This interview is part of the initiative “Resonating Voices: Listening to the Voices of Evidence Users in the LAC Region”. The project is a collaborative effort with the LAC Hub acting as the implementer and Overton as the funder. In this conversation, the LAC Hub engages with John Edison from Colombia.

John Edison is a Health Administrator and Lawyer, with a Master’s degree in Epidemiology. Currently, he serves as an Advisor to the Vice Minister of Social Protection at the Ministry of Health and Social Protection of Colombia.

1. What are the priority issues or problems in your organization?

The financial sustainability of the healthcare system is a pressing issue we have been working on. Particularly, issues related to the production of new health technologies. This has been a recurrent issue not only in our system but worldwide, as it has led to a rapid increase in costs in recent years, causing significant concerns about resources.

Another issue is related to the implementation of comprehensive and integrated service networks and primary healthcare strategies, especially involving the primary level of care.

Lastly, the main activity I am currently supporting is the reform project for the General System of Social Security. It is a reform project explicitly led by this Vice Ministry. We are generating everything related to the proposal of this project and all the progress currently being made in the Congress of the Republic.

2. What role has scientific evidence played in addressing these priority problems or issues, and what partnerships or synergies have supported or enabled this process? 

Evidence is crucial. Most of us involved in this reform process come from academia, and every decision and article being worked on and agreed upon is based on the best available evidence.

Regarding primary care strategies, specifically concerning basic health teams and reducing healthcare expenditure, different departments of the Ministry have been conducting literature reviews. Specifically, the Promotion and Prevention (PYP) department has focused exercises on defining which professionals should make up these basic health teams and estimating the expenditure on these strategies, based on what has been done in other healthcare systems. Likewise, literature reviews have focused on the activities that could be carried out in terms of extramural care.

We also create collaborative workspaces to define questions in the PICO (Patient, Intervention, Comparison and Outcome) structure and conduct a literature review. Particularly, an evidence map was created with support from BIREME (Latin American and the Caribbean Center for Information in Health Sciences) and the OPS. This led to a synthesis of evidence that guided the aforementioned expenditure estimation for PHC (Primary Health Care) teams and is now used as support to justify most of the requests made by senators, congressmen, and civil society, who demand this type of evidence.

Regarding partnerships, we have agreements with universities such as the University of Antioquia, the National University, the University of Los Andes, and the Javeriana University.

There are other types of agreements from previous governments, such as the one with Health Metrics to conduct economic burden studies of diseases.

In terms of international cooperation, once again, we have agreements with the OPS, USAID (United States of America Agency for International Development), IOM (International Organization for Migration), and the French Development Agency, among others, which include research centers and evidence-generating institutions.

3. What are the main barriers and facilitators you identify for institutionalizing and systematically incorporating evidence into the decision-making process?

Barriers:

The main barrier is time. Often, we receive requests for evidence within a short period, during which we must gather the best available evidence and support a decision that has been made or is about to be made.

Another barrier is the lack of continuous training or education in terms of new research techniques and strategies.

The definition of competencies and the job manual can also become a barrier, as sometimes the times or the specific profile for carrying out activities related to evidence production and use are not defined.

The current structure of the system, created more than 30 years ago, perhaps was not planned particularly with the urgent and immediate need to include evidence-generating groups within public institutions. This has led many institutions to undergo transformations.

Lastly, the economic resources available to each entity can be a barrier. Budgets are designed for specific functions, and rarely do they include specific functions for matters like evidence review. There is no explicit budget for that, nor are there people dedicated exclusively to it.

Facilitators:

The dynamism and modernization of the state, where we seek to review those functions well, and where we hope that there can be specific functions for supporting evidence use. When institutions have access to the best available evidence, they transform.

Support from international cooperation organizations, agreements developed with study centers, research centers, and institutions dedicated to working with evidence.

The precision of the evidence is a very important facilitator because every administrative act is subject to public scrutiny. In that sense, evidence is a very important supporting and defense mechanism that we have against oversight bodies.

The easy of access to evidence is also an important facilitator. Scientific literature is more accessible than it was a few years ago.

Another facilitator is that we currently have the Ministry of Science, which is also part of the decision-making bodies.

Lastly, thanks to agreements with universities and academic programs, opportunities have been created for certain officials to receive training, generating benefits in terms of capacity building.

4. What advice would you give to researchers and decision-makers who want to improve the impact and use of scientific evidence in policy decisions?

For researchers, the advice is to be very aware of the political reality of the system. Different research topics stem from there to guide decision-making. Often, researchers only focus on the context they can discern in study centers and rarely know the political and contextual reality of the system as a whole. If we manage to get academia into these political scenarios, I believe an important synergy can be generated.

And for those involved in decision-making, the main advice I would give them is that in practical terms, evidence reduces the uncertainty of decisions, and that can contribute to generating accurate public policies that fit the reality of the population. We always have oversight bodies watching and paying attention to the decisions we make, and evidence becomes a probative mechanism to defend the decision made. All of this helps ensure that the success of any decision can better translate into the framework of public policy.

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Interviewee contact: edison.betancur@udea.edu.co