Status: Completed

Demand Driven Systematic Reviews and Meta-Analysis

This project seeks to address the evidence gap in the policy making landscape that was exemplified in the Niche of Impact Evaluation in East Africa report.  Five Demand Driven related Systematic Reviews and Meta-Aalysis being developed include:

1. Impacts of resilience and adaptive capacity interventions to climate change on children and women's nutrition in East Africa.

Author:  Annet Adong

Globally, climate change is a top policy agenda to achieving the Sustainable Development Goals. In response to the growing threats, African Governments have since 2010 incorporated climate-smart agriculture (CSA) strategies in their respective national agriculture, food, and nutrition security investment plans. Several international agencies have also continually integrated the concept of CSA in their activities. Research has since been conducted to assess how several interventions ensure smallholder farmers' resilience and adaptive capacity. Nevertheless, an appraisal of the evidence of the impact of resilience and adaptive capacity interventions on climate change on children and women nutrition in Uganda, Kenya, Tanzania, and Ethiopia needs to be done to provide policy-relevant evidence for East Africa.

To shed more light on the existing evidence and gaps in research on climate change interventions and nutritional outcomes for women and children, this systematic review and meta-analysis will appraise the existing evidence on the impact of the resilient and adaptive capacity responses and interventions to climate change on the nutrition of women and children.

2. Political economy and governance in Kenya.

Author: Michael Mbate

Currently, there exist a large literature on governance, especially in the field of local governance and inter-governmental relations. However, such studies are often scattered and conducted in isolation. In addition, while individual studies can provide important input into policy, it is often viewed as of vital importance to have a systematic body of studies that build knowledge overtime. In the Kenyan landscape, a cursory evaluation of the current research on decentralization shows that there is no single study that attempts to address this gap by providing a systematic review of existing policy questions that have been researched as well as the ensuing results. In addition, there is limited cross discipline and cross-country comparisons, despite their importance in enriching the current studies and findings.

The literature on good governance as well as experience from successful governance reforms have underpinned the importance of systematic reforms and meta-analysis. From a policymaking perspective, a well-developed database can be used to monitor and analysis the current situation in order to identify the starting point for future projects, establish a benchmark against which progress can be assessed and examine the effectiveness of different government or stakeholder interventions. It can also aid in generating evidence on how governance risks manifest itself and the associated strategies to tackle them.

The proposed systematic review and meta-analysis will focus on devolution and local governance, with the aim of establishing the conditions under which devolution can lead to improved governance outcomes as well improve social economic outcomes.

3. Effectiveness of intervention programs to reduce and improve outcomes of infectious or communicable and NCDs.

Author: Getachew Mullu Kassa

In the recent years, there have been an increasing body of Impact Evaluation (IE) researches in Africa. Although, several countries in sub-Saharan African countries have shown an improved practice in the use of Decision Focused  Evaluation (DFE) researches, the use of these evidences to guide policy is still limited. Particularly, the translation of evidences into policy has been limited in health fields in sub-Saharan African countries. A systematic review on barriers to and facilitators of the use of evidence by policymakers showed the need of timely access to good quality and relevant research evidences as one of the most important factors influencing the use of evidences [1]. The lack of systematic reviews and meta-analysis (SRMA) studies that present DFE in a single and condensed study is one of the reasons for poor evidence to action translation in many of the African countries, particularly east African region.

There are several public health problems in sub-Saharan African countries. The region is currently experiencing a double burden of disease where communicable and non-communicable diseases are common. One of the Sustainable Development Goals (SDG-3) is to ensure healthy lives and promote well-being for all at all ages by 2030 [2]. SDG-3 contains 9 targets and 4 sub-targets. Among these, reduction of maternal mortality, ending preventable deaths of newborns and under-five children, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical disease, reduce premature mortality from Non-Communicable Disease (NCDs) and strengthening prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol are among the targets of SDG-3 [2]. This goal has been signed by all UN members since 2015 and all countries are working towards achieving the global and national health targets by 2030 [2]. The burden of communicable and Non-Communicable Disease (NCD) in sub-Saharan African countries in general and in east African countries in particular is one of the main developmental challenges.

This proposal for systematic review and meta-analysis therefore focuses to synthesize evidences on major health related SDG targets for East African countries, with a focus on impact evaluation researches on communicable or infectious diseases and NCD.

4. Gender inclusive political leadership.

Author:Amos Njuguna

The origins of gender biases have been associated with the 1750-1850 agrarian revolution that gendered labor roles where men engaged in fieldwork and women in child rearing branding women second-class citizens. Since then, gender roles and gender gaps have been perpetuated through generations.

Gender bias puts women in a paradox – if they conform to the societal stereotyping, they are not seen as strong leaders yet if they exemplify agentic qualities associated with sturdy leadership, they are evaluated negatively and branded as “unfeminine”.

Sadly, the perpetuation of negative gender sentiments entrenches a culture of negative social attitudes against women and is thought to be one of the root causes of violence against women and inadequate representation in “democratic” societies.

The Kenyan parliament has not been able to develop a law or policy that guarantees one third representation in all elective positions (despite this being a constitutional requirement put forth in 2010). Despite the existence of the law, women comprised 9.2% of the 1835 elected office bearers in 2017 (7.7% in 2013) despite having 47 seats exclusively reserved for them and accounting for 46% of the registered voters.

This systematic review will seek to understand interventions that can be applied to enhance gender-inclusive political leadership, with a focus on experimental studies to inform policy and practice.

5. Effective HIV self-test models of delivery for different populations, HIV positivity yield and linkage to further HIV services.

Authors: Werner Maokola Christina Fille and Prosper Faustine

Countries including Tanzania have adopted UNAIDS goals of ending HIV as an epidemic by reaching 90-90-90 targets by 2020 and 95-95-95 targets by 2030. The first 90 and 95’s refers to a target to have 90% and 95% respectively of those with HIV know their HIV status. According to a recent survey in Tanzania, only 52% of those with HIV knew their HIV status (1) (2). Thus showing that the country is yet to achieve 90-90-90 targets at population level.

World Health Organization recommends HIV Self-Test (HIVST) as a strategy to diagnose more people with HIV infection to reach UNAIDS targets. HST refers to an HIV testing strategy in which an individual conducts his/her own HIV test in privacy and seeks further diagnostic steps if turns out to have HIV positive results from HIVST (3).

Most countries including Tanzania are at initial stages of adopting HST strategy. HIVST is already a policy in Tanzania. Its full implementation is waiting for results of a demonstration project which will inform policy. Evidence-based decision making is needed to guide countries on the best ways to implement HIVST. Systematic review is at the top of the hierarchy for providing evidence-based practices (4).

This systematic review therefore will study the effective model of delivering HST to different types of populations as well it will gather evidence on the HIV positivity.