On 3–4 October 2024, WHO convened a two-day meeting at the newly formed WHO collaborating centre for evidence-based decision-making in health at Humanitas University, Milan, Italy, to explore the governance of data, structures, and processes in the health decision-making ecosystem.
The meeting brought together a multidisciplinary group of global experts and provided an opportunity for the Global Coalition for Evidence to start work on one of its key objectives – improving the alignment and integration of evidence workstreams within the health sector to help ensure that diverse sources of evidence are applied effectively to improve health outcomes.
Decision-making takes place at all levels of the health system, involving policymakers, the public, clinicians, payers, programme managers, scientific communities, and regulators. Decisions by these actors are typically informed by recommendations or options provided in guidelines, health technology assessments, essential medicines and diagnostics lists, and evidence briefs for policy. However, processes are often poorly coordinated both globally and nationally. A decision made in isolation from others on the same topic can result in unnecessary or conflicted inputs to the health system, confusion, and wasted resources.
This meeting was the first time the working group tasked with achieving the Coalition's objective on evidence integration could come together to understand the barriers, enablers, and essential prerequisites for strengthening the health decision-making ecosystem.
During the meeting, the global experts explored how to align and streamline the contributions of different actors in the health decision-making ecosystem, discussed example of countries connecting decision-making workstreams, and exchanged lessons learned and innovative approaches to fill the gaps between evidence and policy.
Patrick Mbah Okwen, Team Lead at eBASE Africa and Medical Officer, presented a case study from Cameroon and explained, "Varying capacities exist in evidence generation, synthesis, translation, and implementation at individual and institutional levels in Cameroon. WHO has supported government efforts for most of the evidence-based healthcare guidance initiatives (malaria, HIV, and tuberculosis). This is an opportunity to harness and strengthen the evidence ecosystem in Cameroon."
Describing the different actors involved in influencing and making decisions in Brazil's public health system, Luciane Cruz Lopes, Professor, Sorocaba University, São Paulo, Brazil, said "The extent to which different actors use structured processes and transparent criteria differs. They are not always well coordinated, despite growing interest in using crucial evidence and the proximity between the processes. The insights and discussions in this working group generated essential reflections on how the process can be better coordinated and implemented at a national level."
The meeting also provided space to discuss the next steps in operationalizing this new conceptual framework to health decision-making at the country level. The framework is based on work showing that the criteria and methods employed by actors involved in this area of work differ but frequently coexist and overlap.
"Connecting the various actors in the health decision-making space requires an underlying theory, framework, and application in learning health systems. The outcomes of this meeting will help bring the framework to the next stage with an international coalition and reshape it for the future." said Holger Schünemann, Professor of Public Health and Preventive Medicine, Humanitas University and Co-director, WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations.
The working group plans to further develop the comprehensive conceptual framework to health decision-making to improve coordination and coherence across the evidence ecosystem and draft a roadmap to pilot and operationalize the framework.
