Issuu

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam April 2022

Oxford University Clinical Research Unit

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Chapter 5. Researchers’ Experiences and Perceptions about Policy Engagement at OUCRU

TABLE OF CONTENTS Lists

1. Researchers' perspectives about activities as being part of policy engagement 2. Policy related outcomes researchers expect from their research 3. Researchers' perspectives about strengths for policy engagement in OUCRU 4. Researchers' perspectives about weaknesses for policy engagement in OUCRU

About Us

About the Project

Chapter 6. Researchers’ Willingness to Engage with Stakeholders

Acknowledgements

Summary

Chapter 1. Introduction

1. List of Tables 2. List of Figures 3. List of Abbreviations

1. Introduction 2. Project Overview

Chapter 2. Theory of Policy Engagement

1. What is Policy Engagement

Chapter 3. Internal Review Methodoloy

1. Internal review data collection tools 2. Sampling and recruitment 3. Analysis 4. Ethics approval and Strategic Committee approval 5. Study participants

Chapter 4. OUCRU Researchers’ Experiences and Perceptions about Policy Stakeholders 1. Types of stakeholders researchers have engaged with 2. What researchers think stakeholders do 3. Why researchers think stakeholders want to engage with researchers 4. Researchers' perspectives about how stakeholders use evidence 5. What researchers think their own challenges are in engaging with stakeholders 6. Researchers' perspectives about approaches to engagement with policy stakeholders 7. Engagement experience scores among OUCRU researchers 8. Ways researchers engage with policy stakeholders 9. Researchers’ questions for stakeholders i

1. Factors that facilitate researcher engagement with stakeholders 2. Factors that confound researchers’ willingness to engage

Chapter 7. Suggested Ways to Improve Policy Engagement at OUCRU

1. What should be done? 2. When should we engage? 3. How should we engage? Policy engagement as a communication exercise 4. Who should play a role?

Chapter 8. Lessons Learned from the Internal Review

1. The policy engagement process in OUCRU and its gaps 2. Talking about policy engagement facilitates policy engagement 3. Policy engagement is not about changing policy

Appendix 1 – Recommendations for Social Science Studies

Appendix 2

1. Ethics approval and Strategic Committee approval 2. Internal review timeline

References

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Lists List of Tables 1. Table 2-1. List of definitions 15 2. Table 4-1. Researchers’ ideas of stakeholders – by theme 22 3. Table 3-1. Internal review timeline 81

List of Figures 1. Figure 3-1. Interviewee selection process 20 2. Figure 4-1. Researchers’ opinions about challenges in engaging with stakeholders 27 3. Figure 4-2. Researchers’ approaches to engaging with policy stakeholders 32 4. Figure 4-3. The main themes of researchers’ approaches to engaging with stakeholders 33 5. Figure 4-4. Scoring the interview for experience captured from NVivo 12. 37 6. Figure 4-5. Engagement experiences scores 37 7. Figure 4-6. Themes of questions raised by researchers for stakeholders 40 8. Figure 5-1. Researchers’ understanding about policy engagement 46 9. Figure 5-2. Researchers’ expectations 50 10. Figure 5-3. Researchers' perspectives in terms of strengths for policy engagement in OUCRU 52 11. Figure 5-4. Researchers' perspectives in terms of weaknesses for policy engagement in OUCRU 54 12. Figure 6-1. Facilitators for researchers’ willingness 60 13. Figure 6-2. Confounding factors of researchers’ willingness 63 14. Figure 7-1. Policy engagement as a communication exercise 70

List of Abbreviations AMR

Antimicrobial Resistance

GDPM

General Department of Preventive Medicine, Ministry of Health

HTD

Hospital for Tropical Diseases

IRB

Institutional Review Board

MoH

Ministry of Health

MSA

Medical Service Administration

NHTD

National Hospital for Tropical Disease

NIHE

National Institute of Hygiene and Epidemiology

PACCOM

People’s Aid Coordination Committee

US-CDC

Center for Disease Control and Prevention

WHO

World Health Organisation

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

About Us The Oxford University Clinical Research Unit (OUCRU) is a largescale clinical and public health research unit with site offices in Viet Nam, Indonesia, and Nepal.

OUCRU-NP Kathmandu, Nepal

Part of the Centre for Tropical Medicine and Global Health at the University of Oxford (UK), OUCRU was first established in Ho Chi Minh City in 1991, hosted by the Hospital for Tropical Diseases (HTD), Viet Nam. In 2003, OUCRU-NP was established in Kathmandu, Nepal, hosted by Patan Hospital and the Patan Academy of Health Sciences. OUCRU Ha Noi was established in 2006 in partnership with the National Hospital for Tropical Diseases (NHTD) and the National Institute of Hygiene and Epidemiology (NIHE), Viet Nam. In 2008, the Eijkman-Oxford Clinical Research Unit (EOCRU) was established in Jakarta, Indonesia, in partnership with the Eijkman Institute for Molecular Biology and Faculty of Medicine University of Indonesia.

OUCRU Ha Noi Viet Nam

OUCRU Ho Chi Minh City Viet Nam

Our vision is to have a local, regional and global impact on health by leading a locally-driven research programme on infectious diseases in Southeast Asia. Our research programme covers clinical and laboratory research with hospital and community-based patient populations, including epidemiology, immunology, host and pathogen genetics, molecular biology, microbiology and virology, mathematical modelling, bioinformatics, biostatistics, and social science. This work is supported by an extensive clinical trials unit and data management centre compliant with national and international regulations and comprehensive management, finance, public engagement, and administrative support offices. OUCRU receives considerable support from Wellcome as part of the Africa and Asia Programmes. Together with our partners, we have led a highly successful effort in enhancing the infrastructure and capacity to perform clinical trials and basic scientific research in Viet Nam, Indonesia, and Nepal. Website: www.oucru.org

Eijkman-Oxford Clinical Research Unit Jakarta, Indonesia

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

About the Project Since our its establishment in 1991, OUCRU Viet Nam has been actively engaging with policy stakeholders as a leading clinical and public health research unit. Over the last 30 years, OUCRU has had many successes, and achieved some remarkable impacts on health policy in Viet Nam and in the region. This report is carried out as one of the key outcomes of the Project “Establishing systemic policy engagement at OUCRU: A pilot project” which was conducted from October 2019 to August 2021 by OUCRU Viet Nam. In this project, we worked with researchers in OUCRU Viet Nam to find out more about their engagement experience, and attitudes towards engagement with policy makers. This report is authored by Katrina Lawson and Nguyen Kim Ngan. Other authors include Prof. Guy Thwaites, Assoc. Prof. H Rogier van Doorn, Dr. Jennifer Van Nuil, Dr. Hugo Turner, Nghiem Nguyen Minh Trang, and Ngo Phan Bao Tran.

Acknowledgements The project team would like to express our great appreciation to OUCRU Director Prof. Guy Thwaites and OUCRU Hanoi Director Prof. Rogier van Doorn for their continuous support and valuable advice to improve the effectiveness of this project. To all group heads, researchers and staff who agreed to participate in our interviews, and share their experience – thank you. The project team have tried our best with all dedication and enthusiasm to conduct the review and carry out the best results in the hope of contributing, to some extent, to the enhancement of OUCRU’s policy engagement system.

Photo: The British Embassy's visit to the Hospital for Tropical Diseases to show appreciation for care given to Bristish patients in Viet Nam. 25 June 2020

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Summary Background Since its establishment in 1991, OUCRU Viet Nam has been actively engaging with policy stakeholders as a leading clinical and public health research unit. Over the last 30 years, OUCRU has had many successes, and achieved some remarkable impacts on health policy in Viet Nam and in the region. This study aims to explore the current state of OUCRU’s policy engagement efforts – from the researchers’ point of view, identify existing challenges, and propose relevant recommendations for future development in engaging with policy stakeholders in Vietnam and beyond.

and contributing to the policy making process (such as hospital directors). Researchers believed that stakeholders wanted to engage with them for the improvement of quality of service for the stakeholders themselves, for collaboration and partnership in research, for technical and infrastructure know-how and support, as well as for perceived high status or rank in being involved with OUCRU (for OUCRU is associated with high quality). Researchers’ challenges to engagement included difficulty in getting approval and administrative burden, stakeholders’ limited capacity and infrastructure to collaborate in research, stakeholders’ low willingness, conflicting priorities, as well as maintaining connections when staff change.

Methods

Researchers described a number of practical approaches they took when engaging with We conducted in-depth interviews with OUCRU stakeholders, which can be categorised into researchers on their past experiences in policy four main themes: Actively taking a position in engagement and their future plans. We asked them professional groups, engaging within the project about their perceived strengths, weaknesses, and establishment and preparation process, engaging challenges in engaging with policy stakeholders, through project implementation process, and as well as the support they need for policy scientific communication. Some researchers were engagement activities. The interviews took place already engaging in multiple ways with stakeholders between November 2019 and March 2020, and 55 (i.e. involved in activities that could be categorised researchers were invited for participation, among into all four main themes), but most participants whom 43 provided their consent for the data had less varied engagement (i.e. reported obtained from their interviews to be analysed. engagement activities in only one or two of the main themes).

Results

In the study, OUCRU researchers identified four types of policy stakeholders they often engaged with: Advisors, Vietnamese Government employees, International stakeholders, and Funders. Stakeholders’ roles were perceived to be supporting research in practical ways (such as getting approval, implementation, and monitoring) and as being people working in ministries who contribute to or support policy development, as well as those working in other non-ministerial areas

Participants identified a wide range of activities as being part of policy engagement. We grouped and ordered them into six categories based on level of engagement: Research publications, getting approval for research, implementing research activities, reading policy-related materials, disseminating research results, and direct consultation with stakeholders (with research publications as ‘least engaging’ and direct consultation as ‘most engaging’).

An important realisation through the interviews was that policy engagement was a new concept and activity for OUCRU – one which both the researchers and the organisation were still inadequately equipped for. In terms of policy-related outcomes from their research, researchers expected their research outcomes to improve treatment and health outcomes in general and to be integrated into regulation documents; they also expected to engage with the public as part of their research. However, the exact ways to achieve such outcomes could not be obtained from the interviews, and few researchers were able to produce concrete examples of their research being used to inform policy. They shared copies of their publications and stated that the publications had been used or referred to, but were unable to clearly say how their research had been used, or by whom, or provide evidence of that use (for example, by showing a policy document which cited their research). On an organisational level, researchers viewed OUCRU’s expertise, quality and technical capacity, our long-term relationships with stakeholders, as well as our strong and diverse networks with hospitals and other relevant parties as our key strengths for policy engagement. Our main weaknesses included communication gaps, ad hoc engagement, difficulty in measuring the impact of our engagement efforts, as well as difficulty to balance between various factors that could affect the engagement process. There were a number of factors that facilitated researcher engagement with stakeholders, and when some or all of these factors were in place, researchers tended to be more willing to engage. These included personal motivations, positive perceptions about policy engagement, positive experiences in policy engagement, as well as funders' requirements for engagement, and

evidence of policy impact. Conversely, when there was a lack of relationships between researchers and stakeholders, when researchers held negative perceptions about stakeholders, when researchers had negative experiences in engagement efforts, or when they lacked time and resources, their willingness to engage decreased. Participants also made some suggestions on how to improve policy engagement at OUCRU, which were classified into four main themes: “What” should be done in terms of policy engagement, “When” should be the suitable time to engage with policymakers, “How” scientists should engage, and “Who” should play a role in the policy engagement activities. They recommended that policy engagement efforts start from specific areas and with specific objectives, that such efforts should be embedded in the structure of the organisation itself, and that more scientific outputs should be translated into Vietnamese to reach policy stakeholders. Participants felt that policy engagement activities could be done at the end of a study, when results are available, but also identified the benefits of engaging with stakeholders at the start of the research process. They suggested that OUCRU researchers get involved in formal policy making opportunities or channels (such as being members of an advisory board for the government and international health organisations), and that we facilitate more systemic engagement and strategic communications throughout the research life cycle and on a strategic level for the whole unit. They also suggested that OUCRU strengthen the existing relationships with individuals and key organisations, as well as recognise the mutual benefits of engagement for all parties involved. Participants were clear that they needed a person or team to support them during the engagement process.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Summary (cont.) Conclusion OUCRU’s vision is to have an impact on health, and one way to realise this is through effective policy engagement with stakeholders – locally, regionally, and globally. OUCRU’s policy engagement goal at the organisational level is to facilitate and enhance continuous engagement across a broad spectrum of engagement opportunities for both researchers and stakeholders. Our specific goal for the policy engagement team is to improve the engagement with policy makers by using authentic communication at multiple phases of the research life cycle to facilitate impact on health by influencing policy. Overall, the study shows that the policy engagement process at OUCRU often starts at the implementation (getting approval) phase of research, which many participants believed to be ‘the beginning’ of the policy engagement process. However, we suggest that the beginning is actually the conceptualisation phase, where the lack of appropriate channels to facilitate engagement with stakeholders is particularly significant. This presents the opportunity to create more channels within OUCRU for researchers to access – at all stages of the research life cycle – in order to have meaningful engagement with policy stakeholders.

From looking at the study results, it is clear that communication needs to be a central activity for policy engagement, and engagement with policy stakeholders should be an essential part of our research culture. From the study, we have learnt that the simplest way to create a policy engagement culture was to provide opportunities for people to talk freely about policy engagement. There should be more concerted efforts to facilitate more conversation about policy engagement within OUCRU, which could include providing training support for researchers, seminars and workshops focused on policy engagement, connecting with international policy engagement networks, and expanding the conversation to the rest of the programme. Policy engagement is not only about changing policy; it is also about changing our own practices as an institution to create a research culture and environment that can facilitate those changes. We have already started on a project of change in our institution, to systematise our policy engagement, by including policy engagement as a core activity and by incorporating policy considerations into project designs and into our scientific communications. It is clear from this study that there is more work to do.

Photo: Opening ceremony of the National Reference Laboratory for AMR at the National Hospital of Tropical Diseases, Ha Noi. 5 February 2018

Chapter 1. Introduction

1.1. Introduction One key element of the Policy Engagement Pilot Award funded by Wellcome, Establishing systemic policy engagement at OUCRU: A pilot project, was to understand the perceptions of OUCRU researchers about engaging with policy makers in Viet Nam. We wanted to know what our researchers know and think about policy engagement, what experiences they have in engaging with policy stakeholders in Viet Nam, and where their key relationships with policy stakeholders are. To do this, the project team conducted in-depth interviews with OUCRU researchers - we called this ‘the internal review’. We asked our researchers about their past experiences in policy engagement, as well as about their future plans. We asked them what they think their own challenges are for engaging with policy stakeholders, what their weaknesses are, and what support they think they need. The interviews took place between November 2019 and March 2020 – just before the consequences of the COVID-19 pandemic started impacting normal life in Viet Nam. Here, we present key outcomes from these interviews to demonstrate an overview of the situation as it was at that moment, what our researchers identified as strengths and weaknesses, and our recommendations for how we can approach policy engagement in the future at OUCRU.

1.2. Project overview Internal review objectives Key objectives of the internal review included: 1. Explore the total policy engagement effort that is taking place currently within the OUCRU, from researchers’ point of view; 2. Track and record the known policy-related outputs among OUCRU work, creating a database of policy outputs; 3. Identify current challenges and opportunities for development in the future. This report will present the results of Objective 1, and some recommendations towards Objective 3. The database for objective 2 was also created, and is now stored on the Policy Engagement files on the OUCRU server and regularly updated.

CHAPTER 1. INTRODUCTION

Chapter 2. Theory of Policy Engagement 2.1. What is Policy Engagement The University of Oxford’s policy engagement team define policy engagement as:

“An umbrella term describing the many ways that researchers and policymakers connect and explore common interests at various stages in their respective research and policy making processes. From informal enquiries to formal enquiries, in consultation or sustained collaboration, policy engagement enables researchers and policymakers to improve public policy through making the most of academic evidence, expertise and experience.”1 As discussed in more detail in the results section below, we found that OUCRU researchers had diverse opinions about what a policymaker is – and indeed about who from the research world should have responsibility for engaging with ‘policymakers’. As such, throughout this report, we have adapted our language around policy making to identify the stakeholders who are active in the policy making process as ‘policy stakeholders’ (see the definition in the Table 2-1 below) rather than ‘policymakers’ (see the definition in the Table 2-1 below). We believe that this term is more inclusive, and more accurately reflects the diversity of agents in the policy making process in the health sector in Viet Nam. We also have simplified the language around the actors in the research side of the engagement process, and for the purposes of this report, OUCRU staff (research, operational and support staff) and students are referred to collectively as ‘researchers’ and policy stakeholders are referred to as ‘stakeholders’. Sometimes stakeholders are identified as individuals, and sometimes as organisations. In this report we have tried to be clear about when we are discussing individuals versus organisations. When we use the phrase ‘stakeholders’ with no distinction, we mean both or either individuals and/or organisations. Our interviews also clearly show that effective policy engagement does not only benefit stakeholders, it also has significant benefits for researchers. And therefore, our definition of ‘policy engagement’ is:

“An umbrella term describing the many ways that researchers and stakeholders in the policy environment connect and explore common interests at various stages in their respective research and policy making processes. From informal enquiries to formal enquiries, in consultation or sustained collaboration, policy engagement enables researchers and policymakers to improve both public policy and research through making the most of evidence, expertise and experience on both sides.”

CHAPTER 2.

Therefore, policy engagement is a process from the perspective of researchers and research engagement is the same process, but from the perspective of stakeholders.

THEORY OF POLICY ENGAGEMENT 14

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Table 2-1. List of definitions Term

Definition

Policy engagement

An umbrella term describing the many ways that researchers and stakeholders in the policy environment connect and explore common interests at various stages in their respective research and policy making processes. From informal enquiries to formal enquiries, in consultation or sustained collaboration, policy engagement enables researchers and policymakers to improve both public policy and research through making the most of evidence, expertise and experience on both sides.

Policy stakeholder

Someone employed in a government agency who drafts, writes, reviews or approves health policy documents, develops health programs, or makes, or contributes to the policy making process significantly. Policy stakeholders are distinguished from health stakeholders or research stakeholders in the involvement or contribution in a policy making process. A health or research stakeholder can be a policy stakeholder if they are involved in the policy making process. Sometimes stakeholders are identified as individuals, and sometimes as organisations. In this report, we have tried to be clear about when we are discussing individuals versus organisations. When we use the phrase ‘stakeholders’ with no distinction we mean both individuals and/or organisations.

Policy-related document outputs

A review, report, discussion paper, draft or final policy, formal directive, program plan, strategic plan, ministerial brief, implementation plan, guideline or protocol with a focus on health service or program design, delivery, evaluation or resourcing (such as treatment guideline, regiment guideline, standards criteria, national survey).

Photo: OUCRU researchers attending the closing event of Project VIZIONS. Ho Chi Minh City, Viet Nam. February 2017

Chapter 3. Internal Review Methodology 3.1. Internal review data collection tools We conducted in-depth interviews using a semi-structured questionnaire with OUCRU researchers to better understand their experiences of policy engagement. We decided to use the in-depth interview method because we wanted to explore our participants’ understanding of some of these more complicated concepts. The in-depth interview also helps to provide context or other data (coming up without being asked), and can offer a more complete picture of the perceptions, and contributing factors to those perceptions. We developed the questionnaire ourselves, and the questions were tailored to meet the objectives of the review project. The questionnaire was reviewed and piloted with researchers before use. During the interview process, some questions were added for non-scientist interviewees. The main themes we discussed included key motivations, advantages, weaknesses, and challenges of policy engagement activities. We also asked about the current forms of policy engagement being used at OUCRU, key outcomes of these activities, and opportunities to enhance the communications between researchers and stakeholders (please see Appendix 1 for more detail). We audio recorded the interviews and/or documented the content using handwritten notes. Interviews were conducted in either Vietnamese or English, depending on the preference of the interviewee. We designed the interviews to take from 40 minutes to 1 hour.

3.2. Sampling and recruitment

CHAPTER 3.

We used purposeful sampling and snowball sampling as sampling methods in this review. We identified and selected participants based on seniority, group, role, engagement experience, existing relationships with stakeholders, and their influence within OUCRU. Participant roles included group heads and senior researchers, as well as key individuals in the operations teams, in order to collect a range of experiences. Then we sent email invitations to all of them to request their consent to either be interviewed, and/or nominate others in their groups for interview. Potential participants were excluded if they did not give their consent. An additional 14 participants were nominated to participate by those originally contacted. All nominated staff gave their consent and participated in the interview. The total number of invited participants was 55.

INTERNAL REVIEW METHODOLOGY

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

3.3. Analysis All recorded interviews were transcribed, and those conducted in Vietnamese were translated into English. The information was then imported into the qualitative data analysis software program, NVivo 12, for analysis. We used thematic coding for this analysis with themes and sub-themes generated from the interviews.

3.4. Ethics approval and Strategic Committee approval The project was approved by the OUCRU Strategic Committee for conducting interviews with audio recording and granted approval by the Oxford Tropical Research Ethics Committee (OxTREC) and the Institutional Review Board (IRB) of Hanoi University of Public Health.

Potential participant list (n=41) Nominated by group heads (n=14) Total = 55

3.5. Study participants The internal review took place from Oct 2019 – May 2021 (Please see Appendix 2 for more detail). In total, we invited 55 researchers to be interviewed. 43 researchers provided their consent for the project team to proceed with data obtained from their interviews. Of these interviews, there were 2 directors, 18 group heads, 13 senior researchers, 7 staff, and 3 PhD students. Data from those who did not give their consent (n=12) were excluded from the analysis, and the results are presented here (Figure 3-1).

No response or denied (n=6) Agreed to participate (n=49) No consent for analysing (n=6) Number of interviews for analysis (n=43)

Figure 3-1. Interviewee selection process

Photo: Policy Engagement Team's interview with study participants. Ho Chi Minh City, Viet Nam. October-November 2019 19

Chapter 4. OUCRU Researchers’ Experiences and Perceptions about Policy Stakeholders

4.1. Types of stakeholders researchers have engaged with In the interviews, we asked the researchers to identify the range of stakeholders in the policy context in Viet Nam. Four key types of stakeholders were discussed in the interviews: 1. Advisors (Vietnamese or non-Vietnamese) 2. Government employees (Vietnamese) 3. International stakeholders (Government and non-government) 4. Funders (Non-Vietnamese or Vietnamese)

Table 4-1. Researchers’ ideas of stakeholders – by theme

CHAPTER 4.

Theme

Description

Number of people who mentioned these Themes*

Advisors

Advisors are people who are involved in the policy making process, but may not be directly part of the government. Examples include academics from universities and research institutes, NGOs, civil society groups, service providers such as hospitals, etc.

Viet Nam Government employees

This category includes anyone who is a professional civil servant, or employed by special government entities such as the Ministry of Health or other government agencies.

International stakeholders

Any non-Vietnamese institution or individual who is involved in the policy-making environment, such as WHO or US-CDC.

OUCRU RESEARCHERS’ EXPERIENCES AND PERCEPTIONS ABOUT POLICY STAKEHOLDERS

Note that there can be overlap between international stakeholders and advisors, but as a significant number of researchers mentioned international stakeholders specifically, we have created this separate category here. Funders

Research funders

* If researchers mentioned at least one type of theme during their interviews, then it was counted as 1.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Many researchers (n=31) mentioned engaging with Advisors (as per the definition above). The researchers shared that Advisors play a major role in the policy making process by providing their expertise and academic knowledge. For instance, researchers could identify a national hospital as an Advisor in the policy making process, because they are the lead on a national program which contributes significantly to the evidence-informed policy making process. When the researchers talked about ‘policy makers’, for the most part they were talking about Government stakeholders, who have clearly defined, policy-related jobs, and who work directly for the government. The most commonly mentioned Government stakeholders were MoH or MoH’s subordinates (MSA, GDPM), Provincial Departments, People’s Committee, and PACCOM. Examples of International stakeholders that were mentioned included non-government organisations, worldwide organisations, embassies. The three most common international organisations that our researchers mentioned in interviews were UN agencies FAO and WHO, and the US-CDC. Funders who provided financial support for research projects were also listed as key policy stakeholders by a few participants (n=3). Some researchers shared that research proposals need to have a policy impact section, and that evidence of policy impact is often a reporting requirement – sometimes for several years beyond the end date of a project.

4.2. What researchers think stakeholders do In the section above, researchers listed stakeholders as people or organisations outside of OUCRU. Often, the stakeholders were identified because they supported research in various practical ways such as getting approval, implementing, monitoring, coordinating or supervising. These stakeholders come from both government sectors and non-government sectors and at different levels (local, national, and international). Researchers shared that stakeholders in policy engagement are not just ministers themselves, but people who researchers work with in their research and who hold a key position to contribute or support to develop a policy, or present the policy to the ministers. “For me, I believe the policy makers: the actual people who make the decisions are very senior and you could name them. The Minister of Health, for example, that’s one person. But they don’t develop the policy. It’s not them that the researchers need to be in touch with if they want to influence the policies that go to the Minister of Health. There is a whole raft of other people who are unnamed, usually. And we don’t know quite who they are. I think they’re the people that need the closest relationship with researchers. They’re the ones that actually develop the policies for presentation to the minister.” For example, the stakeholders could be directors of laboratories, statisticians, epidemiologists, or medical doctors. These people have many different roles but they still fit in the category of Advisor. These people are not the very top individuals in the ministries, but are recognised by OUCRU researchers as playing a role in the policy making process by contributing their experience and expertise. “[They are] the directors of one of the reference laboratories for example, and senior person in the organisations (that I had collaborated with), but not [the] very top person at the organisation. So, that was enough people to be able to have that conversation at a high level.” “Well, I am thinking of (not the policymakers), but I am thinking of colleagues, statisticians, or maybe the epidemiologist or the medical doctor as well.” An example of a hospital director being seen as a policy stakeholder is mentioned below. “We are working with [the National Hospital] in Hanoi, and the director there is also the Head of [National Programme], so he will be a key policymaker. I met him on a trip two years ago, I will meet him for sure again when we start the project this year, and he is probably the person to have a first conversation with, when I meet him again. I am not sure that there is anyone more important to talk with in the government about our project, he would probably be the best person to discuss with.”

Photo: Memorandum of understanding signing ceremony between OUCRU and HCMC Center for Disease Control. Ho Chi Minh City, Viet Nam. 2020

However, some researchers expressed some uncertainty about who makes the decisions in the policy making process in Viet Nam. “I don’t know, I don’t know about the Vietnamese system. I don’t know who makes the decision - whether it’s them, or whether it’s the person above their head.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

4.3. Why researchers think stakeholders want to engage with researchers We did not explicitly ask researchers about why they think stakeholders want to engage with researchers, however, some researchers shared their ideas on what they think stakeholders are looking for in the relationship. Researchers expressed that they believe that stakeholders will benefit from engaging with researchers. The kinds of stakeholder benefits identified included • Improved quality of service for the stakeholders • Collaboration and partnership in research itself • Technical and infrastructure know-how and support • Perceived high status or rank in being involved with OUCRU, because OUCRU is associated with quality. Eight researchers felt that the stakeholders were engaging with OUCRU mainly for their own benefit and that stakeholders were not necessarily engaging with OUCRU with an intention to provide any benefits to OUCRU. However one researcher pointed out that OUCRU needs to benefit too (please see Section 4.9 Researchers' questions for stakeholders for some researcher benefits). “[..] personally I get the feeling then that OUCRU is almost being used as a screening board to improve local (organisations) and to give them an option to have (their staff) internationally qualified […]. I think it probably got a lot of benefit for the local (organisations). Because they are going to be tied to OUCRU. And I think OUCRU is a quality name, and it may open doors for collaborations and partnerships across research.” “When we submit a research proposal, what they care about is how their hospitals can benefit from the research. […] The usual question is how they will benefit from the research, so it’s an issue which is very difficult to resolve.[…] They only care if the hospital can maintain ISO […]. They are interested in what modern equipment can be brought to the hospital, so they can have a higher rank in improvement and high technologies, etc. However, if a research project is not related to these, they don’t want to work with us.” “I will establish [an advisory] board but be careful about what the role of the board is, in a way that they have to see that benefit them, to be honest. And we have to feel the benefit for us too.”

4.4. Researchers' perspectives about how stakeholders use evidence

Very few people knew about how stakeholders use evidence and those who mentioned it had mixed opinions. Only seven researchers shared ideas on how stakeholders used scientific evidence to inform their policy making process, possibly indicating a lack of awareness about the policy making process in Viet Nam. This is discussed in the next section about Researchers' questions. One researcher expressed an opinion that in Viet Nam, stakeholders have a strong bias in their selection of evidence to inform policies – indicating a belief that stakeholders look for evidence that supports their pre-existing policy goals, but are not genuinely engaging with evidence to inform policy making. This researcher also shared their concern that the policy making process in Viet Nam may be affected by political influences. “I think it’s one-sided. For example, what supports a Ministry’s policy proposal will be put into the draft. They usually choose what supports it, not what is against it. […] This barrier is not only our barrier, but other research organisations’, which is the fact that policies in Viet Nam are not evidence-based. That’s what we want to go forward, though any policy written is based on political decisions rather than scientific decisions.” Others reflected on their personal experience in working with policy making subcommittees, and observed that World Health Organisation (WHO) guidelines had been used as a primary resource. Perhaps reflecting variations in personal experience, some mentioned concern that policy making committees did not consult scientific publications as part of their process, whereas others said they did. “[Policy making] committees often make decision based on their personal experiences, or use examples from other countries. Importantly, they don’t use or even read scientific studies.” “When they need to write a treatment guideline, they will refer not only to books but also research organisations.”

Researchers sometimes (19%) framed stakeholder motivations to engage negatively – depicting the stakeholders as self-serving, or not authentically interested in collaboration. However, the fact that we can identify benefits for stakeholders in engaging with OUCRU researchers is a positive learning – even if we perceive those benefits as self-serving. We need to be able to demonstrate and communicate to our stakeholders the benefits for them of engaging with us, in order to continue to grow and improve our engagement. However, we also need to acknowledge and understand the benefits that engaging with our stakeholders brings to us, as researchers and as an institution.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

4.5. What researchers think their own challenges are in engaging with stakeholders

Researchers identified a number of challenges to engagement. A challenge is an outside factor, something that is outside of the power of the researcher to change or improve. Later in this document, we also talk about engagement weaknesses. There is a subtle difference in these two terms as we apply them here. A challenge is something that is brought to us by external factors which we do not have power over, whereas weaknesses are internal factors that we can influence and change. In this section we are talking about external challenges.

•

Getting approval

Ten researchers mentioned 25 times the difficulties in getting approvals for implementing research or IRB approval as being a particular challenge for policy engagement. Correspondingly, researchers also mentioned approvals as being a key component for policy engagement (see Section 4.6. Researchers' approaches to engagement with policy stakeholders, and Section 5.1. Researchers’ perspectives about activities as being part of policy engagement, for more discussion about why they think this is a challenge). •

Stakeholders’ low willingness to engage

Some researchers shared what they think about stakeholders’ attitude to engagement. While six researchers shared examples of stakeholders showing strong willingness to engage, in 11 cases there were examples of low willingness, with stakeholders being considered not open, not actively reaching out to researchers, not wanting to get involved in projects, or not wanting to share resources. “I mean we should via the unit engage with people working in [Ministry A], [Ministry B], and push forward ideas for new government legislation, but often, I think they are not open. This is the past experience. […] the problem is [Ministry A], they don’t want to get involved, and [Ministry B], they don’t want to get involved, so we have a problem between two ministries.”

Challenges

“I think unless OUCRU goes to tell the [Specific Department] that we will write the guideline for them, they won’t come to us for it.”

Difficulty in getting approval, administrative burden (n = 25)

Stakeholders' limited capacity and infrastructure to collaborate in research (n = 17)

Stakeholders' low willingness (n = 10)

Conflicting priorities (n= 9)

Stakeholders' human resources (high turnover) (n = 9)

Stakeholders' time constraints (n = 7)

One researcher noted a general unwillingness to work with a foreign NGO among stakeholders, or an unwillingness to contribute their own resources (see also Section 4.3. Why researchers think stakeholders want to engage with researchers). “Even they [officials in the province] are nice people but they have never put in their own resources. You know we don’t feel like they are putting their own resources in. I have heard another friend who works in another NGO, say [the province] is suspicious. They are not very open to foreign NGOs. I don’t know why.” •

Figure 4-1. Researchers’ opinions about challenges in engaging with stakeholders

These perceived challenges were selected for discussion because of how frequently they arose in the researchers’ responses.

Stakeholders’ capacity

Stakeholder capacity was also considered to be a challenge. Four participants said they worried that it could be a challenge if stakeholders do not have enough equipment, facilities, or technical support to collaborate in their research. These limitations could be their resources in lab, manpower, management system.

“Secondly, we are willing to collaborate with [partners] to carry out scientific research, but they (the partners) don’t have equipment. There are projects that require extensive laboratory experience, which they cannot meet either.” Beside the challenges in the context of collaboration on a project, there were concerns related to the capacity to understand scientific information, use scientific evidence to develop policy related outputs, or manage a policy implementation process.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

“Because I don’t think the policymakers have a very good understanding of the technical reality. You know, these are not policymakers who read [scientific] papers, because they don’t understand what it means, right. But they are still policymakers, and we still need to talk to them, and they still have an impact.” “Sometimes they are co-authors of a publication as we got research permission from [the institute], so they all know what we are doing. But when we have the outcomes, they don’t understand their meanings, which is the difficulty. I’m sure you have heard of it from other groups.” •

Stakeholders’ time constraints

Just as researchers struggle to find time to engage with policy stakeholders, they also recognised that stakeholders too have limited time for engaging with researchers.

•

Maintaining connections when staff change

A number of researchers discussed staffing changes at stakeholder offices. When there are staffing changes among stakeholders, researchers sometimes find that they lose contacts, and may have to start again to build new relationships. Researchers clearly stated that these sorts of changes not only affected their collaborations, but also their work and negatively impact their own willingness to engage with stakeholders. Researchers pointed out that if contacts are lost it can slow down the research process and end any engagement initiatives that might have been in progress. “The director changed about four years ago and then it leads you to lose the relationship. … So you have to start again. When we tried to develop something two years ago with them, they only have like an acting head, they have not nominated the new head. And then the acting head does not want to be responsible for anything. And we are waiting and waiting and waiting, you know, a year and a half. We tried to get something done and then we just gave up. So, I have not worked with them for a couple of years.”

“Sometimes I think they are very busy, it is hard to get their time, their attention.” “Most of their support is effective, only some busy doctors lack in support because of their time limitation.” As with the researchers themselves, this challenge was sometimes seen to be related to the stakeholder priorities for choosing how they should spend their time. “Sure, the most difficult challenge is that they are too busy. For example, they are assigned to join the project, they still have many studies and routine work as a doctor, e.g. doctors are busy to examine patients or do their own projects, which slows down our project.” •

Conflicting priorities

The time that it takes to build networks is a factor that affects researchers’ ability to cope with these kinds of changes. With new people come new processes and new priorities. “Now they have changed the director board, they will change the communication procedure, so we don’t know what channel we can use to have impact on the ministry. Those are effects from external barriers.” At the same time, researchers are realistic – and know that human resource changes are inevitable. “You know there’s always going to be changes of personnel. There are changes of ministers or changes of people on task forces, there’s changes of priorities, there’s always going to be changes.”

The differences in priorities between researchers and policy stakeholders were identified by researchers as challenges (n=9). “I think the challenge will be the priorities a [Ministry] had or the government had may actually and quite normally be different from that of the researchers. You know, it may be there is important incompatibility actually, between what the government would like and what the researcher would like to do.” Some researchers acknowledged that it is important for researchers to know about stakeholders’ priorities to ensure that their research is aligned. Because when researchers did not have information about stakeholders’ priorities, they may spend their time and resources to do research which cannot be used by stakeholders, or they would not be supported by stakeholders’ resources (especially when stakeholders are also funders). “For example, if they tend to prioritise prevention, then they would allocate more resources for research in prevention. In this situation, if researchers focus on treatment, they would go the wrong way. The two interests are discordant.”

Recommendation: OUCRU should develop institutional structures to help manage the fall-out from unavoidable changes at stakeholder institutions. By having centralised stakeholder management support, we can limit the impact of personnel changes and better support researchers to manage long-term relationships with stakeholder institutions.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

4.6. Researchers' perspectives about approaches to engagement with policy stakeholders Researchers described a wide variety of practical approaches for engaging with stakeholders which they had previously conducted or were involved in. Engagement approaches provided by these participants can be categorised into four main themes: 1. Actively taking a position in professional groups; 2. Engaging within the project establishment and preparation process; 3. Engaging through project implementation process; and 4. Scientific communication.

Recommendation: While it is clear that researchers are engaging with stakeholders, they are unable to demonstrate the impact of this engagement, because they do not routinely collect evidence of, or report on that engagement. OUCRU should centralise collecting policy engagement outputs in a systematic way, and produce regular reports that highlight our policy engagement outputs.

The number of researchers who experienced these approaches are presented in Figure 4-2 below, and the main themes of these approaches are presented in Figure 4-3. Of these, engaging through a project implementation process and scientific communication were cited by the researchers as the common activities. In addition to this, many researchers also communicate with stakeholders during the establishment and preparation process of a project. While the approach of “actively taking a position” in a professional group is shared only by few researchers, the second approach of “engaging in project establishment and preparation process”, and the third approach of “engaging in project implementation process” are shared across the researchers. Data from interviews showed that getting approval, collaboration through the research implementation process and dissemination workshops were considered to be at the center of policy engagement activities. Stakeholders tend to be involved in the approval and research implementation stages more than the other phases of the project life cycle. That engagement is often described as facilitating approval (from the MoH or other committees e.g. HTD IRB) for the research process, or facilitating the research activities themselves. Few researchers mentioned that they consulted stakeholders at the conceptualising or project design phases. Stakeholders are sometimes partly informed at this stage of the project design, but they are just normally provided with general information about what we are going to do, and not invited to participate. Some researchers mentioned that their research had been used to inform policy in the past. When this came up, we asked the researchers to send us examples of the policy outputs that had been produced. However, only a very few researchers were able to produce concrete examples. Many sent copies of their publications, and stated that the publication had been used or referred to, but were unable to clearly say how their research had been used, or by whom, or provide evidence of that use, e.g. by showing a policy document which cited their research.

Figure 4-2. Researchers' approaches to engaging with policy stakeholders

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

• Engage through establishment and preparation

Actively taking a position in professional group

Getting approval

ENGAGEMENT ACTIVITIES

Co-author in scientific papers

Technical support and training

Engage through project implementation activities

Involve stakeholders in implementation, coordination and supervision

Only a few researchers (n=9) reported that they were a member of a professional group as a form of policy engagement. Via these professional groups, they have been able to establish good networks with other members who come from the policy environment and are involved in the policy making process. Some of these groups are established and operated by the Government, which provides legitimacy and clear pathways of engagement. These professional groups may be national or international, providing professional expertise or peer review in the development of policy-related outputs (e.g. treatment guidelines, national standards). Examples that came up in our interviews included: An advisory board for a Government World Health Organisation Review Board; National Advisory Board on Antibiotic Resistance A national technical working groups for the development of Dengue fever treatment guideline Hospital Director’s Boards of the South of Viet Nam Ethics Committee of Viet Nam Ministry of Health. Participating in these groups was considered a way to engage with policy because it could bring change in the policy making process. Researchers shared their opinion that the role of these boards was (e.g.) to give advice on the introduction of a new drug, or to develop a treatment guideline, to provide a report for specific health issues, update information, develop national survey protocol for a specific issue, and connect with government sectors. “I mean, my interaction with policymakers and my impact on policy is more through direct interaction and sitting in a committee rather than writing documents. So, I am a member of a national advisory committee on [a specific health issue].”

Science communication

Provide scientific evidence (data, information, documents) that could be used by stakeholders

Workshop or conference

Press (Being interviewed or mentioned by journalists). Press conference

Figure 4-3. The main themes of researchers' approaches to engaging with stakeholders

Actively taking a position

•

Engagement during project establishment and preparation

Among the kinds of project establishment and preparation activities that emerged from the interviews, the most talked-about activity was “getting approval” (e.g. ethics approval, implementation approval). Researchers spent time with government authorities, sent those supporting documents, budget plans, and research plans, seeking the government’s permission for the project or getting ethical-related approvals Another ad hoc engagement activity was inviting policy stakeholders to speak to academic audiences about any procedural updates in the approval process. “Actually, we prepared everything, then we sent to them. They just did approval. We did ask if they had any comment but they did not, they just gave out approval. They did not have any comments.” Researchers had many ideas about ways that we could increase engagement in the project establishment and preparation stages, mentioning activities such as organising training workshops, choosing intervention sites, recruiting participants, including stakeholders as co-investigators or coordinators of projects, etc. “The stakeholders [are] involved in the implementation phase (not earlier). Their roles are ethic approval, coordination, patient recruitment.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Engagement during project implementation

During research project implementation, activities that involved collaboration between researchers and people at government sectors were considered as engagement activities as well – and particularly by people whose responsibility was to conduct these tasks, such as research coordinators, PhD. students, and research assistants. These activities included “recruiting research subjects”, “involving stakeholders in implementation, coordination, and supervision”, and “technical support and training” on research design and the way to implement. “Yes, the key stakeholders provided support for implementation and coordination, some of them are involved as a Co-PI of the research.” The participants also confirmed that these kinds of engagements or collaboration were for getting research done rather than making any policy change. We noticed that researchers could bring different viewpoints in terms of policy engagement activities depending on their roles and experience. More junior researchers and operational staff tended to describe policy engagement as a process of connecting with government stakeholders for preparing documents for approval or recruiting research participants – engagement for the benefit of the research project. Whereas the researchers who were senior researchers tended to describe policy engagement in project implementation as collaboration, and contributing to more long term relationships: in the research process, in writing scientific papers, sharing data, and in membership of advisory boards. We noticed when being asked about their policy engagement experiences, researchers talked about approval and administrative processes within in which they have to interact with stakeholder from the government – such as seeking approval and permissions. As we examine in more detail in Chapter 5, these activities can be a part of the engagement process, but on their own this is very weak engagement. The process of seeking approval (by researchers) and granting approval (by stakeholders) does obviously facilitate research, and there are some limited opportunities to develop relationships and communicate about research priorities in those activities. But the benefit for stakeholders who are seeking to developing policy from engaging in approval processes is extremely limited, and the approval process for research is very different from the policy development process. The fact that researchers mentioned approvals and permissions so frequently as examples of policy engagement, indicates what effective policy engagement is among OUCRU researchers, as well as a lack of understanding of the policy development process.

•

Engagement as scientific communication

Researchers talked about the various ways that they used scientific communication to engage with stakeholders. These included seminars and workshops (mentioned in 18 interviews) – whether hosted by OUCRU, or attended by OUCRU researchers; providing scientific evidence (mentioned in 10 interviews) – including data, information, documents, scientific publications); engagement with press (mentioned in 3 interviews). When OUCRU researchers were hosting workshops or seminars and inviting stakeholders to participate, these workshops were mainly conducted at the later stage of the project implementation, in order to communicate research results. Very few workshops (mentioned in 3 interviews) were held at the time of research conceptual development. Researchers presented at workshops hosted by the government or that had strong government representation when invited. However, researchers reported that they did not have enough information about these workshops in order to actively join on their own initiative. It is worth noting that workshops and seminars mentioned by researchers were more likely to be research projectbased communication, rather than strategic, programme level communication. Some researchers reported being specifically approached by stakeholders and asked to provide scientific evidence or information. For example, some researchers reported receiving calls from authorities or government agencies seeking issue-related data or gathering evidence that might support the decisionmaking process by policy stakeholders. There were a small number databases that had been developed as part of research projects in collaborations with stakeholders, that continued to be used after the project ended. Some researchers also mentioned that they had seen their scientific data used at meetings by stakeholders. “I saw those results from the paper presented at several meetings, in different meetings not only by the government but by stakeholders, people that are really close to the government.” Some researchers also mentioned sharing their scientific publications with stakeholders, as a way to provide information to policy stakeholders. The researchers were aware that it could not only be used as scientific evidence for policy making, but they also stated that it could help them have more credentials when engaging with policymakers. There was a perception that attempting to change or influence policy can be slow, in comparison to publishing in scientific publications. But that scientific publications in high impact journals will have greater impact on the policy making process.

Recommendation: OUCRU researchers would benefit from some education or training about the concept of policy engagement itself.

“[…] you also need credibility, scientific credibility, which gives you weight, gives your opinion some weight. So, the more you publish in a big journal and big results, the more weight your voice and your approach for the policymakers has… I think usually, in my experience, policy change is slower than the time for publication. So, if you publish the data that pushes you faster than changing policy. Changing policy is quite slow, I think. Unless there’s some crazy emergency.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

4.7. Engagement experience scores among OUCRU researchers We wanted to try to quantify the experience of our researchers in engaging with policy makers, to try and see what proportion of our researchers are highly experienced, and engaging in many ways, and what proportion have less experience, or are only engaging in some of the four main themes in Figure 4-5. To do this, we scored the researchers according to their experience they mentioned in their interviews, from zero to four. A score of 0 meant that the researcher did not mention any experience that aligned with the themes. A score of 1, meant that the researcher had mentioned activities that belong to at least one of the four main themes, and so on. Researchers who mentioned activities that could be categorised into all four main themes were awarded the score of 4. We used NVivo to create a case classification to make it easier to count activities of each interview as below. B: Actively taking a position

C: Engage through preparation

D: Engage through implementation

E: Scientific communication

2: 10... Member of professional groups

Get approval

Involve stakeholders in implementation

Contribute to develop...

22: 2... Member of professional groups

Get approval

Technical support and training

Discuss or interview

41: 6... Member of professional groups

Get approval

Involve stakeholders in implementation

Contribute to develop...

Figure 4-4. Scoring the interview for experience captured from NVivo 12 Then we used Excel to draw a chart showing the engagement experience scores. The chart shows us that some researchers (n=3) were engaging in multiple ways (i.e. mentioned activities that could be categorised into all four main themes) with stakeholders already (see Figure 4-5). But what is more common is that people are engaging a bit (had activities belong to at least two or three main themes, but perhaps could think about enriching the ways in which they engage to make it more impactful). Only three researchers reported no engagement at all.

4.8. Ways researchers engage with policy stakeholders

Most researchers agreed that personal engagement is more effective especially at the beginning of the relationship. Researchers agreed that at the first engagement, it is best to meet and talk directly with stakeholders in person. It could be done in many ways, organising a workshop, joining a conference, communicating through other personal relationships, long-term professional relationships, or using the OUCRU hospital network. “My personal experience is, the only way to really build a relationship is face-to-face. Emails and things for me have never really been that effective. If you build up an incredibly good face-to-face relationship and personal relationship and then you send somebody an email telling them something – maybe that will be OK. But otherwise, no. For me, it’s about personalised meetings.” “For example, I’ve joined an international conference, so we’ve known each other. We will introduce who does what, and they know I’m from OUCRU and I’m doing this technique. For example, I was working with [someone from NIHE], but the [national hospital] didn’t know who I was. [NIHE said OUCRU could [do this technique] and [this individual from NIHE] told the [national hospital] that if they wanted to know this technique, contact me. Then they asked me if I could show them and I said yes.” The ways that people chose to engage depended on the relationship status, the context, and the purpose of engagement. “It depends on the importance of the context. If it is necessary, a meeting should be conducted. If it is not, so email or phone calls are fine.” It was clearly considered beneficial to meet in person to establish new relationships and maintain them. However, researchers identified that when there is an emerging issue with time constraints (such as an outbreak), then emails or phone calls can also be good. Other online channels such as websites and media campaigns were also suggested. For example, one researcher talked about a publication which they had shared with the media through a press release. In this case, the research results had indicated a potential public health issue, and within a week of the press release, the government had made announcements about improvements directly related to the same issue. In that case, the researchers had not received a direct response from the government, but the government had responded in turn in the press itself. “That particular press conference was very effective […] We wrote that in the newspaper, the government did not send us anything. But you can see how they respond to that issue, by the news. That is a very good example, to see the government respond. You can follow the news to see how they responded to the research.”

Figure 4-5. Engagement experiences scores 37

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

4.9. Researchers’ questions for stakeholders We asked the researchers ‘what questions do you have for policy makers?’ By asking this, we were hoping to find out what gaps in their knowledge about stakeholders that our researchers would be able to identify for themselves. We also wanted to try to understand researchers’ motivation for engaging with stakeholders in the first place, and so we looked at some of the reasons that they stated for wanting to ask these questions.

What channels exist

About policy background information

These purposes or reasons were varied, as expected, and some key themes emerged: • • • • • • • •

What updated on National action plan, resources, guildelines, future policies

Finding an efficient way of implementing research Convincing policymakers about the usefulness of research results Disseminating the research results; Getting approval Having more financial support Adjusting research activities Giving recommendations for policy making process Having an impact during or after the research.

One interesting insight about this is that most of the researchers were clearly thinking about how this engagement could be useful to them, as researchers. However, there was one example from a researcher who was clearly also interested in how that engagement could be useful to the stakeholders: “If I would have thought about starting new research I would ask you what do you want, what to decide about the specific topic in a couple of months." Some researchers had very clear questions, however, what also happened was that in thinking of one question, another related aspect would pop up. And you can see how complex this is in the analysis in Figure 4-3 (below) which shows the inter-relatedness of many of the questions and themes that arose in the researchers’ responses. The dash arrows show the way questions related to each other.

About stakeholders' needs from OUCRU, their priorities, interests, and long-term requirements How policies are developed; how evidences are used; what types of evidence

Questions for policy stakeholders

About policy making process

A lot of different questions emerged in the interviews, but there were some key questions that came up regularly and could be categorised into four main themes (Figure 4-5). 1. Questions about policy background information (n=13); 2. Questions about the policy making process (n=9); 3. Questions about stakeholders’ needs from OUCRU, their priorities, interests, and long-term requirements (n=11); and 4. Questions about the ways to engage (n=7).

Who are policymakers and their stakeholders

What are resources for policy development and implementation About ways to engage

Figure 4-6. Themes of questions raised by researchers for stakeholders

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Researchers’ questions about policy background information

A lot of researchers (mentioned in 13 interviews) raised questions about policy background information that would relate to their research topics. Researchers expressed interest in finding out more information about what the latest updates included on: -

Legal documents (i.e. law, decree, circular) National action plans Stakeholders’ resources relevant to their research activities Treatment guidelines Future plans/policies relevant to their research activities.

Many researchers explained that by having up-to-date information about these kinds of documents, and stakeholder activities, they would be better able to develop their own research plans and to contribute to policy. However, it is interesting to point out that very few researchers had talked about engaging with policy makers at the beginning of the research process. This indicates a gap – with many researchers acknowledging the usefulness of considering policy during the project design phase, but very few researchers actively engaging with the policy community at early stages of their research. The mention of documents, such as legal documents, action plans and guidelines can be seen as an indication that the participants also want to engage with policy by exploring policy-related materials – if not with more direct communication. Some researchers raised questions about what channels they could access to get this background information – e.g. they expressed that they would like to know information about meeting plans to be conducted by the government, or where they could get this information, and they also would like to know whether there were any chances or any space for their recommendations to influence policy development. “I guess an update on policy like if you have a channel to know about the policy, update on what new policies are being introduced that are relevant to our work and a space to give a recommendation.”

•

Researchers’ questions about the policy making process

Participants also expressed their desire to understand more about the policy making process in terms of who (the decision-makers are), what (factors will be considered), when (they should engage), and how (these activities will be undertaken). A key concern was about whether or not international guidelines (such as WHO’s guidelines) would be used as a basis to build national guidelines. Participants stated that they did not know clearly who played a key role in the policy making process or who made decisions. There was an existing idea of ‘the right person’ - a specific person or department who played an important role in this process, and researchers had questions about how to identify ‘the right person’. These questions also indicated the participants’ concern about the contribution and application of their research in the policy developing process, not only at the research implementation period but also in the long term. •

Researchers’ questions about stakeholders’ needs from OUCRU - their priorities, interests, and long-term requirements

Another important concern raised by researchers was the needs, priorities, and requirements of stakeholders for evidence to inform the policy making process. In particular, researchers wanted to know where those needs overlapped with the researchers’ own priorities. Researchers were interested in immediate needs of stakeholders, and also longer-term requirements – recognising that if they are aware of the stakeholders’ needs, then they are better able to meet them. “My request is just to be informed by the policymakers about their long-term requirements, like their 5-year, or 10-year plan.” “The key thing is try to understand the priorities and the way in which things like task forces around a particular topic work together. Because then I think it is possible to affect it.” Researchers were interested in future priorities (e.g. for future research plans), but also clearly interested in where there is an overlap between stakeholders’ current priorities with their current research. We noticed this opinion coupled with the idea in the above section that researchers think policymakers do not always use scientific evidence in their policy making process. While showing concern about the lack of evidence-based policy making process, researchers also looked for an opportunity to improve this process by contributing scientific evidence or adjusting research objectives in order match with policy priorities.

Recommendation: OUCRU policy team should find ways to inform researchers of new and existing channels and opportunities to engage with policy stakeholders. A regular email update similar to the grants opportunities monthly email would be a useful first step.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Researchers’ questions about the ways to engage

Researchers had a lot of questions about the best ways to engage with stakeholders, and about what channels exist that they could access to facilitate that engagement.

Researchers stated that they would like to know how to be involved in task forces and working groups, to know when the process happens, and to know how to explain or send information to stakeholders (e.g. how to write a policy brief). One participant raised a concern about what kinds of things we should avoid when communicating with stakeholders, and in particular this person was concerned about tone, and political influences as much as content.

◊ What are the existing channels of engagement? Researchers talked about wanting ‘channels’ to engage with policy makers, or wanting to know what the existing ‘channels’ were. We interpret ‘channels’ in this context as organised structures that facilitate engagement and allow people to exchange information. A channel allows for two-way communication, enabling researchers to send information to stakeholders, and stakeholders to feedback to researchers, and it is something that exists and is managed within an organisational or official framework – as opposed to an unofficial personal or professional network. The idea of channels came up in relation to the questions about the way to engage, and questions about priorities, interests, and long-term requirements of stakeholders. ◊ Who is responsible for engagement?

“I want to know what (information or opinions) that (policy makers) want to avoid mentioning in their debates. Knowing that is more important.” As discussed above, researchers raised questions about existing channels to access stakeholders. But even when researchers were aware of some mechanisms or channels in place for active engagement, they were not sure about how to access those mechanisms, or how to get involved. The clear indication in the response below was that the OUCRU policy engagement team could help with this. “Information from the policy team about events, or conferences, meetings where policymakers will go, so I will hear about those, knowing like meetings happening at the ministry or something that we should try and get our research on the agenda.”

Some researchers clearly felt that the responsibility for engagement between researchers and stakeholders rested with the stakeholders. For example, in the below quote the researcher clearly believed that policy makers were the ones who were responsible for communicating with researchers about their plans/priorities. “They should announce their policies within the 5-year plan so that researchers can base on that to conduct their research. I think that is the most important. Sometimes they have but they don't inform researchers. And if they don't inform researchers, then it is very dangerous that researchers would waste their efforts and money conducting research of which results could not be applied to policy…” What mechanisms exist to facilitate this engagement is not clearly understood by researchers, and they are probably not adequate (see 4.8. Ways researchers engage with policy stakeholders). ◊ Who, what, when and how? Some researchers expressed uncertainty in terms of who they should engage with, and how they should engage to have the most impact. “I guess that it would be nice to know how they make their decisions, what kind of evidence they use, what did they think is necessary, what did they think unnecessary or nonsense, and what kind of pressure they have. You know, who are their stakeholders? And if we engage a couple of individuals, is that enough? Or do we need to engage a larger and larger scale? How much is enough? How far do we need to go in our communication: If we speak to individual policymakers who are in a position to impact policy, or do we have to convince these policy makers and then these policymakers will go and try to convince other people, or do we have to convince this person and then we have to convince these people and then we have to convince…, how long did that go? […]. That is the process I don’t understand.”

Recommendation: There needs to be a channel (or many channels) in place for stakeholders to be able to access the OUCRU research community, and a corresponding channel in place for OUCRU researchers to be able to access the stakeholders. The OUCRU policy team should find ways to facilitate engagement between researchers and policy stakeholders at very early stages of project development, using these channels.

Chapter 5. Researchers’ Experiences and Perceptions about Policy Engagement at OUCRU

5.1. Researchers' perspectives about activities as being part of policy engagement Researchers identified a wide range of activities as being part of policy engagement, which we grouped into 6 categories, and then ordered from ‘least engaging’ to ‘most engaging’ (Figure 5-1) : 1. Research publications 2. Getting approval for research 3. Implementing research activities 4. Reading policy-related materials 5. Disseminating research results 6. Direct consultation with stakeholder (e.g. participating in special interest groups)

Researchers' understanding about policy engagement

CHAPTER 5. RESEARCHERS’ EXPERIENCES AND PERCEPTIONS ABOUT POLICY ENGAGEMENT AT OUCRU

1. Research publication

2. Getting approval

3. 4. 5. Implementing Reading Disseminating research policy-related research activities materials results

Least engagement

6. Direct consultation with stakeholder

Most engagement

Figure 5-1. Researchers' understanding about policy engagement

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Research publications

A lot of researchers mentioned their publications as being one way that they can engage with policy stakeholders. Research publications are of course an important part of the science communication toolkit, but there are just too many research publications in the world, and they are written for an academic audience. However, when we have good engagement with stakeholders, the likelihood of them picking up and reading our publications is greatly increased. Publications are certainly part of the toolkit, but they are ineffective without other forms of engagement, so we give them the lowest ranking. •

Getting approval for research, and implementing research activities

In previous sections, researchers tended to talk about policy engagement as being part of the process for getting approval or permissions from stakeholders to conduct research project. While there is an element of engagement and consultation in these kinds of activities - particularly for complex projects, or projects in new settings - it is not authentic policy engagement of the sort we have defined in Chapter 2. This level of consultation is informative and approval-driven: Where we give information about our projects, and seek approval to implement those projects, there may be minor adjustments to our project plans in response to these consultations, e.g. adjusting a method of data collection, or working with one very specific community instead of another. When we conduct these consultations, we are not seeking to influence the framework in which those approvals are given, and we are not seeking input from the approvers on the overall research questions, project design or methodology. The large number of responses that focus on this informative and approval-driven ‘engagement’ is an indicator of the lack of understanding among OUCRU staff of what policy engagement is about, and of who policy stakeholders are. Approvers, such as ethics committees and provincial authorities, are perhaps considered to be policy stakeholders by OUCRU staff because they are part of the government, and there is a perceived equivalence between ‘government’ and ‘policy’. Another emerging realisation was that policy engagement is a new concept, and new activity for OUCRU – and one which both the researchers and the organisation are not well prepared for.

•

Disseminating research results and direct consultation with stakeholders

The most obvious way that OUCRU researchers talked about policy engagement was in disseminating their research findings. There is a clear idea that we should engage with policy makers when we have interesting or relevant findings, and share these findings with the stakeholder community, for their use in developing policies. Researchers’ ideas for how OUCRU can do this included sharing and translating research publications, holding seminars or academic meetings and inviting stakeholders to take part in those meetings, and participating in committees. “I think one of the most important things for local impact is translation of papers into Vietnamese. I think this should be done centrally at OUCRU (with the authors).” “We will organise a seminar or meeting and invite them. And we will present our research outcomes and we have to select the most valuable research to present.” Some researchers had a much clearer concept of policy engagement, mentioning the desirability of engaging with policy makers throughout the research life cycle, and also their willingness to be involved in that engagement. “Uhm, the activity related to policy engagement is an activity throughout the procedure of generating project ideas until the end of the project and using the project outcomes after that. And we should think about how to get policy influencers or influencers involved in it.” “But I think there is a benefit of doing it more systemic and assign a clear point of contact within different ministries and within different departments in the ministry to be more specific and clearer about this impact. And work from the beginning of the project rather than from [when] the results are in. So have more interaction with policymakers, so if they can also have a say on the content of the work, maximising the potential impact from the conception rather than after delivery.”

“From the beginning we were research oriented. So we didn’t think about policy engagement from the start. It was like that before, our tradition is like that. That’s why when we step into this field, we are confused.”

Recommendation: Policy engagement needs to be better embedded into the research culture of the organisation, so that researchers are familiar with the concept and terminology, and are able to plan engagement activities as part of their research practice.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

5.2. Policy-related outcomes researchers expect from their research In our analysis of the interviews, we looked at different ways that researchers described policy-related outcomes that they expected could or should arise from their research. These expectations varied, but generally driven into 3 categories (Figure 5-2), summarised into the position statements below: 1. ‘I want my research to improve treatment and health outcomes in general’ (n= 5) 2. 'I want my research outcomes to be integrated into policy documents, like treatment guidelines’ (n=9) 3. ‘I want to engage with the public as part of my research’ (n=4).

Expected outcome of interviewee's research

1. ‘I want my research to improve treatment and health outcomes in general When researchers described the aims of their research, they often did so in terms of the impact that it could have on policy. They did this in a number of ways, but usually by describing the aims of their research in relation to the real world application of those results. For example: • • • •

Studying pathogens which cause diseases that have high health burdens, Finding suitable drugs, to determine which genotype or populations would benefit from the drug, Identifying the hotspots of transmission, in order to prevent or control disease Developing or testing new technologies for diagnosing infectious disease. “The purpose was to see what viruses, bacteria, and parasites caused diarrhea the most in children, to study what drugs they were resistant to. And we would use the information to see how we could treat patients and how we could reduce their transmission in the community.”

Improve clinical treatment process health outcomes

Integrate the research outcomes into regulation documents

Public engagement

2. 'I want my research outcomes to be integrated into policy documents, like treatment guidelines’ Some researchers were very clear that they expected their research to be able to have an impact on official documents and procedures. As one participant described: “The aims are talking to them about reviewing current treatment guidelines in primary health care, and then respectfully of those ideas to look at the best work and come up with some new advice.”

Improve Support doctors efficiency in in clinical diagnosis, treatment treatment and prevention

Contribute to regulations, guidelines, standard tools

Provide information to policy strategy

Improve knowledge and information for community

Community involvement

Figure 5-2. Researchers’ expectations

3. ‘I want to engage with the public as part of my research’ Some researchers very explicitly mentioned their public engagement activities in the interviews, highlighting the potential links between public engagement and policy engagement. Clearly in response to the established public engagement activities and support mechanisms that already exist at OUCRU, researchers talk about their public activities as being part of their research projects and integral outcomes of their research – not as add-ons to the research. “Our public engagement was trying to get the perspective of the public, like to get farmers to understand the risk, what are the drivers for their behavior, what are their motivations – and so we are trying to bring in line a human side to the project with our engagement.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

But how does it happen? Although researchers had expressed many expectations about the outcomes of their research for policy making, they did not draw a clear picture of how their research outcomes could make these improvements in practice. “So they wanted to decrease by 90% by 2035, and we currently, Viet Nam will miss that target, which means that [a lot of] extra people will get [disease]. So in order to kind of try to help Viet Nam to get closer to that target, to hit this target, we need a new strategy. What we currently doing, what Viet Nam is currently doing is working, you know, [the burden of the disease is] decreasing, but we need to speed it up, we need to make this decrease faster. So to do that, we need, I think a new strategy. And my work informs those strategies.”

5.3. Researchers' perspectives about strengths for policy engagement in OUCRU Participants shared common opinions on their strengths for policy engagement within OUCRU. These can be categorised into three main themes (Figure 5-3) • • •

Expertise, quality, and technical capacity Having long-term relationships with stakeholders Having strong networks.

Q: Do you think that they will use the data of the research? “Yes, hope so, not sure, but I hope that they would use the data.” These kinds of statements suggest an existing perception that the expected outcomes can be achieved by doing scientific research on its own. The researchers may think that their research outcomes, scientific publications, or recommendations will automatically go to clinical practitioners, or be used in the policy making process. There was little evidence of understanding among researchers of exactly how scientific evidence gets used in the policy making process, and little sense of agency on behalf of the researchers. They ‘hope’ that the evidence is taken up, but can’t articulate how that would happen, or their role in ensuring that it does happen.

Strengths

High-quality research, diverse expertise, technical support, and modern infrastructure and equipment

Recommendation: OUCRU researchers would benefit from more education about the policy making process in Vietnam, as this will help them to target their communication with policy stakeholders in a way that is more likely to produce the desired uptakes of their research data.

Strong network and different levels to contact (hospital network, personal network)

Long-term relationship

Figure 5-3. Researchers' perspectives in terms of strengths for policy engagement in OUCRU

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Expertise, quality, and technical capacity

OUCRU’s ability to carry out high-quality research, provide diverse expertise, strong technical support, and modern infrastructure and equipment was considered one of our strengths for policy engagement. Because we are strong in these areas, researchers felt that we are able to provide information, expertise or support that is recognised and appreciated by the stakeholder community. Participants (n=10) described many ways in which they provide expertise to support their stakeholders such as consultation in establishing laboratory activities, support to implement services in hospitals, providing high quality data, modeling, diagnostics, and new technologies. “[One strength that we have is] modern infrastructure and equipment; the first organisation which pioneers new diagnostic methods and smart devices.”

5.4. Researchers' perspectives about weaknesses for policy engagement in OUCRU Researchers were able to identify several weaknesses in OUCRU’s policy engagement capacity: • • • •

Communication gaps Ad hoc engagement Difficult to measure the impact Difficult to balance

This technical expertise is an integral part of the OUCRU brand, and seems to be an important pillar of trust in the relationship between OUCRU researchers and policy stakeholders. •

Long-term relationships with key stakeholders

Researchers identified OUCRU’s strong, long-term institutional partnerships with stakeholders as being particularly important. These relationships are strengthened by the institutional experience and relationships we have, as well as by our sustained partnership over a long period of time. Researchers (n=7) talked about the importance of having these long-term institutional relationships with stakeholders, and listed examples such as VN MoH, WHO, US-CDC, NHTD, NIHE, HTD. However, they also mentioned that building and maintaining personal relationships with individuals from those partner organisations is also important. “The strength is that we have a diversity of people who know how to access people who can give me the information that I need, and they have a broad range of contacts both in Hanoi and Ho Chi Minh City.” •

Ad hoc engagement and one-side contribution

Communication gap

Difficult to balance

Difficult to measure the impact of policy engagement

Having strong, diverse networks

Networking with hospitals was considered another strength for policy engagement. And these individuals in hospitals had, in turn, served as contacts introducing OUCRU staff to their own networks. Having a unit in both Hanoi and Ho Chi Minh City was also a strength because it provides researchers with more opportunities to meet with people working at hospitals or government agencies from both regions. OUCRU staff identified relationships with hospital staff or stakeholders who may not be directly employed at the Ministry of Health as being important for policy engagement, because the policy making process in Viet Nam exists within, and depends upon these broad social networks. “We have a good connection with these important policymakers already, you know, with the [hospital] and that comes through [our project], so we have that kind of connection already.”

Weaknesses

Difficult to explain, Lack of summarise information about or translate what, when, scientific results where, how, who to non-scientific language

Language barrier

Balance between Balance between interest of international and funders, local relevance of government and the research researchers

Maintain the integrity and leadership when involving powerful partner(s)

Figure 5-4. Researchers' perspectives in terms of weaknesses for policy engagement in OUCRU

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Communication gaps

•

Ad hoc engagement

There is a strong perception of a communication gap between researchers and stakeholders.

Ad hoc engagement is another weakness that was consistently expressed by researchers.

One of the biggest factors of the perceived communication gap is the language barrier between English – the primary language used at OUCRU, and Vietnamese –the primary language of the stakeholder community.

Despite having strong institutional networks and long-term relationships, researchers identified that most of their engagement had been on a case-by-case or project-by-project basis – ad hoc engagement. For example, a partnership that has formed for a study where stakeholders are collaborating, or engagement about a very specific topic.

“I’ve only met with Dr. A. He does not speak English and I was not speaking Vietnamese, so it is difficult for us to have a very fluent conversation.”

These engagements were perceived as being valuable, but researchers felt that there was a lack of systematic interaction and feedback from both sides.

Researchers perceived that the language barrier does not only affect interpersonal communication, it can also prevent evidence from being used in the policy making process.

“A weakness [is] that our projects are mostly ad hoc, most of our engagement with the ministry is ad hoc. […] So we move away from a sort of ad hoc or opportunistic engagement and go toward … having more systematic interaction and opportunity to have feedback from both and each other.”

“It is about understanding the evidence, and sometimes the best person to give the evidence doesn’t speak Vietnamese […] to be the right people to give advice, sometimes that would be in Vietnamese, or sometimes that would be in English.” A perceived language barrier also conflicts with the areas of strength in engagement identified in the previous section. When people are not able to communicate fluently with one another, they are less able to develop strong interpersonal relationships and access the networks that foster strong engagement, and are less able to develop long term relationships. Another aspect of language gap is the perceived gap between scientific language, and language of policy. Some researchers expressed difficulty in ‘translating’ scientific research results into non-scientific language that is accessible to the stakeholder community. “We don’t know how to communicate with the policy maker. We don’t know how to communicate our science in a way our policy makers understand it. Well, we are learning, but that is not what we are trying to do. So the weakness is, our junior scientists should learn how to talk with policymakers, to learn how to translate the result [so that] policymakers may pick it up.” While researchers recognise the need to communicate with policy stakeholders, there is a lack of understanding about what to communicate, when, where, how and who with. This indicates a structural communication gap – there is a recognised need to communicate, but no structure in place to facilitate that communication.

•

It is difficult to measure the impact of policy engagement

Some researchers mentioned that the complexity of the policy making process could make it difficult to directly recognise their contribution. “The key stakeholder could mention OUCRU when they use the data from OUCRU, but it is not in a formal way. The key stakeholders … can use this information/data/report from OUCRU for reporting at their meeting with the MoH. However, this report has not been authorised by the MoH. We do not know whether the stakeholders mentioned OUCRU in their report or not, but only the report from the stakeholders are authorised by the MoH (due to their function assigned by the MoH).” Policy engagement can be time-consuming, but its impact is not measured in units of time spent. There is a lot of focus on ‘impact’ in the research ecosystem – we even use this word in our OUCRU vision statement ‘…to have an impact on health…’ – but it is not clear how we know we are achieving that impact, or which impacts are important. Some researchers, therefore, mentioned that the difficulty of measuring policy engagement impact is a weakness for OUCRU. “How much can you help research to influence policy? How [do] you measure that, right? It is almost impossible. Because it is impossible, it’s like you’re praying [to] God.”

•

Policy engagement as a balancing act

An emerging theme from the interviews was the difficulty that researchers experienced in achieving balance. When considering their policy engagement activities, there are a lot of factors that they need to balance, including: • • • •

The international and local relevance of the research Maintaining their independence, integrity and leadership over their own research The interests of funders, government and researchers Their personal interest and time.

Within each of these areas there can be conflicts, and these can lead to less engagement, or lower quality engagement. Researchers, therefore, need support to manage the balancing act that policy engagement can entail. “The problem is whether I see that I have enough concern about it or not, whether I want to spend time on it or not. […] I think that I don’t have enough time for it as other things related to me directly such as management [of my group], research orientation [for my group], they take lots of my time to make sure I do them well. To make sure all is done well.” The concept of research integrity also came into the discussion about balance here – researchers are interested in engaging with stakeholders, but they also need to protect their integrity and independence as researchers: “I mean although we all work to benefit the health of Vietnamese people. Our interest may not necessarily be the same and they are a very powerful partner to work with. So that the balance you have to maintain - that we don’t lose our integrity and don’t lose our leadership of the project when the powerful partner is involved.”

Photo: OUCRU building in Ho Chi Minh City, Viet Nam

Chapter 6. Researchers’ Willingness to Engage with Stakeholders 6.1. Factors that facilitate researcher engagement with stakeholders From the examples provided in the interviews, we were able to identify four main factors that can act as facilitators for OUCRU researchers to be willing to engage with policy stakeholders (Figure 6-1): 1. Personal motivations 2. Positive perceptions about policy engagement 3. Positive experiences in policy engagement 4. Funders require engagement, and evidence of policy impact. When some or all of these factors are in place, then researchers tend to be more willing to engage. The challenge for OUCRU if it is to have more systemic policy engagement is to create an environment that fosters these facilitating factors.

Facilitators

Personal motivation

CHAPTER 6.

Positive experiences

Researcher wants to bring benefits for community health

Understand the importance of policy engagement in doing research

Had good experience in engaging with stakeholders (good feedback, friendly partnership)

Personal relationship

Belief that engagement can be beneficial

Having long-term relationship

RESEARCHERS’ WILLINGNESS TO ENGAGE WITH STAKEHOLDERS

Positive perceptions

Personal curiousity

Able to visualise impact of policy engagement

Involving stakeholders in project activities

Funders

Providing funding specifically for policy engagement

Require reporting of policy impact - both at proposal and award stages

Figure 6-1. Facilitators for researchers’ willingness 60

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

In terms of personal motivation, many researchers strongly expressed their desire to put their knowledge, and their project results at the disposal of those who are contributing to making the relevant policy decisions, to bring about better outcomes for health. “I mean when we do a project, we don’t just spend money to do activities for the project and when it’s done, it’s done. It’s not like that. The further desire is about policies and they can affect local government. I mean when a project is done, the local authorities still maintain the activities for their provinces and also change some of their regulations and policies to support local communities more.”

Researchers tended to be result-focused when talking about stakeholder needs. It is worth mentioning here that few, if any, of our researchers said that they had begun their research with a deliberate strategy to engage with policy stakeholders. More commonly, researchers completed their research and then began to look for policymakers who may have a question that corresponds to the answers they have. They may have thought about the practical policy impact of their research to some extent, but not early on, and engagement activities to facilitate that impact were not commonly mentioned as being part of the research proposal. The role of the funders

Another facilitating factor was the pre-perception and experience of researchers. Some researchers stated that they were more willing to engage if they had a long-term relationship or good experiences in the past with stakeholders. Those researchers who stated that policy engagement is important to their research also reported high willingness to engage. For instance, researchers who expressed opinions that engaging with stakeholders can be beneficial, or described advantages of doing policy engagement, such as, to “solve problems together” or “having impact” or “being introduced to an important person” tended to show more willingness to engage in general.

Researchers may be motivated by their desire for their work to make a better world and the relevance of their research to the policy, however, it is also important to look the requirements from funders. This is a major facilitating factor for engagement with policy stakeholders. One example of this is when the funders ask researchers to report the impact of their research on policy as one of their key outcomes.

“The advantage is that when we have policy engagement, project outcomes will be more meaningful. They will have more impact when we have feedback from partners in that project.”

Many researchers mentioned the difficulties of adequately resourcing their policy engagement in terms of human resources, time and money. As mentioned previously, time limitation in particular is a major factor, as researchers need to balance the time spent on policy engagement activities, vs their core research responsibilities.

“There are requirements from funders and they are talking a lot about the policy impact, and we have to think about that direction.”

“That we want to engage with them to solve the problems together.” Positive past experiences with stakeholders also facilitate researcher willingness to engage. For example, when stakeholders invite researchers to engage with them, or give positive feedback or friendly support, or when stakeholders contribute their resources to projects. “You know some of the provinces we go for, they will give you a room, they will supply the sound system, and you know they will invite someone. You know they will do half of work, and you really feel like a partnership.”

“I will be involved in a process now to helping to draft more guidelines and it will take one year, and I will have to do, probably I suspect I will spend maybe over that year, maybe 40 hours working on it or 24 hours work on it, which I don’t get paid for. That does not matter too much except that what I do get paid for is doing my science, and if I can’t do my science because I am working on the guideline then I don’t get refunded. Then that should be a problem. Because If I don’t have the science outputs, I won’t be employed. So I can’t get too busy doing a guideline here, a guideline here, if it means that my work suffers.”

“They were very interested in our proposal, and then when they review it. We sent them everything, and then they made comments like “we like it”, “come and see." So [researcher] and I flew up to meet them, we did a presentation to them.”

Recommendation: One way to counter the perception that stakeholders are not willing to engage unless we have the right evidence at the right time, would be to ensure that researchers are aware of the needs of the stakeholder community, and can therefore target their engagement in a way that is aligned with those needs.

Recommendation: One way that funders can explicitly facilitate researchers’ willingness to engage with stakeholders is by funding it, but funders will only provide funds that are requested by researchers themselves as a cost of the research. Researchers should include policy engagement activities in their grant applications, and cost them accordingly.

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

6.2. Factors that confound researchers’ willingness to engage We were also able to identify some factors that can decrease researchers’ willingness to engage with stakeholders – and we call these confounders to engagement (Figure 6-2).

•

While more experienced researchers talked about OUCRU’s strengths with institutional relationships, those with less experience and those new to Vietnam also mentioned that they lack connections and do not know who to engage with about their research – both at a personal and organisational level. Additionally, some researchers talked about the difficulties of losing track of relevant connections over time, especially when there were changes in staffing at stakeholder organisations. “Well, it’s hard to know who is in charge within the government, the group and also they invited from people but they changed every time so there is no consistency.”

Confounders • Lack of relationships

Negative perceptions

Negative experiences

Belief that stakeholders lack capacity

Stuck in approval mode

Belief that stakeholders lack willingess or interest

Lack of confidence/ expertise

Emphasis on importance of research results

Unexpected outcomes

Figure 6-2. Confounding factors of researchers’ willingness

Lack of relationships

Lack of time and resources

Researchers’ negative perceptions

Our researchers had a number of negative perceptions about engagement with stakeholders. One example is when researchers have a perception that stakeholders have limited capacity to engage. Because some researchers consider policy engagement and research activities to be so closely interlinked, then when they considered stakeholders did not have the capacity to contribute or collaborate in a research project, then they also considered that those stakeholders would not have capacity for engagement with researchers on a policy level. “There were a lot of factors for that matter, not only about power but capacity. For example, it’s true that V. has a certain impact in hospitals, but they don’t have resources of labs, manpower, microbiologists, etc.” Some researchers worried that if the engagement did not bring obvious immediate benefits to the stakeholders’ office, or if stakeholders did not understand the benefits to them, then stakeholders would not be willing to engage. The pressure of thinking about the benefit for stakeholders, or having to convince the stakeholders of the benefit of engagement can reduce the motivation of researchers to engage with stakeholders. “So if you [are] providing goals, they need to be short-term goals to benefit the individuals, otherwise they [the stakeholders] are not going to bother. I find that very difficult because it’s a negative, self-serving motivation. But if you want to play the game and you want to get something done, you need to convince the individuals that there is something in it for them. […] I get frustrated with it because again, I can see it is very self-serving.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Researchers reported less willingness to engage if they felt that the evidence they had was not sufficient to conclusively prove a point, or if the research was implemented on small scale or not at the right time. “I’ve always found the difficulty [is] to know what information is enough to go to speak to policymakers, to say we think this is a real problem. For me, I would wait and gather more information. And do more studies, before I will go to speak to somebody directly about policy, but I think I am conservative that way. So [if] somebody else wants to speak to me, then I am happy with that.” “I still think that it’s more interesting to create the evidence. I haven’t got the evidence about how to reduce antibiotic use so I’m not confident to engage people. Even the project in [Province], which has almost finished, the evidence is not the best.”

•

Some researchers reported negative experience with engagement in the past. As discussed earlier, the perception that engagement is somehow linked with approval, or permissions leaves some researchers stuck in approval mode when considering their experiences of engaging with stakeholders. Seeking approval is often slow, unrewarding, and difficult, so it’s no wonder that researchers report negative experience with engaging with stakeholders when the purpose of that engagement is to seek approval only. Despite being willing to engage, some researchers had experienced lack of confidence in that engagement in the past, which affected their willingness to engage again. “I got complaints at the very beginning, so I felt very difficult working with doctors, I felt a bit of hesitant and lack of confident when talking with doctors.”

Evidence – or more specifically lack of evidence – was a big reason offered by researchers as to why they do not engage with stakeholders. “Because we have no evidence. Don’t put the cart before the horse, which means that we have no evidence, but we already have policies. I think whenever we have scientific evidence, it’s when we can talk to them.” “OK, yes, so it is absolutely essential, but for my study, it would come at the end, policy engagement, would be a bit premature at the moment before I got any data which to engage policymakers, the result of this study, depending on what they show, maybe valuable or very valuable to policymakers, both here or at international level.”

Negative experiences

One researcher reported feeling not listened to, and not respected when engaging with stakeholders in the past. “I think these guys show up, they sit down, they play with their phone, and then they leave. They have no interest in being there. Yes, they don’t listen.” If researchers had attempted engagement in the past, but it did not work out as expected, that was very demotivating for future engagement. “So it was not the best collaboration I had ever had, but it was difficult because the people who do want to work there and the people who [were] trying to work with us were so great and we really want to work with them. […] But there was so much frustration and then, in the end, the [result] was not really good. So that, honestly, turned me off to working with government.”

This reflects the attitude that stakeholders are only interested in results, and that the purpose of engagement is to explicitly influence policy or change stakeholder perceptions from the outside. We know that this model of engagement only has very limited effectiveness, and so the challenge for OUCRU is to create a culture of engagement throughout the research life cycle, that works in partnership with stakeholders, and is not only focused on the communication of results. •

Researchers lack time and resources

Researchers frequently cited the lack of time as a major reason to prevent them from doing policy engagement. Many researchers noted that given time limitations, they often had to balance and choose priorities that their institutions or funders valued (e.g. scientific publications). Additionally, they said that policy engagement may be out of their scope of their roles. Some researchers mentioned that there was little recognition for policy engagement work, both within the whole research environment, and institutionally within OUCRU. For a researcher who is under pressure to complete a grant, deliver publications, and supervise students, it can be difficult to justify the investment of time in policy engagement activities when there is no recognition for those activities. “… you can’t put too much effort and get into nothing […] so I probably don’t want to spend too much time on that, and I focused on something [else], the focus of my work. It is just too difficult.” Recommendation: When thinking about systemic policy engagement, we do not need to have the projects completed and research results in place before that engagement takes place, and it is preferable if engagement is happening throughout the entire research life cycle. 65

Recommendation: OUCRU should find ways to recognise researchers for their policy engagement work. 66

Chapter 7. Suggested Ways to Improve Policy Engagement at OUCRU

Researchers made some suggestions on how we could improve policy engagement at OUCRU. Their suggestions were categorised into four main themes “What” should be done in terms of policy engagement; “When” should be the suitable time to engage with policymakers; “How” should scientists engage; “Who” should play a role in the policy engagement activities.

7.1. What should be done? •

Choose a key or specific thing to engage about, and have a clear objective

Researchers felt that policy engagement should start from a specific area, with a specific aim. Each research group had scientific evidence, background and experiences about specific health issues. Therefore, their contribution to policy could vary depending on the topic. They also considered that there were specific stakeholders who worked in similar areas. Therefore, it would be helpful to have policy engagement activities specifically based on particular topics or themes. “So there needs to be a decision I think about what policies we’re trying to affect. And you can say, OK, I want to affect treatment guidelines; so treatment guidelines for what? Treatment guidelines in hospitals, or in tertiary care institutions, or treatment guidelines in primary care institutions, or treatment guidelines in the community or... I think we need to be much more specific actually of what we are trying to achieve. Because only then will we identify the best route, and a workable route to be able to do it.” •

Have organisational aims, group aims, themes to give impact

Researchers identified the value of having policy engagement at an organisational level – embedded in the structure of the organisation itself. This shifts the focus away from project to project, to being more about our scientific groups and themes, and our overall strategic purpose.

CHAPTER 7. SUGGESTED WAYS TO IMPROVE

“I think it is about having those conversations and defining very clear aims that might be organisational aims, delegating group aims or defining group aims, spending time thinking about how they fit in and organising things, so we are not doing bits and pieces, but doing definite things or themes. That we thought about policy beforehand; we thought about the policy impact that we want to have.”

POLICY ENGAGEMENT AT OUCRU 68

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

More of OUCRU outputs should be translated into Vietnamese

The language barrier raised in previous part as one of the weaknesses could be addressed in many ways. One of the ways to address this is by translating some key outcomes or relevant outcomes from English to Vietnamese to help Vietnamese stakeholders to access research outcomes easily. However, it is not necessary to translate all scientific documents to Vietnamese. Researchers should select key messages, that they think are aligned with stakeholder needs to translate. “Yeah, I mean, we have translated abstracts, something like that in the past, I don’t think we are doing so much at the moment. To be honest, I don’t think it is helpful to do it on a, I mean, of course, it is helpful to translate everything, but it is a lot amount of work. So, you have to think where the best, how the best use of resources.”

7.3. How should we engage? Policy engagement as a communication exercise

From looking at the researchers’ suggestions for how we should go about engaging with stakeholders, it is clear that communication needs to be a central activity for policy engagement. When we think about stakeholder engagement or policy engagement as being a communication exercise, there are a number of ways (Figure 7-1) that we can approach that communication, and some simple things we can do to improve the quality.

7.2. When should we engage?

Treat engagement as an authentic communication exercise

As mentioned in Chapter 5, researchers can easily identify the value of engaging with stakeholders once research results are available, and typically at the end of a study. “OK, yes, so it is absolutely essential, but for my study, it would come at the end, policy engagement, would be a bit premature at the moment before I got any data which to engage policymakers, the result of this study, depending on what they show, maybe valuable or very valuable to policymakers, both here and at international level.” However, there are many other opportunities to engage with stakeholders throughout the research life cycle, some of which were able to also be identified by the researchers. In particular, researchers identified the benefits of engaging with stakeholders at the start of the research process. “if you involve the stakeholders really early, not when everything is already decided but at the point where you honestly asking their advice for things, then that they feel like they are invested in that projects. If you come to them when the project has already finished, and say “Here, I want you to do something with this”, yes, they might like it and they might not.” One of the ways that researchers felt this could be done was by consulting with stakeholders at the beginning of a project in an advisory capacity, or by allowing stakeholder to give feedback on a research proposal. The conversation with policymakers should start early to identify the policy needs, or what is important for the stakeholders.

Get involved in formal opportunities/ channels

Have more systemic engagement, and strategic communications

Strengthen relationships with individuals and key organisations

Recognise the mutual benefits of engagement

Figure 7-1. Policy engagement as a communication exercise

Within the communication framework above, there are three key ways that we can communicate with stakeholders, all of which various OUCRU researchers are already currently engaged with.

“When we started the research we thought of it from the beginning. We don’t wait until the research is being carried out and think of doing engagement activities.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

•

Get involved in formal opportunities/channels

There are a number of formal channels (organised and managed by stakeholders) through which researchers can be involved in the policy making process, as discussed in Section 4.6. Researchers' perspectives about approaches to engagement with policy stakeholders. Some examples include being members of an advisory board for the Government; WHO Board of Review; national technical working groups for the development of a treatment guideline; the Hospital Director’s Boards established by Ministry of Health; or Ethics Committee of Viet Nam Ministry of Health. •

Have more systemic engagement, and strategic communications

A number of researchers mentioned the desirability of engaging with stakeholders throughout the research life cycle, as well as on a strategic level for the whole unit (as discussed in Section 5.1. Researchers' perspectives about activities as being part of policy engagement). As an organisation, OUCRU can provide more institutional infrastructure (or channels) to support these kinds of activities, such as supporting OUCRU advisory boards, and providing policy engagement practitioners or staff to help advice and facilitate. Not all research is simple and easy to communicate clearly, but as some researchers pointed out, it is important to take the time to communicate the complexities and uncertainties of the research as well as the simple and clear results.

•

Strengthen relationships with individuals and key organisations

As discussed in Chapter 5, Section 5.3. Researchers' perspectives about strengths for policy engagement in OUCRU, one of the greatest strengths for OUCRU in terms of engagement with stakeholders is the existing institutional relationship – many of which have persisted for a long time, as well as the individual relationships that many researchers have themselves developed. OUCRU can build on this, by centrally managing some of these relationships, and maintaining information about our key stakeholders in a central repository or database. It is also important that we nurture and maintain the relationships that we already have, beyond the end of a single research project, to allow for longer term relationships to grow and develop. Building relationships over time can help to demonstrate the benefits of our research to our research community, and build opportunities for collaboration. “When they see the picture that how it is bringing benefits to the Vietnamese community, or to our children, they will start bilateral collaboration.” It is important to understand the stakeholders, their viewpoint, differences, difficulties, working environment, pressures, and languages. Some researchers recognised that they can strengthen the relationships with stakeholders by using empathy in their communication.

“I think primarily it should be clear, it should be based on good scientific evidence so if there are uncertain things I think that should be mentioned as well. I think that is not always done, especially if you want to give advice or guideline. People are inclined to ignore the uncertain thing that still exists. And then it is necessary to explain why we think that those research are valid.”

“it is a different mindset, they have different goals and people to answer to, and a big decision, that they need to make that are more important than the decision that I make every day, I feel. So they have a different type of pressure, stuff like that so it is understanding each other I think is the big part of starting again open dialogue about things, overall.”

Some research has clear and obvious policy links. If we understand why our stakeholders might be interested in our research, it is easier to draw links with them, and to communicate in a way that benefits both sides. One researcher mentioned that breaking the research down into long and short term goals can be a useful strategy for engaging with stakeholders, and also to help build longer term relationships.

“I think the way to influence policy is to ultimately understand the point of view of the policymakers, and understand the constrain that they are under, you know understand the financial constraint, political constraint, and then be able to tailor the type of advice that you give to them or the type of information that you give to them, and lots of this will be about them understanding how we work as much as we need to understand how they work.”

“In your communication, you can make it interesting by adding short-terms goals while you still have long-term goals. You highlight. You need to understand what the interest of your partner is. And then try to formulate the project in a way that becomes interesting for them. While you don’t lose the other side making human health benefit. Also, see the benefit of your partner.”

Additionally, some researchers suggested the importance of being trustworthy, polite, respectful to stakeholders and understand each other. “Secondly, in order to have a good relationship with each partner, like the hospital director, we need to show our respect, our politeness to our partners. When we work with nurses who have a closer relationship, we should be more caring with them." “I think conversations beforehand, introductory conversation, we get to know each other, what kind of work, make sure each of us understands the limitations, of each other, kind of work or role or ability to do a different thing, and then are individual goal, kind of coming together to talk about that a little bit. We understand each other, would be helpful, in order to, for everybody to understand how to frame the conversation, so I think that would be really helpful.”

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

7.4. Who should play a role? •

Recognise the mutual benefits of engagement

Policy engagement benefits all parties – the researchers and the stakeholders, and many of our researchers were able to identify this in the interviews. There are many benefits for stakeholders in engaging with the research community, including having scientific evidence to inform policy development; being involved in channels with researchers to discuss priorities and mutual interest; and extending professional networks. Similarly, it is beneficial for researchers to be engaged with stakeholders because it can foster a strong understanding of health policy priorities; nurture and develop long-term relationships, and ultimately impact on health.

•

Researchers were clear that they needed a person or team who could support them during the engagement process. There were some ideas on how the person/team could support and what skills and knowledge they should have. Researchers pointed out that communication skills were one of the key requirements for this person/team. Additionally, understanding the working environment of both researchers and stakeholders could help this person/team in facilitating relationships. Researchers also mentioned that the team/person should have strong science communication skills to translate science. The word “translate” used in this context by researchers means the ability to frame, summarise, explain, and understand the scientific information shared with stakeholders.

“Of course then you will end up with a mutual benefit for sure. If you go in with that “I want something from you." They had a million people who want something from them. So for me, I would always go in with “This is what I can do for you. This is how I can make your job easier. This is how I can help you access the information that you are looking for. This is how...” If you want to build a relationship with somebody who is senior or who is influential, you need to go in with an offer of something.” “For me, you should talk to them to see what they want first. For example, we have many ideas, we want to say we are going to do this and that, we think this is good, that is good, but it’s not important. The important thing is whether they need it or not, whether they need to do this research project or not. We cannot engage them if we cannot make them interested in joining it.” “They can just not engage in that process - they may not be a person who spends much time with policymakers, but they have to think about how their research might be perceived or might be articulated to policymakers.” “It is all about their self-interest. So, if you cannot convince them that engaging with them is going to be of benefit to them, specifically, then you are wasting your time. They have to know that they are going to get something out of that.”

Who could help?

“I think that a person needs to be more, I guess, business-oriented, in a way, [and] policy oriented than we are. So somebody who understands that side a lot more than our side - does not necessarily have to have lab, epidemiological, sort of research [experience]. [Someone] who takes the time to get to know how we work and how a researcher's brain works, but then has enough experience on the other side of things to do that translation, I think that is the kind of support.[…] I think somebody who [is] good at summarising things in a different way for non-scientists, or for people who [are] making a policy decision. That having, working with people directly to make sure that we [are] making the correct point and [that it is] concise and clear enough for policymakers to understand and see why what we talking about this.” •

Who should be doing this engagement?

We discussed what kinds of stakeholder researchers can engage with and who those stakeholders are likely to be in Chapter 4, Section 4.1. Types of stakeholders researchers have engaged with. However, we would like to make a special point here about the fact that researchers across OUCRU at all levels can be involved in engagement with policy stakeholders. With the help of the policy engagement team, engagement with stakeholders can and should be an activity that any researcher who is interested can be involved in.

Recommendation: Researchers, and key operational staff at all levels in OUCRU can and should be involved in engagement with policy stakeholders. OUCRU policy engagement team should find ways to facilitate that engagement, and maximise opportunities for people across the organisation to actively contribute.

Chapter 8. Lessons Learned from the Internal Review 8.1. The policy engagement process in OUCRU and its gaps OUCRU has been actively engaging with policy stakeholders since its very beginning in 1991. Over the last 30 years, OUCRU has had many successes, and achieved some remarkable impacts on health policy in Viet Nam and beyond. Hence, we started our policy engagement pilot programme from a position of experience. However, there is still room for improvement. This internal review highlighted some weaknesses in our policy engagement, such as misunderstanding about policy engagement, language barriers, ad hoc engagement, and lack of systemic support. The interviews with researchers showed that most often, engagement with stakeholders at OUCRU was starting at the implementation phase of the research. This is the stage of the research project where is being setup, recruitment is starting, sites are being chosen, partners are being engaged in the project. A lot of researchers mentioned seeking approval and permission as being part of the engagement process here, and we have already talked about how ‘being stuck in approval mode’ can be a barrier to effective engagement. However, even if we ignore the approval mode comments, there is still a reasonable amount of engagement with stakeholders at this stage of the research, as it is the part of the project where stakeholders are commonly asked to participate in the project, or to provide detailed feedback about the project. However, many of our researchers tend to think that this implementation phase is ‘the beginning’ – whereas, we suggest that the beginning is actually the time when a project is being conceptualised – a proposal is being written, and the objectives of the project are being articulated. Researchers commonly talked about a lack of appropriate channels to facilitate engagement with stakeholders, and this gap is present most strongly at the early, conceptualisation phase of research. This gap may exist because researchers tend to rely on stakeholders to provide the channels for engagement. Therefore, the opportunity for the policy engagement team is to create more channels within OUCRU for engagement with policy makers that are in place for researchers to access at all stages of the research, including the very early stages of research design.

CHAPTER 8. LESSONS LEARNED FROM THE INTERNAL REVIEW

Engagement between researchers and stakeholders needs to happen at various stages in the research life cycle, and no stage is more important than any other. What is important is to have continuous engagement, and a broad spectrum of engagement opportunities for both researchers and stakeholders. By having many different ways to engage, and many different channels to tap into, we are more likely to facilitate authentic communication between these two communities, and ultimately generate impact from our research. Researchers repeatedly mentioned that they do not understand enough about the policy making process in Viet Nam, and they do not know how to access opportunities to be involved in this process. Creating more OUCRU-managed systemic channels for engagement with stakeholders (such as advisory boards) should help to narrow this gap. By having stakeholders regularly participating in those channels, we will create more opportunities for OUCRU researchers to engage with them, at more phases of the research life cycle and hopefully also create more opportunities for stakeholders to connect with researchers and invite them to be part of their own channels and processes. 76

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

8.2. Talking about policy engagement facilitates policy engagement This internal review process created an opportunity for researchers to share their ideas and experiences about policy engagement. For the policy engagement team, we quickly realised that the simplest way to create a policy engagement culture was to provide opportunities for people to talk freely about policy engagement. Just by inviting people to talk about policy engagement, the internal review helped to provoke discussion, debate and new thinking at OUCRU about how, when, and why we do policy engagement as an organisation We did not intend for the interview process to be ‘motivational interviews’ or to be part of a change process. However, the interviews helped to create a language for policy engagement in the institution, and to legitimise it as an important activity in its own right. Very quickly after the interviews we were able to observe some significant changes in the way the organisation has approached policy engagement – from the creation of the Outbreak Advisory Board in August 2020, to including policy engagement in the Core grant application. Recommendation: Future opportunities to facilitate more conversation about policy engagement within OUCRU could include, providing training support for researchers, seminars and workshops focused on policy engagement, connecting with international policy engagement networks, and expanding the conversation to the rest of the programme.

8.3. Policy engagement is not about changing policy For many scientists, policy engagement is driven by a strong desire for their work to make a difference in the world, and to change policy for the better. This is a huge, long-term goal. However, with such huge goals in mind, it can be difficult to know what the first step should be, and this can make researchers feel helpless. Researchers are also aware that the policy making process is affected by many factors, not only the contribution of science but also the resources, the capacity and infrastructure, the priority, the location, or the demand of the public. For OUCRU, our vision is to have an impact on health. Our goal in the policy engagement team is to improve the engagement with policy makers by using authentic communication at multiple phases of the research life cycle, in order to facilitate impact on health by influencing policy. We aim to influence policy, but the responsibility for changing policy still rests with the policy stakeholder community.

Photo: Policy Engagement Team's interview with study participants. Ho Chi Minh City, Viet Nam. October-November 2019

We have already started on a project of change in our institution, to systematise our policy engagement, by including policy engagement as a core activity, and by incorporating policy considerations into project designs and into our scientific communications. It is clear from this review that there is more work to do. Aside from changes in policy, another measure for successful policy engagement is the engagement itself – the number of engagements, the quality of those engagements, the relationships created and maintained. Strengthening these engagements means strengthening our relationships with our stakeholders, and strengthening our research by ensuring that it is aligned with stakeholder needs. Therefore, policy engagement is not only about changing policy, it is also about changing our own practices as an institution, in order to create a research culture and environment that can facilitate those changes. 77

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

APPENDIX 1: RECOMMENDATIONS

Throughout this report we made a number of recommendations (highlighted in blue boxes). These are repeated in this appendix for reference. • OUCRU should develop institutional structures to help manage the fall-out from unavoidable changes at stakeholder institutions. By having centralised stakeholder management support, we can limit the impact of personnel changes and better support researchers to manage long term relationships with stakeholder institutions. • While it is clear that researchers are engaging with stakeholders, they are unable to demonstrate the impact of this engagement, because they do not routinely collect evidence of it, or report on it. OUCRU should centralise collecting policy engagement outputs in a systematic way, and produce regular reports that highlight our policy engagement outputs. • OUCRU researchers would benefit from some education or training about the concept of policy engagement itself. • OUCRU policy team should find ways to inform researchers of new and existing channels and opportunities to engage with policy stakeholders. A regular email update similar to the grants opportunities monthly email would probably be a useful first step. • There needs to be a or channel (or many channels) in place for stakeholders to be able to access the OUCRU research community, and a corresponding channel in place for OUCRU researchers to be able to access the stakeholders. The OUCRU policy team should find ways to facilitate engagement between researchers and policy stakeholders at very early stages of project development, using these channels. • Policy engagement needs to be better embedded into the research culture of the organisation, so that researchers are familiar with the concept and terminology, and are able to plan engagement activities as part of their research practice.

• OUCRU researchers would benefit from more education about the policy making process in Viet Nam, as this will help them to target their communication with policy stakeholders in a way that is more likely to produce the desired uptakes of their research data. • One way that funders can explicitly facilitate researchers’ willingness to engage with stakeholders is by funding it, but funders will only provide funds that are requested by researchers themselves as a cost of the research. Researchers should include policy engagement activities in their grant applications, and cost them accordingly. • One way that funders can explicitly facilitate researchers’ willingness to engage with stakeholders is by funding it, but funders will only provide funds that are requested by researchers themselves as a cost of the research. Researchers should include policy engagement activities in their grant applications, and cost them accordingly. • When thinking about systemic policy engagement, we do not need to have the projects completed and research results in place before that engagement takes place, and it is preferable if engagement is happening throughout the entire research life cycle. • OUCRU should find ways to recognise researchers for their policy engagement work. • Researchers, and key operational staff at all levels in OUCRU can and should be involved in engagement with policy stakeholders. OUCRU policy engagement team should find ways to facilitate that engagement, and maximise opportunities for people across the organisation to actively contribute. • Future opportunities to facilitate more conversation about policy engagement within OUCRU could include, providing training support for researchers, seminars and workshops focused on policy engagement, connecting with international policy engagement networks, and expanding the conversation to the rest of the programme.

APPENDIX 2

REFERENCES

1. Ethics approval and Strategic Committee approval

1. University of Oxford. (n.d.). Guidance note 1: What we mean by policy engagement | University of Oxford. Retrieved April 4, 2021, from https://www.ox.ac.uk/research/support-researchers/policyengagement/guidance-policy-engagement-internationally/guidance-note-1-what-we-mean-policyengagement. 2. Haynes, A., Turner, T., Redman, S., Milat, A. J., & Moore, G. (2015). Developing definitions for a knowledge exchange intervention in health policy and program agencies: Reflections on process and value. International Journal of Social Research Methodology, 18(2), 145–159. https://doi.org/10.10 80/13645579.2014.921457

The project was approved by OUCRU Strategic Committee for conducting interviews with audio recording and granted approval for Institutional Review Board (IRB) of OxTREC and Hanoi University of Public Health. This project was initially conceived as an internal project – merely talking with our staff, and trying to understand our own position as an organisation. However, after the first few interviews it became clear that we were collecting large amounts of useful data that could be of interest to others. We decided that we would start to record the interviews using voice recorders and transcribe and translate those interviews in order to analyse them. These changes – both in the process of how we collected the data, and how we were thinking about using the data in future meant that we needed to seek additional approvals for this part of the project. Therefore, we decided to seek internal approval from the OUCRU Strategic Committee (SC) for conducting interviews with audio recording. The SC approval was granted in December 2019. In March 2020, the policy engagement team was advised to also seek Institutional Review Board (IRB) approval for this internal review. Finally, the study obtained ethical approval from both OxTREC and Hanoi University of Public Health, Ha Noi, Viet Nam. After getting IRB approval, a consent form was sent out to all participants. 43 researchers provided their consent for the project team to proceed with data obtained from their interviews. Data from those who did not give their consent were excluded from the analysis and results presented here.

2. Internal review timeline Timeline

Activities

October 2019

Preparing questionnaire and inviting participants

October – November 2019

Conducting in-depth interviews with hand notes (no recording) (n=12)

November 2019 – March 2020

Conducting in-depth interviews with audio record (n=30), transcribing and translating

March 2020 – August 2021

Qualitative data cleaning and analysis

August 2021 – April 2022

Reporting and disseminating results

Table 3-1. Internal Review Timeline

Researchers' Engagement with Policy Stakeholders at OUCRU Viet Nam

Oxford University Clinical Research Unit Website: oucru.org For more information, contact us at: communications@oucru.org

Researchers' Engagement with April 2022 Oxford University Clinical Research Unit Policy Stakeholders