funded individual projects.
This paper therefore reports the experiences of HPSR
group in a Nigerian university when seeking to ‘do’
GRIPP, and describe the important features and chal-
lenges of this process within the African context. The
research will contribute to the body of knowledge on
how to bridge the gap between researchers and policy
makers in Nigeria and elsewhere.
Background of the Health Policy Research Group (HPRG)
The HPRG is a mult i-disciplinary group based in the
College of Medicine of the University of Nigeria,
Enugu-campus. It was founded in 2004 and is dedi-
cated to conducting public health, policy-relevant re-
search and analysis to inform policies, providing
policy advice and technical assistance in policy formu-
lation and e valuation a nd conducting policy dialogues.
The HPRG has established regular and wide-ranging
communication and information with policy makers
in Nigeria and is involved in various capacity building
programmes for local policy makers, CSOs and mem-
bers of the academia. The HPRG ha s over the years
increased the levels of ac credited research outputs
and publications and is currently a member of several
international health policy and system consortia in-
cluding the Consortium for Health Policy & Systems
Analysis in Africa (CHEPSAA) http://www.hpsa-afri
ca.org. and Responsive a nd Resilient Health Systems
(RESYST) http://resyst.lshtm.ac.uk. The HPRG is in-
volved in: Conducting policy-rele vant research and
analysis; Providing policy advice and technical
assistance in policy formulation and evaluation; con-
ducting policy dialogues at national and i nternational
levels , that is bringing together policy makers, civil
society and researchers to draw upon evidence and
debate key policy questions; training and capacity de-
velopment for policy makers;
Methods
This paper analysed the various stages and experiences
from seven selected cases where studies conducted by
the HPRG were investigated with a specific focus on
how the finding s from these studies had influenced pol-
icy or managerial practice.
The seven cases that represent most of the experiences
of HPRG over the ye ars in three States of Nigeria
(Enugu, Anambra and Lagos) were selected by the au-
thors to demonstrate the different approaches the HPRG
has utilised in seeking to influence policy and/or man-
agerial practice in these states, the important features of
these approaches and challenges encountered. These
cases were purposively selected from a number of stud-
ies conducted by the group because they all show evi-
dence of influencing policy and practice in these States.
These cases were not full sample of the group ’s recent
studies selected but a sample selected to reveal the dif-
ferent types of experience we have. The other studies
conducted by the group were excluded because they
have not shown any clear evidence of influencing policy
and practice. The cases involved a variety of projects,
some mainly initiated by researchers and some by policy
makers. The authors examined these cases both from
the stakeholder/policymaker and researcher perspective.
Fifteen respondents who were purposively sele cted
were interviewed in this study. The 15 respondents were
purposively selected because the policy makers and
stakeholders were either involved in the various cases or
were involved in policy making or were end users of the
research findings and in a position to influence policy.
The HPRG researchers and other researchers were se-
lected because they were involved in one or more of the
studies. Beyond the 15 interviews, the writing team has
inside knowledge of these cases and this knowledge is
being used in the paper and was tested and extended
through the interviews.
Data collection
In-depth-interviews using an interview guide based on
the objectives of the study were used to explore their ex-
periences with reference to the selected cases. Out of the
fifteen respondents interviewed, eight were stakeholde rs/
policymakers in various organizations who had different
types of engagement with HPRG and six researchers
who had been involved in one or more of the cases , and
one researcher who is also a policy maker.
Uzochukwu et al. Globalization and Health (2016) 12:67 Page 3 of 15
Information w as collected on stakeholder involve-
ment in generation of resea rch questions, research
process (data collection and analysis), generation of
results and dissemination of findings. Responses were
also colle cted on the various methods of dissemin-
ation of finding s employed by the HPRG, and their
opinion on which methods that might have worked
best for GRIPP. Furthermore, information on factors
supporting effectiv e policy engagement and challenges
to research utilization in health policy were collected.
The responses from the HPRG researchers who were
part of the respondents were validated in a feedback
meeting after data collection.
Data analysis
Thirteen of the fifteen interviews were audio re-
corded and notes were taken. Audio files were tran-
scribed verbatim and subsequently edited. Two
inter views were not recorded, but detailed notes were
made of the interviews. Conventional content manual
analysis (inductive) [27] was used in da ta analysis.
This involved a process of generating of a provisional
list of codes/themes that were based on the research
questions and study objectives including (stakeholder
involvement in generation of research questions , re-
search process, gene ration of results and dissemin-
ation of findings, various methods of dissemination
of findings employ ed by the HPRG, and the ir opinion
on which methods that might have worked best for
GRIPP, factors supporting e ffective policy engagement
and challenges to research utiliz ation in health pol-
icy); familiarization with the transcript s to identify
recurrent/common themes (initial coding); develop-
ment of the final coding scheme for analysis; applica-
tion of the coding scheme to the qualitative data;
sorting and grouping of coded data to add a more
detailed layer of meaning; and exploration of rela-
tionships between the themes. All interview tran-
scripts were coded manually by 2 people to reduce
inter-coder variability.
Results
The analyses indicated three main ways of engagement
between researchers and policy-makers and four more
detailed strategies to support evidence informed policy
making. This is further presented below and represented
in Table 1 and Fig. 1.
The cases selected were categorised into 3 broad types
of research-policy engagement: I) Policy maker-initiated
empirical research studies; II) Projects directly address-
ing GRIPP it self; and III) Researcher-initiated empirical
research studies (Table 1).
I. Policy maker-initiated empirical research studies
Strategy 1: Policymakers and donors seeking evidence from
researchers
In this strategy, stakeholders request evidence on imple-
mentation/scaling up. The research is either funded by
policy and decision makers or funded by an external
agency if the proposal is accepte d. Thus the strategy is
about being respons ive to opportunities created by
policy makers calling for evidence. Two cases are used
to illustrate this:
1. “Wil lingness to pay and benefit-cost analysis of
modern contraceptives in Nigeria”
HPRG was approached by the United Nations Popula-
tion Fund (UNPF) Nigeria, to conduct a study in order to
generate evidence for the national population policy evalu-
ation. The study provided new knowledge on the max-
imum amount of money that people from different
socioeconomic groups and from urban versus rural resi-
dential areas was willing to pay for the main contracep-
tives available in Nigeria and also shed light on factors
which explain the WTP decisions in the Nigerian context.
2. “Examining appropriate diagnosis and treatment of
malaria: availability and use of RDTs and ACTs in
public and private health facilities in south east
Nigeria”.
Here, the HPRG was approached by the Enugu State
ministry of health to assess the availability and use of RDTs
and ACTs in public and private health facilities in Enugu.
There is evidence of the usefulness of the results for
policy in Enugu State as stated by respondents thus: “We
wanted to know the status of RDTs and ACTs in our
State so, we approached HPRG to see if they can come
up with something for us as we didn’t have any evidence
of what was happening with respect to these malaria
control commodities”(Policy maker, Enugu State)
“We used the result of availability and use of rapid
diagnostic tests and artemisinin-based combination
therapy in public and private he alth facilities study
when we were supplying RDTs and ACTs to our
health center s………….the study guided us very well
and we have RDTs and ACTs all over the facilities
now” (Policy maker Enugu State)
In the two case examples, continuous stakeholder
engagement was essential and employed for the effective
translation and dissemination of research evidence . Thus
beyond the stage of setting the objectives, contact with
stakeholders was active and maintained through bi-
monthly face-to-face updates on the process .
Uzochukwu et al. Globalization and Health (2016) 12:67 Page 4 of 15
Table 1 Research-policy engagement groups and strategies
Type of research-policy
engagement
Strategies Project name Citation Date of conduct Geographic
location
Main focus
Policy maker-initiated
empirical research studies
Policymakers and stakeholders
seeking evidence from
researchers (S1)
Examining appropriate diagnosis
and treatment of malaria:
availability and use of RDTs and
ACTs in public and private health
facilities in south east Nigeria
Benjamin SC Uzochukwu, Lausdels O
Chiegboka, Chibuike Enwereuzo et al.
Examining appropriate diagnosis and
treatment of malaria: availability and
use of rapid diagnostic tests and
artemisinin-based combination therapy
in public and private health facilities in
south east Nigeria. BMC Public Health
2010, 10:486
2009 Enugu Malaria Diagnosis
Willingness to pay and benefit-
cost analysis of modern
contraceptives in Nigeria
Onwujekwe O, Ogbonna C, Ibe O,
Uzochukwu B (2013). Willingness to
pay and benefit-cost analysis of
modern contraceptives in Nigeria: an
equity analysis. International Journal of
Obstetrics and Gynaecology. 122(2):
94–98.
2013 Enugu Family Planning
Involving stakeholders in
designing objectives of a
research and throughout
the research period (S2)
Promoting universal financial
protection: constraints and
enabling factors in scaling-up
coverage with social health
insurance in Nigeria.
Chima Onoka, Obinna Onwujekwe,
Benjamin SC Uzochukwu, Nkoli Ezumah.
Health Research Policy and Systems
06/2013; 11(1):20. DOI: 10.1186/1478-
4505-11-20
2012 Enugu and
Abuja
National Health
Insurance
Establishment of Monitoring and
Evaluation (M & E) systems for the
Anambra Malaria Control Booster
Project (MCBP)
Onwujekwe OE & Uzochukwu BSC.
Establishment of Monitoring and
Evaluation (M & E) systems for the
Anambra Malaria Control Booster
Project (MCBP). Project Report
2009–2011 Anambra Monitoring and
Evaluation
Projects directly addressing
GRIPP itself
Facilitating policy maker-
researcher engagement in
best ways of using research
findings to influence policy
and practice (S3)
The PREVIEW (Policy Research
EVIdence for Effective Working of
the Nigerian health systems) project-
Concept and implementation
Onwujekwe O, Uzochukwu B. 2013.
Policy Research Evidence for Effective
Working of the Health Systems.
Technical Report, Nigerian Academy
of Science. www.nas.org
2011/2012 Lagos Policy maker-
Researcher
engagement
Researcher-initiated
empirical research studies
Active dissemination of own
research findings to relevant
stakeholders and policymakers
(S4)
CBHI Scheme in Anambra state,
Nigeria: an analysis of policy
development, implementation
and equity effects. (S4)
BSC Uzochukwu, OE Onwujekwe, S Eze,
E Nkoli, EN Obikeze and CA Onoka.
Community Based Health Insurance
Scheme in Anambra state, Nigeria: an
analysis of policy development,
implementation and equity effects.
(www.crehs.lshtm.ac.uk
2006/2007 Anambra Community-based
health insurance
policy
An assessment of policy
development and implementation
process of District Health System
in Enugu state, Nigeria. (S4)
BSC Uzochukwu, OE Onwujekwe, S Eze,
E
Nkoli, EN Obikeze and CA Onoka An
assessment of policy development and
implementation process of District
Health System in Enugu state, Nigeria
(www.crehs.lshtm.ac.uk
2006/2007 Enugu Decentralization
System
Uzochukwu et al. Globalization and Health (2016) 12:67 Page 5 of 15