PDF version

Short research communication

Sultana Al Sabahi,¹ Kamila Al-Alawi,² Alaa Hashish ² and Jean Jabbour ²

¹Centre of Studies and Research, Ministry of Health, Muscat, Oman (Correspondence to S. Al Sabahi: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ). ²WHO Country Office, Muscat, Oman.

Abstract

Background: In addition to the general question about what works, policymakers consider whether health interventions will work in their context, and consider the social values such as affordability, acceptability, equity, equality, and human rights.

Aims: To highlight the importance of having and using an evidence governance system to inform health policymaking in Oman.

Methods: We reviewed the literature and analysed local documents on evidence governance systems in Oman.

Results: The Government of Oman has shown increasing interest in research and innovation in the past few decades. This interest was reinforced through the announcement in November 2021 of the intention to establish a decision-making support unit. Oman’s strategies for evidence-informed policymaking provide direct and well-integrated channels for expert advice, however, the capacity for implementation remains challenging, and there is a lack of clarity in the evidence use mandate. It is not clear how evidence was selected, synthesized and used to inform some of the government policies on health. This can limit the scope of operation and subsequent achievements.

Conclusion: Efforts to strengthen evidence-informed policymaking should focus on building a system for good governance of evidence to ensure that rigorous, systematic, and technically valid evidence is used for policymaking.

Keywords: evidence, decision-making, policymaking, governance, Oman

Citation: Al Sabahi S, Al-Alawi K, Hashish A, Jabbour J. The evidence governance system in Oman. East Mediterr Health J. 2023;29(7):520–523.

https://doi.org/10.26719/emhj.23.081 Received: 28/09/22; Accepted: 22/12/22

Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is 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 policymaking refers to the use of 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 policymaking have only promoted scientific evidence as the form best suited to guiding policymaking (2). However, the concept of evidence-informed policymaking has evolved to better address the political aspects associated with decision-making (e.g. interest groups, public opinion, economic situation, and the role of institutions). This article aims to: (1) clarify the difference between evidence-based medicine and evidence-informed policymaking; (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 policymaking. This is crucial to countries in the process of bringing evidence-informed policymaking 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 policymaking

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 the application of its basic principles to policy development (4), and there have been increased calls to use scientific evidence in ppolicymaking (6).

Policymakers 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 policymaking 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 policymaking, evidence-based medicine and evidence-informed policymaking emphasize the importance of selecting, assessing, and synthesizing evidence systematically and transparently (10).

A system to govern the use of evidence in policymaking

To understand the need for a system to govern the use of evidence in policymaking, we need to first understand the political nature of policymaking. Politics is about who gets what, when, and how (11). Allocating scarce resources and setting priorities are the main concerns with policymaking (12). Hence, policymaking 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 using evidence may 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 may 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 policymaking 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 policymaking 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 policymaking through a governance system is important to ensure system-wide and deeply rooted change in evidence use. The processes should also avoid limitations associated with strategies that focus on individuals (e.g. connecting policymakers and researchers, providing decision-makers with evidence, or providing training to individuals to broker knowledge) who may, 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 use of evidence in policymaking. 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 use could be through establishment or changing the existing structures that use evidence, 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 for 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 fund research and innovation. The government has expressed interest in using 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 policymakers in selecting 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 policymaking 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 policymakers recognized the importance of evidence and used it to inform policies (19). However, it was not clear how 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 policymaking (i.e. transparent and systematic use of evidence to serve the social values of the population). By institutionalization of the practice of evidence-informed policymaking in such approaches, we can envision how systems would mature and how evidence use would improve.

Conclusion

Evidence-informed policymaking is the practice of informing policies with the best available evidence in a systematic and transparent manner. Policymaking is a struggle over different ideas and social values; therefore, scientific evidence and social values have to be considered. Unlike evidence-based medicine, scientific evidence cannot be merely judged by its rigorous methods to inform policymaking. Instead, relevance is more important. As a result of the political nature of policymaking, bias in creating, selecting, or interpreting evidence can occur and affect achievement of the intended social goal. Therefore, efforts to support evidence-informed policymaking should be transitioned 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 policymaking. Oman has shown interest in using evidence to support policymaking. Different institutions have been working on different rules to support evidence-informed policymaking; however, the Government of Oman needs to create the mandates, rules, and regulations that ensure the institutionalization of good practice in using evidence in policymaking. 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 policymaking. If the Government of Oman takes into consideration the points raised in this article when establishing 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.

Funding: None.

Competing interests: None declared.

Le système de gouvernance des données probantes à Oman

Résumé

Contexte : En plus de se pencher sur la question générale concernant l'applicabilité, les responsables de l'élaboration des politiques se demandent si les interventions sanitaires fonctionneront dans leur contexte et tiendront compte de valeurs sociales telles que l'accessibilité économique, l'acceptabilité, l'équité, l'égalité et les droits humains.

Objectif : Souligner l'importance de disposer d'un système de gouvernance des données probantes et de l'utiliser pour éclairer l'élaboration des politiques de santé à Oman.

Méthodes : Nous avons examiné la littérature et analysé les documents locaux relatifs aux systèmes de gouvernance des données probantes à Oman.

Résultats : Le Gouvernement d'Oman a manifesté un intérêt croissant pour la recherche et l'innovation au cours des dernières décennies. Cet intérêt a été renforcé par l'annonce en novembre 2021 de l'intention de créer une unité d'appui à la prise de décision. Les stratégies d'Oman en matière d'élaboration de politiques fondées sur des données probantes fournissent des canaux directs et bien intégrés pour les conseils d'experts. Cependant, la capacité de mise en œuvre demeure difficile et il existe un manque de clarté dans le mandat d'utilisation des données probantes. La manière dont ces données ont été sélectionnées, synthétisées et utilisées pour éclairer certaines des politiques gouvernementales en matière de santé n'est pas claire non plus. Cela risque de limiter le champ d'application et les réalisations ultérieures.

Conclusion : Les efforts visant à renforcer l'élaboration de politiques reposant sur des bases factuelles doivent se concentrer sur la mise en place d'un système de bonne gouvernance des données probantes afin de garantir l'utilisation de données rigoureuses, systématiques et techniquement valables pour l'élaboration des politiques.

نظام حوكمة الدلائل في عُمان

سلطانة الصباحي، كاميلا العلوي، علاء حشيش، جون جبور

الخلاصة

الخلفية: بالإضافة إلى السؤال العام عمَّا هو صالح للتطبيق، ينظر واضعو السياسات فيما إذا كانت التدخلات الصحية صالحة للتطبيق في سياقها أم لا، وينظرون أيضًا في القيم الاجتماعية مثل، القدرة على تحمُّل التكاليف، والمقبولية، والإنصاف، والمساواة، وحقوق الإنسان.

الأهداف: هدفت هذه الدراسة الى تسليط الضوء على أهمية وجود نظام لحوكمة الدلائل واستخدامه في توجيه عملية وضع السياسات في عُمان.

طرق البحث: راجعنا المؤلفات وحللنا الوثائق المحلية بشأن نُظم حوكمة الدلائل في عُمان.

النتائج: وضع السياسات عمليةٌ سياسية، وتُقيَّم الدلائل الموثوق بها المتعلقة بالسياسات في أغلب الأحيان حسب صلتها بمسألة السياسات التي تكون على المحك.

الاستنتاجات: ينبغي أن تركز الجهود الرامية إلى تعزيز وضع السياسات المسترشدة بالدلائل على بناء نظام للحوكمة الرشيدة للبيِّنات، لضمان استخدام دلائل دقيقة ومنهجية وسليمة من الناحية التقنية في وضع السياسات.

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