Brokering evidence during a crisis: Lessons from Ghana

As COVID-19 devastated lives and livelihoods around the world, policymakers needed timely and relevant evidence to inform decisions on how best to manage the spread of the virus and mitigate its impact. At the onset of the pandemic President Akufo-Addo assured Ghanaians that his government’s “policy and measures will…. be driven by the science,” but this commitment proved easier said than done.

At the time of the pandemic, the Strengthening Evidence Use for Development Impact (SEDI) program, funded by the UK’s Foreign, Commonwealth & Development Office (FCDO), was working with a few government institutions in Ghana to strengthen different aspects of evidence-informed decision-making.

The SEDI consortium was led by Oxford Policy Management and comprised national, international, and regional partners, including ACET, which served as the lead national organization in Ghana. As the severity of the pandemic became clear, the program pivoted to respond to the emerging needs of policymakers as they made decisions on how best to manage the effects of COVID-19.

As a result, the program supported the Ghana Health Service to partner with the COVID-19 International Modeling Consortium (COMO) to develop a COVID-19 epidemiological model for Ghana. The Ghana Health Service took a leading role in implementing government policy, gathering timely public health data from two major labs responsible for testing samples from the Southern and Northern Sectors and clinical evidence being provided by the World Health Organization. The CoMo model was designed to draw on this data to develop Ghana’s country-specific epidemiological model.

So, what have we learned from brokering evidence for policy decision-making in Ghana since the outbreak of COVID-19? While evidence is necessary, its supply is not sufficient to ensure uptake.

A few lessons and insights are worth drawing out. 

First, expert committees were the go-to approach for drawing on emerging evidence, but politics played a huge role in whether evidence was used or not.

With the proliferation of evidence emerging from both domestic and international sources, evidence brokers were needed to bridge the gap between research and public policy decision-making. A national COVID-19 team was established to lead the effort, a new deputy minister of health with an extensive background in medicine and public health was appointed, and a former deputy Director-general of the World Health Organization was brought in to coordinate the government’s response.

In such a highly political environment, however, the proximity of these new appointments with policymakers raised questions about the transparency, rigor, objectivity, and independence of their analysis and policy prescriptions. Other scientists, the public, and opposition politicians openly challenged the validity of their recommendations around major policy decisions—such as lifting the partial lockdown and reopening schools – and expert institutions like the Ghana Medical Association publicly doubted the scientific basis for the government’s key decisions.

With Ghana’s elections scheduled to take place barely nine months after the country recorded its first case of COVID-19, political considerations seem to have heavily influenced the policy direction. Despite the rising number of cases, the government lifted the lockdown, and some experts observe that decisions around voter registration and the parliamentary primaries went against the scientific evidence. It was also widely speculated COVID-19 cases were being underreported ahead of the elections.

In general, the “infodemic” and the competition between health and economic objectives significantly complicated the evidence brokering process for COVID-19.

Second, the cultures and incentives within government institutions vary, and their ability to align around clear policy questions is rarely straightforward.

Our own experience found that even when quality evidence abounds, the internal incentives structures of multiple actors need to align. Ghana’s health sector is one of the few sectors with a well-organized evidence ecosystem, and officials were able to gather credible clinical data on COVID-19 over a relatively short period through the District Health Information Management System and other newly introduced data receptacles across the country.

However, we quickly found that the provision of necessary technical support and resources wasn’t sufficient; it needed to align with political incentives to ensure meaningful and sustainable uptake of evidence. Additionally, if clear policy questions couldn’t be agreed, the available evidence was either overwhelming or too generic to be of value. It took more time than initially anticipated to agree on where leadership for the COVID-19 modeling work would sit within government—and how collaboration between national bodies and CoMo, as an international collaboration, would function—before work could get underway.

In the end, the CoMo modeling efforts helped the Ghana Health Service and relevant stakeholders to better understand epi modeling as a policy tool, the policy questions it could help address, and how it could translate into decision-making.

Third, brokering trust-based relationships between stakeholders is key to enhancing more sustainable access and use of evidence.

Prior to CoMo, non-pharmaceutical interventions were largely implemented without the support of any locally driven scenario modeling. Building from relationships that had been established between Oxford Policy Management and ACET and the government of Ghana through long histories of collaboration, SEDI was widely perceived as a trusted and honest broker with the technical heft to convene diverse stakeholders.

Due to sensitivities around access and use of COVID-19 data—which was exacerbated by tensions around the elections and political parties’ efforts to gain political capital from the crisis – SEDI worked with FCDO’s Ghana country office to build trust and broker strategic relationships among crucial stakeholders within government institutions and academia, drawing lessons from previous unsuccessful attempts to build such models in Ghana.

As a result, SEDI was able to establish a technical working group with trusted stakeholders, gain unfettered access to credible data on COVID-19, and kick-start consultations on priority policy questions and how to ensure uptake of digested evidence from the model into decision-making processes.

Fourth, honest and independent knowledge brokers have a crucial role to play in building public trust in policy directives—and a high degree of trust is needed to enable effective evidence brokering.

While the demand for evidence increased, the volume and speed of supply of evidence emerging from the pandemic seemed to have inundated policymakers. The very large amounts of trusted and untrusted information generally posed a challenge for uptake and integration into established decision-making processes.

Public sector institutions struggle to translate large swathes of evidence into policy formulation, and in a politically polarized environment it can be all too easy to dismiss evidence as partisan. In this context, the role of independently constituted evidence intermediaries will always be crucial in policy uptake and ownership in Ghana.

Civil society organizations, think tanks, and NGOs often have the technical expertise to translate evidence into accessible policy briefs. Public trust in government policy direction is often higher when the recommendations of these honest brokers are in sync with that of governments. This became apparent at the height of the COVID-19 crisis, as evidence brokers like the World Health Organization and the West African Centre for Cell Biology of Infectious Pathogens undertook independent research on the speed of transmission or broke down available evidence on COVID-19 for easy assimilation by the public. These and a number of virtual events organized by various think tanks to engage all citizens were well received by the public.

It’s helpful to remember that evidence alone cannot resolve the complex trade-offs between policy areas, politics, government staff incentive structures, and the complexity of implementing policy choices. An unwavering leadership commitment to promote the transparent use of evidence by influencing processes, systems, and culture of policymaking at the national and subnational levels is also needed, as underscored in SEDI’s political economy analysis, The Role of Evidence in Policymaking in Ghana.

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