Abstract / Summary
Abstract Background The process of public health policymaking is characterized by a dynamic interplay of politicians, researchers, institutions, practitioners and technocrats from a variety of sub-sectors, as well as knowledge brokers and interest groups. Evidence-based policymaking in a decentralized context is a complex, non-linear process driven by diverse, autonomous actors with most policy functions and resources still anchored in the national government. Our aim was to understand the complex process of health policy and decision making in the devolved, county system of governance in Kenya, and the use of evidence in constructing political arguments for actionable health policies. Objective We seek to elucidate the complex contextual, political, and organizational influences processes of policy development and decision-making in Bungoma and Busia county governments in Kenya. Methods We leveraged the heuristic descriptive longitudinal integrative capacity framework to describe the organizational resources, structures, competencies, and supportive factors in policy coordination. We developed a Hub-and-Spoke Evidence Twinning model to explore the past and current policy values of stakeholders in the Bungoma and Busia County Departments of Health answering the individual, political and systemic factors influencing decision making. Over 14 months, we co-designed and collaborated with 15 technical managers in the county departments of health as part of enhancing research-to-policy dialogues in two counties. Findings : The county-level policy ecosystem indicated a fragmentation of decisional power and inefficient research-policy dialogues. The evaluation of health systems domains indicated longitudinal, political and integrative blockages in responsive action-oriented policies. Conclusion There is a general fragmentation of cohesive and contextualized evidence use in county policy ecosystems and a need to encourage adoption of scientific citizenship as standard practice in policy decision making. Using a tiered system of scientific consultation and educational initiatives to strengthen public understanding and enthusiasm in evidence-informed policies is fundamental in the improvement of knowledge systems in Kenya. The environment of co-creating impactful health policies must be cultivated cognizant of the concept of power and multisectoral relationships in health policy processes. This calls for institutionalization of knowledge brokerage mechanisms to translate evidence and health data into highly actionable policy briefs that align with political, economic and financial incentives.