There is fairly widespread agreement concerning the factors that support or inhibit the use of evidence in the policy process: personal contact between researchers and policy makers, timely and relevant research, clear research summaries, and good quality research all support the use of research evidence, whereas the absence of these factors undermines it . This study has revealed a number of important ways in which the Fogarty investment in research training in Kenya and Uganda has affected health policy and practice in those countries. The primary manner in which Fogarty training has had an impact on policy and practice is through strengthening the technical skills of researchers, and hence the quality of the research produced and relatedly researchers' confidence in engaging in scientific debates. Former FIC trainees typically recognized that their Fogarty training experience had otherwise done little to prepare them directly for policy engagement, and indeed this was not an objective of the program.
In the scientific fields where FIC has focused much of its support, such as infectious diseases, and especially HIV/AIDS, our case studies uncovered strong networks and close personal contacts between FIC trainees and policy makers. Frequently these networks were strongest when they centered on policy-makers who had also benefitted from FIC training. Networks outside of the core FIC areas of focus appeared much weaker, and policy-makers identified a number of other skill sets (such as health economics) which were sorely needed. While this evidence suggests that FIC research training investments had substantial impact on the development of epistemic communities in countries, it is unlikely that the impacts would have been as great, if it were not for concurrent investments by the National Institutes of Health, the US government, and the broader global community in research on high priority diseases particularly HIV/AIDS, TB and malaria. The context of rapidly increasing funding for HIV/AIDS research, and scale up of services to tackle these and related diseases presented fertile ground for well-qualified researchers in these fields to engage with policy makers and practitioners. A further factor contributing to the impact FIC programs had on the development of epistemic communities was the long duration of support, which allowed inter-generational linkages to occur. For example, since FIC started providing research training support 25 years ago, senior trainees have grown into decision-making positions, and have supported policy engagement among more junior FIC trainees through acting as role models and facilitating personal connections.
Issues concerning the capacity of policy-makers to process evidence have been raised less frequently in the evidence-to-policy literature, with some notable exceptions , however this study suggests that training for policy makers may be a critical and somewhat neglected contribution. Not only can such training help enhance their appreciation of research evidence, but policy maker participation in training programs can also help bridge research and practice communities. Policy makers who had received research training informally played a role similar to that commonly attributed to knowledge brokers .
While it is clear that many FIC trainees were routinely engaged in policy making processes either through technical committees, or informal exchanges with policy makers, many researchers expressed frustration at their inability to get local research findings translated into policy change, without prior changes in global level policies and norms. Both, researchers and policy makers recognized systemic obstacles to better alignment of research with policy-maker needs for evidence. Interactions with policy-makers were seldom systematic or institutionalized, but more driven by individual relationships. Additionally, respondents described how research was “researcher-driven” rather than being driven by policy needs. Current funding structures, and in particular the limited amount of domestic support for health research, which leads to reliance on international donors for research funding, were understood to be an important part of this problem. Financial incentives mean that researchers are more likely to be responsive to evidence needs determined by international or foreign funders, than their own governments.
Much of the evidence on impact comes from the voices of the researchers themselves, who may be inclined to over-state the nature of the impact that their own research has had . While we have triangulated our interpretation of policy impacts through interviewing policy makers as well, our sample of interviewees was biased towards researchers. The citation analysis provides more objective measures of research impact, while our qualitative data collection casts light on mechanisms for influence.