Many speakers throughout the 2-day workshop either mentioned or directly addressed the interface of research, practice, and policy, explaining that this complex nexus of factors should be working harmoniously to ensure that the most effective approaches to IPV treatment and prevention are being employed, with each of the three factors informing the other two. Unfortunately, this has not always been the case throughout the region. Speaker Jessie Mbwambo, a researcher from Muhimbili University, mentioned that for too long in the region, researchers have completed their data collection and analysis and essentially moved on to their next project or study, simply expecting that the results will be taken up by community workers or policy makers. This approach is ineffective and unsustainable. Instead, many participants spoke of collaboration and an approach that fosters the sharing of research, best practices, and policy across borders.
THE LVCT MODEL
LVCT Health, a Kenya-based NGO focusing on HIV prevention, has already been featured in this summary discussing their approach to HIV- and IPV-integrated intervention efforts. In addition to creating programming, LVCT has developed an effective model for interacting with the research, policy, and practice nexus in Kenya. As mentioned previously, LVCT operates based on three pillars: (1) conducting studies, mostly in operations research, information from which they use to (2) inform policy, after which LVCT takes the time to look at how to (3) use the evidence base and policies to bring their work to scale throughout Kenya. This
process requires considerable interaction between governmental agencies and NGOs, but it can lead to better management of the related issues.
For instance, of the 28 operational studies completed by LVCT since its founding, 10 have resulted in tangible policies and other programming efforts. Speaker Lina Digolo explained there is often no overlap between the perceived societal problems of researchers, programmers, and policy makers. In fact, Digolo explained that it is often the case that policy makers and governmental actors will first ask, “Is this even an issue?” Or “Does this intervention that you are suggesting even work?” Because, as Digolo stated, “they [policy makers] are not going to invest in things that they don’t understand.”
Many speakers pointed out that politicians and policy makers have different goals and priorities from researchers and public health workers. Their priorities extend into every aspect of society and governance, and as such, they need to be convinced that IPV, or any issue for that matter, deserves attention, support, and funding. Speaker Nduku Kilonzo, Director of the Kenya National AIDS Control Council, stated in her keynote address regarding the East African response to IPV, “if we want to make intimate partner violence prevention . . . an issue [big] enough to get the response that we are looking for, we must start to speak to the politicians, or rather to the things that are important for politicians.” This necessitates that researchers and those working in public health take the time to deliver tailored and unified messages to their policy makers that have, as workshop speaker Jacquelyn Campbell summarized, “clear, articulate messages . . . that are supported by data.”
Edward Kirumira, Principal of the College of Humanities and Social Sciences at Makerere University and workshop moderator, highlighted the fact that researchers need to develop the communication skills necessary to be able to promote their issues and work with various constituents, and think carefully about both what they are asking for and how they are asking for it.
This process of communication goes two ways: speaker Francis Nyagah of MenKen noted that politicians were able to learn from his organization what language to use within their laws and policies in order to produce the desired change in society. Many speakers noted that although there are many laws in the region that are purportedly designed to protect women from violence, in practice they tend to be ineffective. Many speakers indicated that this could be a result of a lack of understanding of both the problems of IPV and their potential solutions. Digolo explained that an interactive and evolving relationship, such as the one developed by LVCT in which research informs policy, policy informs practice, and each group is responsive to the needs and developments of the other sectors of the interface, could produce more effective results for each facet of the IPV-prevention community.
BUILDING THE CASE
The process of building a case for IPV-prevention efforts includes the task of performing costing studies for the various interventions and proposals that researchers and programmers will be presenting to various policy makers and politicians. Many speakers echoed this sentiment in their presentations and highlighted this aspect of their evaluation design as being a key-step toward scaling up evidence-based prevention efforts.
Kilonzo explained, however, that building the case for policy makers goes beyond a simple economic analysis. Researchers and programmers must also take into consideration the idea of cost-effectiveness. Which intervention is going to deliver the best results for the lowest costs? Kilonzo stated that if the cost of the intervention is too high in relation to its effects or benefits, it will not receive funding. It is important to consider the return on investment across a multitude of factors, including the health and well-being of women, the infrastructure or capacity that a given intervention promises to build, as well as the actual costs saved to society in terms of reduced health care or criminal justice costs and the ability of healthy women to contribute to their community free from IPV. Performing this sort of analysis will require additional inquiry into the societal costs of IPV at the national level. Many of these costs remain unknown and would be helpful in developing a case for funding and support.
Related to the overall costs of a proposed intervention, Kilonzo suggested that researchers and public health programmers alike should think critically about how their intervention operates in order to identify the crucial elements to its success. Should there be negotiations or proposed budget cuts, researchers and intervention programmers need to be prepared to identify what elements absolutely cannot be cut from their programming in order to ensure the efficacy of their work. Conversely, considerations should made to identify the portions of a given intervention that could be removed with minimal effect on overall outcomes or success should the subject of budgetary concerns be raised by politicians.
In addition to the actual costs of a given intervention, many speakers highlighted the need to address or calculate the costs to society of IPV—that is the cost of doing nothing—which could also be persuasive to policy makers. These costs and considerations would likely be expansive in nature given the broad reach of IPV and its effects, including criminal justice costs, health care costs, and costs to families and communities.
Kilonzo explained that outside of financial concerns there must be an identifiable agency or group within the government that is responsible for the proposed IPV initiatives and can serve as a coordinator for the various aspects of a proposed intervention or program. This is no small undertaking given the incredible complexity of IPV with causes and effects that
ripple into countless sectors of society. Although this makes it an appealing problem to solve given its reach, it also means that no one group or system within the government is willing to take responsibility for its oversight.
Related to this, Kilonzo explained that targets and goals must be set, both for the government involvement as a whole and individually for the sectors involved so an effective approach can be identified, measured, and adjusted as needed. Having a clear plan of action and a sense of how the program could operate will be extremely beneficial in making a case to policy makers.
THE VALUE OF A COORDINATED APPROACH
Kilonzo highlighted the need for those working in IPV prevention to identify top priorities and to subsequently develop a common agenda to share with their respective governments. Having a united front and a common agenda, she explained, will help bring together individuals from multiple sectors to work together with a common understanding regarding the issue and the identified target areas within it. This also helps bring into focus the government’s participation. Kilonzo explained that national governments like to have a result that they are working toward, one that, when finished, they are able to identify and explain the tangible impact of their involvement and efforts.
Additionally, Kilonzo noted that this approach can help individuals focus on the top challenges for IPV prevention and focus on implementing targeted and effective solutions together instead of a more piecemeal approach. She went on to explain that this could also result in a more concentrated use of available funding streams, allowing for more money to be put toward priority objectives, while those issues identified as less urgent can be moved to the backburner for future research and intervention programming efforts.
Kilonzo stated that achieving this level of cooperation across the different stakeholders and sectors throughout the region will require effort from multiple sectors within each country and throughout the region. Kilonzo and other speakers highlighted the benefit and value of convening communities of practice across sectors, including research, programming, and policy in order to engage in a meaningful dialogue regarding IPV and its surrounding issues. Those individuals agreed that workshops similar to this and related efforts should be continued throughout the region in order to establish a strong network between countries that encourages the sharing of data, research, programming, and best practices. In addition, building on the work of other countries and developing intergovernmental and intragovernmental relationships will be important steps in reducing the burden of IPV within the resource constrained environment of East Africa.