The role of scientific evidence in decision-making on food and nutrition regulation policies in Chile.
This interview is part of the “Voices of Evidence Users” series, which offers valuable perspectives from people who use evidence in decision making – a collaboration between Hub LAC and On Think Tanks. In this conversation HubLAC interviews Cristian Cofré about the role and regulatory mechanisms for food in Chile related to the scientific evidence.
Cristian Cofré Sasso is a technical advisor at the Ministry of Health of Chile. Expert in Public Health and Nutrition Policies/ Consultant in public policies and regulation in food and nutrition. He is part of the ministerial advisory committees on food taxes, regulation on labeling and alcohol advertising, among others. He is a member of the Advisory Commission of the Food Sanitary Regulation; he is also Co-Coordinator of the National Codex Alimentarius Committee on Food Labeling and Coordinator of the National Codex Committee on Nutrition and Foods for Special Dietary Uses.
1. What are the priority issues or problems in your organization?
There are many questions to be asked because there are so many policies being developed. Specifically in my food and nutrition department, one of the topics that we currently spend the most time on (although not the only one) are those related to regulatory policies. Everything associated with the evidence available on what kind of policies exist in relation to food and nutrition regulation, specifically in aspects related to food labeling and advertising in order to provide information to the consumer.
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?
There is a work in progress on the regulation of nutritional information in fast food restaurants. Its objective is to know the best location where this nutritional information or labeling should be. The work has been done with a unit of the Ministry of Health, the Evidence Informed Health Policy Unit (UPSIE).
This unit has in turn linked with other actors such as the Catholic University of Chile to develop systematic literature reviews and citizen dialogues.
Precisely in the latter, the literature review and regulatory proposals are socialized in order to have the opinion of citizens and key actors for the implementation of future actions in this regard. This information is processed to generate a report that will support decision making to design the regulatory policy for fast food. In Chile there is a pioneering initiative in the world, the front-of-package labeling, and the objective to replicate this initiative with fast foods. Similarly, we have the National Food and Nutrition Policy, whose lines of action are also based on evidence, these are experiences of evidence-informed policies.
Regarding the frequency of evidence requests, this is not previously defined but depends on the priorities established by the health authority regarding an issue of interest. In the area of nutrition, for example, there is a very relevant issue: the increase of obesity in the child population and in general. This means that the request for evidence for the construction and design of policies to address this health problem has increased in recent years.
3. What are the main challenges and opportunities you identify for institutionalizing and systematically incorporating evidence into the decision-making process?
The main challenges we face are the lack of specialized human resources, those who dedicate the time available for evidence-based decision making. There is a high demand for questions, which implies prioritizing many of them due to the absence of human resources. This process takes time and can lead to delays in the generation of evidence. On the other hand, the chances of finding evidence on innovative public policies are low due to the scarcity of supported information. If it comes to public policy formulation, not only technicians should be involved with the use of evidence; but also decision-makers should be aware that policies need to be informed by evidence.
On the opportunity side, international organizations encourage the State to produce evidence-informed policies. This is done through organizations such as the UN, WHO/PAHO, FAO and academia, among others.
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?
The advice to researchers is to show patience for their work to be reflected in public policy. This will depend on many factors and priorities, but if you are patient, it will be achieved anyway. The impact will not be from one month to the next or from one year to the next; the disposition of a policy will take longer than that.Researchers must take advantage of contextual opportunities for evidence-informed policy development. There needs to be a close linkage between research and public policy.
The advice to decision-makers is that their actions will impact on those people who have placed their trust in them; these may be their peers or senior decision-makers, but more important are those people who live in the territory. Decision-makers must follow the principles of effectiveness and efficiency in following evidence-informed policies. These policies should be for the benefit of society and solve the problems that occur. Evidence-informed policies are important for any area, especially in sensitive areas such as health care.
Synergy between academia, citizens and decision makers for the promotion and use of evidence in Colombia
This interview is part of the “Voices of Evidence Users” series, which offers valuable perspectives from people who use evidence in decision making – a collaboration between Hub LAC and On Think Tanks. In this conversation HubLAC interviews Carlos Castaneda about the role and mechanisms of evidence use and generation in Colombia.
Carlos is an economist from the University of Antioquia, has a master’s degree in economics from the University of Los Andes and a master’s degree in Public and Social Policy from Pompeu Fabra University. He is currently Director of Public Policy Monitoring and Evaluation at DNP – National Planning Department of Colombia.
What are the priority issues or problems in your organization?
The priority issues are the evaluation of strategic programmes linked to the country’s National Development Plan (NDP). Precisely, one of the responsibilities of the National Planning Department (DNP) is to elaborate this plan together with the Ministry of Finance and the other sectors of the National Government.
Precisely, the DNP defined 5 strategic lines and 2 transversal lines on which we believe the country should focus for development in the medium and long term, these lines are: 1) Land management around water with environmental justice: climate change, 2) axis of human security and social justice, 3) human right to food (transformation of the agricultural sector, food production and food security), 4) productive transformation, internationalisation and climate action and 5) regional convergence. All of this is framed within two cross-cutting themes: comprehensive peace and macroeconomic stability. We also work within the framework of the 2030 Agenda of SDGs.
What role has scientific evidence played in addressing these priority problems or issues, and what partnerships or synergies have supported or enabled this process?
A concrete example of the use of evidence has been the use of evidence gap maps to identify which actions have worked in the world in relation to the citizen income programs. I mention this because Colombia intends to migrate from conditional cash transfers to unconditional cash strategies. This is one of the ways to make evidence available to decision makers in future programs.
Another example is the “Mi casa ya” programme, a housing programme that subsidised middle and lower-middle class people so that they could obtain housing. We did an impact evaluation about 2 years ago and the results of that evaluation made it possible for the Ministry of Housing to make decisions that allowed the programme to be restructured.
Regarding the types of evidence, these can be different depending on the degree of maturity of the programs. What we do is try to be innovative in the way we provide or transmit evidence to decision makers, sometimes an evidence map is more useful, sometimes an infographic, video among others.
All the evidence we generate is taken to the decision-making bodies, to the councils of ministers and to the medium-term expenditure framework committees, which is where the budget allocated to each sector is defined.
We work in several stages to identify where evidence is needed and we rely, as mentioned above, on the different agencies in the ministries and on consulting firms and national institutions such as Fedesarrollo, Think tanks, the National and Javeriana University of Colombia. We also partner with international agencies such as The Global Evaluation Initiative, University of Berkeley, University of Toronto and professors associated with the University of Chicago.
Regarding the involvement of the citizens’ perspective, we have the citizen perception survey that is conducted every year and we seek to know their perspective on how the evidence and the government’s offer are used. This allows us to monitor the gaps between what the government states.
Everything we generate is public, citizens can download reports, data, surveys, etc., to replicate exercises, or go deeper into the results. We want citizens to come closer and for the government to participate as well.
What are the main challenges and opportunities you identify for institutionalizing and systematically incorporating evidence into the decision-making process?
Among the existing challenges, we find that to develop rigorous evaluations we need more time than we actually have. To accompany this process, we try to have a database in order to perform exercises quickly. In this sense, if there is no academic research, we incorporate faster tools such as machine learning that allows the generation of evidence in a timely manner.
Another challenge is that we have seen that the use of evidence is anecdotal, as there is no systematic measurement of how it is used. We are developing an evaluation use index that will allow us to measure how and when the evidence we are generating is being used. This allows us to see when recommendations are implemented, and how changes are taking place.
On the other hand, there is not always political will among decision-makers; in other words, the guidelines of a program may not require it to be evaluated.
Another major concern is to find the best way to communicate the results of the evidence because the documents are often very large and risk not being read. The evidence is already being displayed on different platforms to attract the general public to get short and eye-catching information.
Among the opportunities, we also have robust tools with the technical quality to inform and make decisions, which we share with countries such as Costa Rica and Peru in order to keep up to date with what is happening in neighboring countries.
And finally, in Colombia we have CONPES 4083 of 2022 for the strengthening of the use and institutionalization of evaluations for decision-making. This gives us the legal framework that obliges us to implement all actions related to evidence and offers an overview of the use of evidence in the country along with improvement actions to consolidate our organization (SINERGIA).
What advice would you give to researchers and decision-makers who want to improve the impact and use of scientific evidence in policy decisions?
The advice to researchers in decision making consists of facilitating evaluations so that policy recommendations can be used. It is necessary to use mechanisms to communicate what is most relevant. For example, a matrix for the use of recommendations is advised to encourage the presentation of results in a clear and simple way to experts.
The advice to decision-makers is to better understand what evaluations and different types of evidence are reporting. For example, 90% of decision-makers often claim that what they need is an impact assessment and when we clarify what the assessment consists of, they realize that they do not need this type of evidence but other types of evidence. Decision-makers need to be better informed about the evaluation method that their program requires in order to reach a common agreement with those in charge of the research. Finally, it is necessary to mention the need to establish synergies between researchers and decision-makers to discuss and analyze the different types of evidence.
Strengthening Brazil’s democracy with digital policies
Welcome to the “Voices of Evidence Users” interview series, offering firsthand insights from the people who use evidence in decision making – a collaboration between the Hub LAC and On Think Tanks.
In this conversation Hub LAC talks to Samara Mariana de Castro, a lawyer with a career in the field of law marked by her work in Electoral and Party Law, Digital Law, Privacy, and Data Protection.
In 2023, Samara assumed the position of Director of the Department for the Promotion of Freedom of Expression at the new Department of Digital Policies of the Secretariat of Communication of the Presidency of the Republic (SECOM), where she has had the opportunity to pioneer an environment for informing digital public policies in Brazil with the best available evidence. In this interview, she discusses the progress and challenges that she and her team have encountered on this journey.
How would you describe your role and what are the top priorities as the Director of the Department for the Promotion of Freedom of Expression in the Department of Digital Policies?
We’ve been dealing with several challenges. This includes supporting the sustainability of journalism amidst changes in advertising, regulating digital services to combat disinformation, and promoting strong values of freedom of expression in a digital era.
Additionally, the department operates in a pioneering environment, where many problems still lack available evidence.
As an unprecedented Secretariat we face the challenge of being part of a Ministry, meaning we don’t have permanent staff. In this regard, we don’t have the institutional memory that other ministries have; we are now creating our own history.
The previous SECOM was under the Ministry of Communications, and there was no smooth transition in critical areas, so we are redesigning a new structure. Our work today also contrasts with the processes created by the previous government, which operated with a logic of disinformation and distrust towards adversaries and other branches of government, in what became known in the media as the ‘hate cabinet.’
Our challenges are not specific to the Brazilian context. These are challenges that democratic governments worldwide are simultaneously facing, as they involve new and emerging issues.
What is the role of evidence in addressing these priorities? How do you cooperate and seek support from research centers and networks within the government and civil society to better inform yourself about the challenges and potential solutions?
Evidence plays a crucial role in decision-making. The government relies on evidence to persuade legislators on regulatory issues, primarily using executive reports containing quantitative and qualitative research.
The active search for this evidence is done in partnership with civil society organizations, academia, and industry, along with my personal network of contacts and direct channels with the legislative and judicial branches.
We also seek international experiences, primarily from Latin American and other global contexts, to create institutional advertising policies focused on ensuring a reliable and trustworthy information environment, that does not directly or indirectly finance illegal, dangerous, or misinformative content, while ensuring equality and rights.
To this intent, a new secretariat was created at SECOM, the Secretariat for Analysis, Strategy and Articulation (SEART), designed to support decision-making informed by evidence for digital policies. We can say that we also act as an evidence hub for other ministries, coordinating interministerial actions on specific issues that require our collaboration.
A recent practical example of our team’s work was the creation of a strategic plan to combat misinformation on vaccination. Calls were made to different areas of the government (Ministry of Health, Attorney General of the Union-AGU, Ministry of Justice, Ministry of Management and Information, Ministry of Science and Technology, Ministry of Communications and Comptroller General of the Union), carrying out meetings with each ministry, according to the points that needed to be aligned to achieve integrated work between these spheres.
Communication tools, even the most informal ones, such as WhatsApp, are being used to disseminate reliable information in a simple and friendly way, easy to understand for public managers with different levels of knowledge in their areas of activity. We also seek to ensure social participation through public surveys and open meetings in decision-making.
What are the main challenges you see in systematically incorporating evidence into the decision-making process?
Some of the main challenges we face include the lack of reliable data and limited access to information from digital platforms.
What we have is rough data that indicates general trends but does not explain phenomena at the granularity necessary to inform our policies.
These are contemporary challenges, and there are still information gaps. There are not many successful experiences, and we have to contend with anti-democratic regimes that steer policies in the opposite direction of what we are striving for.
Furthermore, there is a shortage of funding to institutionalise decision support structures. Within the government, I perceive fragmentation and difficulty in organising, curating, and analyzing the vast range of information we receive almost every day.
What advice would you give to researchers and decision-makers looking to improve the use of evidence?
For researchers, it is crucial to build an advocacy network, connecting to organisations that can provide the most relevant information to decision makers in a way that is personalised to their demands.
It is important to emphasise this: the delivery of evidence must be adapted to the target audience, avoiding standardised reports that do not dialogue with those who need to make decisions based on them.
As for decision makers, it is essential to establish channels for evidence to reach those who need it and in a timely manner.
Training is also needed so that evidence can be processed optimally. Translating information to facilitate understanding and action is crucial to ensuring that evidence has influence and impact, especially in a context where misinformation is widely disseminated.
Listening to partners: Caribbean Centre for Health Systems Research and Development (CCHSRD)
Presentation: the Caribbean Centre for Health Systems Research and Development (CCHSRD) is a Research Centre at The University of the West Indies, St. Augustine, Trinidad and Tobago (T&T). The Centre was established in 2018 to pursue a program of work in Health Policy and Systems Research (HPSR), to address pressing policy and system issues faced by decision-makers in the Caribbean region. We engage in several activities within four core functions: Research Execution, Knowledge Translation, Health Human Resource Training and Development, and Citizen Engagement. For this newsletter, we spoke with Kershelle Barker, Junior Fellow, Evidence Synthesis at CCHSRD.
Hub LAC: Tell us a little bit about the Caribbean Centre for Health Systems Research and Development and its research focuses on evidence-informed policy-making.
K.B: With a mission to generate and facilitate the use of research evidence to strengthen health systems and policymaking processes, much of our work focuses on building individual and institutional capacity in evidence-informed policymaking (EIP). To this end, CCHSRD has conducted Needs Assessments with the Ministries of Health; Labour; Planning and Development; Social Development and Family Services; and Sport and Community Development in T&T, to understand their policymaking processes, their use of evidence, and their EIP training needs. Subsequently, we hosted priority setting exercises and EIP capacity building workshops, and provided coaching and mentoring to selected staff as part of two major projects – the WHO Building Institutional Capacity for HPSR and Delivery Science (Knowledge to Policy Centre Mentorship Program) and the Partnership for Evidence and Equity in Responsive Social Systems (PEERSS) project.
Additionally, CCHSRD successfully launched its Evidence to Policy Fellowship Training Programme in 2020, to promote evidence-informed policymaking and practice by building the capacity of policymakers (to use evidence) and researchers (to support the policymaking process).
The Centre has produced / co-produced several knowledge translation products to inform multisectoral policy or programmatic action. These include six (6) Evidence Briefs for Policy and four (4) Rapid Response Briefs on priorities in health (human resources, sexual and reproductive health services, mental health, and service delivery); and other social sectors (labour, education, social welfare, and community development). We have also hosted a stakeholder dissemination meeting and two stakeholder dialogues, and are engaged in follow-up/advocacy activities to encourage uptake of the evidence.
Hub LAC: What speciﬁc regional efforts has the CCHSRD undertaken to enhance decision-making in the Caribbean context? Could you provide a few brief examples to illustrate?
K.B: The second cohort of CCHSRD’s Evidence to Policy Fellowship Training Programme was open to decision-makers in the Caribbean. One fellow from Guyana successfully completed the programme, and an Evidence Brief for Policy aimed at improving access, quality and equity in health service delivery in Guyana was produced. This Brief contained local evidence on the problem, as well as proposed policy elements to address the problem, informed by the best available evidence. Though the fellowship programme has since ended, we intend to further engage with stakeholders in Guyana, to provide training and capacity-building in EIP skills and processes.
In 2022, CCHSRD collaborated with the Latin American and Caribbean (LAC) Evidence Hub to host a virtual learning workshop. The objectives were to identify local and regional EIP needs; connect key stakeholders from three Caribbean countries (T&T, Barbados and Jamaica); and generate knowledge about EIP in the LAC region. This workshop provided valuable insights about common barriers and facilitators to EIP in the Caribbean, and the factors needed to build a strong evidence ecosystem.
Also, CCHSRD is home to the Caribbean Community of Practice for Health Policy and Systems Research (CoP4HPSR), which is a network of 135 researchers, health professionals, policymakers, and other stakeholders from 14 countries, who are committed to building HPSR capacity in the Caribbean region. Through information-sharing and frequent discourse on HPSR topics, we aim to continue strengthening decision-makers and researchers’ understanding of the crucial role of evidence in policymaking/decision-making in the Caribbean.
In your opinion, what signiﬁcant contributions can a regional collaborative Hub make to address the knowledge translation needs in an evidence-informed policy-making ecosystem in our LAC region?
K.B: A regional collaborative Hub is important in fostering a shared understanding of and commitment to utilising evidence in decision-making in LAC. Common challenges we face on a regular basis, which hamper this effort, include a disconnect between research outputs and policymakers’ needs; and a lack of contextualised data and evidence to inform policies, programmes or interventions in-country.
Having a regional body dedicated to ﬁlling this gap and generating knowledge translation products and services tailored to the LAC region would result in policymakers/decision-makers being provided with timely, relevant evidence to inform actions that are more likely to: (i) be feasible and make better use of already limited resources; (ii) counteract potential context-speciﬁc barriers to implementation; and thus (iii) achieve positive impact, such as improving health and other population outcomes.
Collaboration at the regional level can also help increase decision-makers’ buy-in to the research/evidence-to-policy process, and strengthen relationships between countries, to pool resources and efforts in order to address regional health and social priorities.
Interview with Janessa Oliveira
Listening to partners: Women in Global Health
Starting its journey in 2015 as a Non-Proﬁt Organization, Women in Global Health (WGH) now represents a global movement of action and leadership for gender equity in health. Currently, the organization has 47 chapters in
43 countries, over 5000 members and 100,000 people in some way involved in its activities across more than 100 countries, establishing a broad network of allies in favor of strengthening gender equal leadership in global health. For this newsletter, we spoke with Janessa Oliveira, PhD in Public Health, who currently coordinates the Brazilian chapter of Women in Global Health.
Hub LAC: WGH has actions both in advocacy and as a platform for different initiatives and partnerships. In this sense, could you give us a concrete overview of the initiatives that you develop?
J.O: WGH has been active for eight years through various initiatives to promote gender equality in the health sector. Our advocacy and stakeholder coordination front, dedicated to collaborating with inﬂuential organizations in the ﬁeld proved to be a crucial part of our work. In fact, regional and national chapters are encouraged to seek alliances and contacts to implement actions that generate noticeable change at the local level. Moreover, the organization promotes events for showcasing successful experiences in other countries, so that other chapters can be inspired to lead their own initiatives. A ﬁnal aspect we consider critical to our work is participation in global events, as a way of encouraging the
representation of women in these spaces, and being actively engaged in debates towards tackling gender inequalities in the health sector.
Hub LAC: What are the main pieces of evidence that support your understanding of the nature and magnitude of challenges to gender equality in health?
J.O: As it stands, we rely chieﬂy on secondary data provided mainly by the CNES – National Registry of Health Establishments, and we are working on establishing local alliances to gather information and glean a better understanding of the demographic proﬁle of health professionals in Brazil. With regard to investigating pay inequality, we are in contact with professional councils to obtain robust data. Finally, concerning the various forms of violence that can affect the healthcare workforce, the Brazilian chapter is pursuing data gathering via professional councils and by running its own survey. We do realize this is a sensitive topic, so in order to maximize participation in this survey, we have been forming alliances to disseminate the questionnaire across the country and ensure a more representative sample.
Hub LAC: WGH now has an extensive global network, spanning across ﬁve continents. How are these initiatives engendered, considering the particularities of each region or even between countries?
J.O: WGH’s leadership accords a lot of value to creating regional and global collaboration mechanisms between the chapters. To this end, several regional Hubs were put in place, where chapters can come together to align priorities, organize joint activities, among other things. There are also monthly global meetings where chapters engage, share their updates and discuss a range of current issues in the ﬁeld of global health advocacy.
In order to promote the exchange of experiences and ideas, WGH Global also organizes events and activities with the aim of showing how various themes manifest in different regions. An example of this type of activity were the four regional townhalls (assembly-type meetings) on the subject of Sexual Exploitation, Abuse and Harassment (SEAH) in the health sector, to which representatives of governments, NGOs and activists were invited to discuss proposed issues on the topic.
During these events (which were held for the regions of Eastern and Southern Africa, Asia, Latin America and the Caribbean, Francophone Africa), interesting initiatives were presented, expanding the exchange of ideas and experiences between representatives of these sectors in different countries. The Brazilian chapter was one of the co-sponsors of the event for the Americas and Caribbean region. See here the results of the events.
Another initiative we’d like to mention, which is more in line with the new WGH proposal, launched at the end of last year, focuses on Universal Health Coverage. We’ve secured funding for projects along these lines and our ﬁrst initiative will be to work with podcasts. We believe that podcasts are an excellent tool for disseminating quality content in remote areas where internet coverage is limited, as is the case in the Amazon region. We want to disseminate content that promotes female leadership and improves the quality of healthcare in these areas.