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December 1999 Insights Issue #32Twists in the Mwanza taleDid one HIV research study shift global policy?A recent study has surveyed and analysed the ways UK-based researchers and policymakers see linkages between research and policy, in relation to a particularly well-known case study arising from 1995 research into HIV prevention in Mwanza, Tanzania. The Mwanza study seems to have had a dramatic impact on policy reformulation in many countries. Did it really exert such leverage? If so, how did it and why? Can existing theoretical models of the research-policy interface account for it? Participants' interview responses revealed keen awareness of the policy shift and knew that the widely-cited research in question (Grosskurth H. et al, 1995) was perceived as having had a direct impact on policy change. Yet in the main, their answers suggested that research has a cumulative rather than a direct effect on policy.
Theoretical models of how research influences policy can be separated into two broad camps. A 'rationalist' view is that new research can directly prompt policy change. The 'political' camp on the other hand assumes that various external factors play a part both in defining the question that a research project tackles and in influencing the impact of the answers on policy. At first glance the Mwanza story seems to fit clearly into a rationalist framework. Publication of its results has been trumpeted as a defining moment in the history of HIV and a justification for much current sexual health programming. But the results of this research combined with the use of a timeline approach and chronological analysis indicate that a policy shift had already started many years before the Mwanza study appeared in print. Trial results were published in 1995. Yet many events throughout the 1980s and even beforehand were crucial to a 'cumulative and non linear' policy shift according to interviewed respondents. This process was characterised by one participant as 'a sponge soaking up water'. Another commented that 'Mwanza fell into a ready-made bed'. Universally, responses were twofold. Firstly, that conditions prevailing when the results were published strongly favoured policy reformulation. Secondly, that that the need to justify existing policy change and to marshal 'hard data to support an existing contention' predisposed many to back the Mwanza research from the word go. Particular theoretical models were more apt at particular stages of the policy-making process. Political models that explain the links between research and policy were more useful in describing the initial stages of the Mwanza trial implementation, for example, gaining donor support for the research idea. Later on in the process, rational models were more apt in explaining the direct effect the trials had in convincing those outside an already convinced core group of policy makers of the wisdom of policy change. These 'outsiders' were defined by one participant as 'the social development people and the accountants', the implication being that medical experts were already convinced. Some participants talked about how a medical approach to HIV prevention became a motivating force, whereas others mentioned changing technology as important, as STD treatment became available in primary health care clinics. Policy shift was not a smooth 'domino effect' or a sudden revelation but a gradual stop-go process, with many peaks and troughs, working many variant effects on different institutions and individuals. Almost all interviewees felt Mwanza influenced policy by supplying a push that helped an already rolling stone. Many respondents highlighted 'fact creation' or use of 'magic bullet' statements as motivating forces for policy shift. Complex epidemiological data were reduced to a single fact as it came to be translated and relayed within different research and practitioner communities. The Mwanza research became widely known for a particular statistical result, a reduction of HIV incidence by 42 percent. This fact was 'worshipped' as an immutable truth that could be applied wholesale to other contexts, no matter how different. This fact's easy 'digestibility' and intuitive appeal was seen as a vital spur to acceptance of the research findings. Among the main lessons of this review of the impact on policy of the Mwanza case study, are:
The policy change process was a narrative within a changing context, not a simple cause-and-effect transaction as many of the models and commentators have suggested. There is no guarantee that in a new context research of similar significance would have the same impact on policy.
Contributor(s): Tel: +44 (0)171 336 6677 Source(s): Date: 08 December 1999 Other related links: Search Eldis for sources on Health and Population issues
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