ACCESSING EVIDENCE IN TIMES OF CRISIS - PowerPoint Presentation

Slide1

ACCESSING EVIDENCE IN TIMES OF CRISIS

Disaster Information Specialists’ webinar15 November 2018

Ben Heaven Taylormailto:bhtaylor@evidenceaid.orgSlide2

Why the need for better evidence in disasters?

Over the past decade, average of 200 million people affected each year by ‘natural’ disasters. In 2016, 65 million people forcibly displaced by armed conflict.Humanitarian actors assist millions of vulnerable people each year. Worldwide, last year, £21 billion was spent on international humanitarian relief efforts.

The stakes could not be higher – ultimately, our collective aim is to save lives, reduce morbidity, protect livelihoods and safeguard well-being for some of the most vulnerable people on the planet.Those affected by disasters – and those paying for the response – deserve the highest possible standards in the design, targeting and execution of humanitarian aid. We have both a moral and a pragmatic obligation to ensure that humanitarian action is rooted in the best available evidence.Slide3

A call for better coordinated, more accessible and better evidence to underpin humanitarian action

Patchy evidence. Big gaps in our knowledge base. Study by LSHTM into humanitarian public health research found 131 robust studies into communicable diseases, but only 8 on NCDs. No studies at all into acute respiratory infection.Poor or questionable quality evidence. Same study by LSHTM, found only 345 out of 50,000 papers met quality standards. Similar reviews by Oxfam and others have largely replicated these findings. Many published studies don’t specify their research methodologies, severely limiting their usefulness (and wasting money!).

Inaccessible evidence. We often don’t know what we know. Much existing research and evaluation is not published or is not well publicised or is not well communicated to practitioners. Significant ‘publication bias’.Slide4

Too many incentives for poor research and publication biasSlide5

Towards evidence-based humanitarian decision-making

Not just about quantity or quality of humanitarian evidence … it’s what we do with it that matters.

Practitioners, researchers, donors and policy makers must support and incentivise the use of evidence to underpin policy, programme guidance, funding decisions, training and on-the-ground decision-making.“We are not talking about making decisions and choices by slavishly following rigid research conclusions. Professional judgement – such as feedback from your stakeholders – will always be important. This practice guide is not about replacing professional judgement but increasing evidence use in humanitarian action” Slide6

Getting it right - treatment of acute malnutrition

Prior to mid-2000s, therapeutic feeding (in response to severe acute malnutrition) mostly done via in-patient facilities, often specifically set up for the purpose (not always very well).

A series of studies showed that community-based, outpatient treatment using ready was just as effective (and cheaper).

A 2002 systematic review showed that severely malnourished children on average 51% more likely to recover using the new protocols than the old inpatient model.

Source:

Lenters

L.M.,

Wazny

K., Webb P., et al. 

Treatment of severe and moderate acute malnutrition in low- and middle-income settings

: A systematic review, meta-analysis and Delphi process. 

BMC Public Health, 2013;13

(

Suppl

3):1-15.Slide7

Evidence-based humanitarian action

Based on:

Barends E, Rousseau DM, Briner RB. (2014) Evidence-based Management: The Basic Principles. Amsterdam: Center for Evidence-Based ManagementSlide8

Cholera in DRC

Cholera is a fact of life in many parts of DRC. Outbreaks regular often severe. In 2017, a particularly severe outbreak resulted in 53,000 cases and 1,000 deathsWater, Sanitation and Health Promotion (WASH) is an integral part of the humanitarian community’s response to cholera.

Global evidence base reasonably strong for well disinfection, treatment of water sources and household-based water treatment (chorine tablets). Other interventions, less so (e.g. latrine building).Moderately good evidential basis for household-based health promotion interventions, including handwashing. Systematic reviews on the benefits of health promotion important in early 1990s for the popularisation of this kind of interventionSlide9

Triangulating global and local evidence

Cholera transmission poorly understood by humanitarian actors in DRC – not helped by a lack of systematic epidemiological data at national level. Actors need to go digging for raw data published by health zones.

Health data in DRC shows a correlation between proximity / contact with surface water and cholera infection (i.e. many of those who get sick are fisherfolk, herders, women washing clothes in rivers, lakes and ponds).

Keep doing WASH! Properly implemented, it’s a good first response, supported (in part) by robust evidence. But look at broader based interventions that address specific local risk factors (e.g. pay fisherfolk to stop fishing in lakes!).Slide10

Questioning our own effectiveness (a bit like John)

“

I know nothing …” John Snow

“…

the attacks had so far diminished before the use of the water was stopped, that it is impossible to decide whether the well still contained the cholera poison in an active state, or whether, from some cause, the water had become free from it

.”

Broadwick

St. pumpSlide11

What is Evidence Aid?

Founded by medical researchers who were keen to see whether and how robust medical research could be applied in humanitarian settings.Strong links to Cochrane, an independent global network of researchers working to build evidence-based decision making in world medicine.

Primary focus is to collate systematically reviewed, creating practitioner-orientated thematic evidence collections with clear summaries of findings and recommendations.We also engage with humanitarian actors – including practitioners, policy makers and donors – through events, online communication and advocacy.Ultimately, our aim is to save lives and livelihoods by supporting evidence-based humanitarian action.Slide12

Collecting and synthesising robust evidence

Range of ‘evidence collections’ arranged around key humanitarian themes, including:

Prevention and treatment of acute malnutrition

http://www.evidenceaid.org/prevention-and-treatment-of-acute-malnutrition-in-emergencies-and-humanitarian-crises/

Epidemiology and management of Ebola

http://www.evidenceaid.org/ebola/

Resources for windstorms

http://www.evidenceaid.org/windstorms-resources/

Resources for earthquakes

http://www.evidenceaid.org/earthquakes-resources/

Epidemiology and management of Zika

http://www.evidenceaid.org/zika-resources/Slide13

Resources

Evidence collections on key humanitarian ‘themes’

http://www.evidenceaid.org/

Join us for Humanitarian Evidence Week (this week!)

http://www.evidenceaid.org/events-and-training/hew/

Online version of the practice guide

http://www.evidenceaid.org/use-of-evidence-in-the-humanitarian-sector-a-practice-guide/