{"paper_id":"28015ae1-b289-4a40-9301-e2cdb42ba79d","body_text":"Human variables and social contexts in the institutionalisation of evidence - informed decision-making in low-resource health systems using rapid evidence synthesis platforms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Human variables and social contexts in the institutionalisation of evidence - informed decision-making in low-resource health systems using rapid evidence synthesis platforms Ronald Munatsi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6679660/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Policy institutions, particularly those in the health sector, have been increasingly involved in forging networks with key stakeholders and developing the capacity to sustainably institutionalise evidence-informed decision-making (EIDM) over the past 20 years. Aspects of sustainability include the capacity development intervention's ability to carry out planned activities, the involvement of the target audience, stakeholders, and beneficiaries, as well as the expected outcomes of the strategy. However, this sustainability is threatened by problems including weak relationships, broken support networks, and changing responsibilities or involvement in the collaborations. Methods The role human and social variables in the process of institutionalising EIDM using rapid evidence synthesis platforms was examined through a qualitative case study of Zimbabwe entailing 17 key informant interviews and an analysis of 33 strategic documents. Results The study highlighted that, policymaking institutions' personnel linked to vibrant networks play a crucial role sustaining EIDM. Institutionalising EIDM using rapid evidence synthesis platforms requires a fundamental change in systems and practices, affecting responsibilities of technical staff. Current intervention programs are also insufficient in offering incentives and establishing social networks. Finding different human incentive structures in the integration of these platforms to encourage regular evidence synthesis and utilisation in health policy and health systems decision making is crucial in sustaining EIDM. The rapid evidence synthesis approach to EIDM institutionalisation tends to put less emphasis on the ‘softer’ and less tangible elements like leadership, political dynamics, interpersonal relationships, and social networks, and more emphasis on the more concrete individual, institutional, and systemic level factors, such as skills, systems, and procedures. Conclusions Interventions for capacity-development must be systematic, comprehensive, and deliberate in order to result in long-lasting change. Addressing structural and value issues is also necessary to improve current capacities. Such an approach calls for the provision of equal weighting to classic elements like systems and procedure as well as human factors and social settings. Evidence ecosystem actors must aim for professionalism in collaborations, open communication, and the advancement of social justice, equity, and inclusivity in order to promote intentional, methodical, and active multi-stakeholder engagement that is characterised by balanced power dynamics. evidence-informed decision-making institutionalisation rapid evidence synthesis platforms health staff networks incentives human variables social contexts Contributions to the literature The study shows that while the rapid evidence synthesis model is viable in institutionalising evidence-informed decision-making, the process is unsustainable if focus is mainly centred on classic elements like processes and procedures while not giving the same emphasis to human factors and social contexts . While there is a need to enhance technical procedures and associated individual-level skills, the research established that policymaking institutions' personnel linked to vibrant networks play a crucial role in sustaining EIDM institutionalisation. However, current intervention strategies, like rapid evidence synthesis platforms, are insufficient in providing incentives and creating social networks, including reorienting systems and practices that impact technical staff responsibilities. By determining how, when, and why human factors and social settings impact sustainable EIDM institutionalisation, these findings fill in acknowledged gaps in the literature and offer a more nuanced understanding of these components' roles in institutionalising EIDM in low resourced health systems. Background The use of evidence in public institutions' decision-making processes has received tremendous interest within the last one and half decade. 1 Since evidence-based decision-making (EIDM) first emerged in the health sector, the aim has been for EIDM to be the norm in its policy and practice settings, and there has been substantial growth towards this end. 2 Even though decision-makers in health policy and health systems have always used EIDM in one form or another, the past 20 years have been marked by an increase in programs to develop their institutional capacities to use robust evidence. 3 This trend may be attributed to the increased demand for transparency and accountability, including equity and inclusion in policy and other decision-making processes. 4 While some academic institutions are incorporating the EIDM concept into their degree program curriculum, others who support EIDM are going further and advocating for it to be recognised as a distinct study area that is not currently integrated into other disciplines. 5 Research and capacity development programs supporting EIDM in Africa and the Global South primarily focused on academic and research institutions, but now focus has shifted to policymaking organizations. The majority of EIDM institutionalisation programs are typically established as a component of research and development projects and operate in areas where national policy aims and interests in international development may not necessarily align. 6 Likewise, these efforts are usually a component of local, regional, or international networks that strive to promote EIDM and depend on the efforts of proponents of EIDM who are committed to improving the use of evidence in decision-making. As much as this combination is usually necessary for the EIDM systems to function, feasibility and sustainability are not always easy to attain for various reasons. 7 These factors include connections deteriorating, support structures collapsing, and expounders' priorities shifting, which results in little to no involvement. Subsequently, if appropriate feasibility studies and strong sustainability strategies are lacking, the operations of established EIDM processes may easily come to an end and become inactive. The ability of the programme’s providers to carry out the planned activities, the focus audience's, stakeholders', and beneficiaries' participation, as well as the approach's intended results, are all considered aspects of feasibility. 8 Institutionalisation refers to the sustained integration of practices, systems, networks, and relationships to support EIDM in health systems and policy institutions, achieving desired outcomes over time. A number of sustainability models have been proposed. One such model is the United Kingdom National Health Service (NHS) developed for the National Health Services (NHS). It offers a weight-based scoring system and a predetermined evaluation questionnaire. The three main components of this model are personnel, processes, and organisation. 9 Nevertheless, there have not been many thorough analyses of most of these models to determine how well they can forecast the sustainability of the results and the sustainability of the actual implementation of EIDM initiatives. The actor-network theory can also be used to explain the sustainability of EIDM institutionalisation approaches by arguing that EIDM practices are sustained by the ongoing construction and rebuilding of networks between researchers, knowledge users, and their environments. 10 Institutionalisation involves adopting new approaches and methods in an organization, with networks playing a crucial role in maintaining EIDM practices by establishing valuable and accessible knowledge within relationships. Therefore, more attention should be paid to the ways in which these networks are fostered in connection to routine EIDM practice, such as the ways in which the relationships that shape the social context produce expert practitioners or the ways in which the interactions elevate the perspectives of marginalised groups. 11 This moulding of the social context suggests that upholding EIDM practice calls for redefining the organisation as a political system and acknowledging that having strong evidence to back up decisions is not enough. Comprehending the initial perspectives of organisations regarding evidence and knowledge is crucial for shaping the institutionalisation and sustainability of EIDM, regardless of the model employed. Policy institutions and implementing agencies’ personnel is now an important target of EIDM capacity development in policymaking institutions, including other ecosystem players. 12 This focus to enhance EIDM has resulted the need to also strengthen the institutional and broader evidence systemic environments. Institutionalising EIDM has become more innovative as a result of the expansion in capacity development strategies and partnership models. Stakeholders and employees do not always see these developments favourably, though. Employees at policy institutions, for example, can see these programs as additional obligations that go without rewards. This qualitative case study of Zimbabwe examines social and human context variables in institutionalising EIDM. To understand the socio-political and economic imperatives and how to prioritise and manage them for the sustainable institutionalisation of EIDM in low-resourced health systems it is essential to investigate these variables. Methods The Zimbabwe Ministry of Health and Child Care (MoHCC) was used as a case study to examine the impact of human variables and social contexts in institutionalising EIDM. The research used a qualitative methodology - key informant interviews and document analysis. The study focused on the Embedding Rapid Reviews in Health Systems in Zimbabwe (ERAZ) project supported by World Health Organisation Alliance for Health Policy and Systems Research (WHO/AHPHSR) and used rapid evidence synthesis platforms to institutionalise EIDM in low resourced settings. Qualitative research places a strong emphasis on the socially constructed form of reality, the close relationship between the researcher and the subject of the study, and the situational limitations that guide the investigation. 13 Such research highlights the investigation's beneficial nature and aims to provide answers to questions that highlight the creation and meaning-giving processes of social experience. 14 Thus, the \"what, how, and why\" were investigated by the technique. By analysing which project components have and have not been successful, the outcome was extensive and intricate data on human variables and social contexts in affecting the institutionalisation of EIDM in practice. 15 The method's capacity to produce nuanced data allowed me to collect specific information to answer the study objectives. To ensure appropriate conclusions about the role of these human and social variables in the sustainable institutionalisation of EIDM, and transferability to other similar low resource contexts, this approach added more rigour to the collection, synthesis, and reporting of multiple factors around the same. 16 Despite the design's benefits, there are limitations related to generalizability, primarily stemming from the small sample size. Key informant interviews (KIIs) were conducted with purposefully selected participants and these provided qualitative data on staff motivation, incentives, and other variables, as well as insights into the construction and interpretation of social experience. The key informant interview guide with open ended questions allowed focused responses and flexibility. As such, the interviews provided nuanced evidence, particularly in a complex programme such as ERAZ where there could be many factors with potential to influence change. 17 The interviews comprised seventeen (17) respondents with an average experience of five (5) years in government service, nine (9) of whom were male and eight (8) female. These participants were policymakers, important project personnel, and other stakeholders. The key informants came from the MoHCC's various departments and agencies, affiliated governmental or quasigovernmental institutions, and partner civil society organisations. The study also utilized document analysis, specifically content analysis, to triangulate data from key informant interviews. This technique systematically assesses documented evidence to answer specific research questions. Document analysis is like other qualitative research methods as it requires consistent data review, analysis, and construal to gain meaning and experiential knowledge of the paradigm under study. 18 Document analysis is a practical and cost-effective research methodology that converges and substantiates evidence through different data sources, bringing about credibility and integrity of findings 19 As a result, EIDM institutionalisation problems like policy, strategic priorities, organisational cultural background, and activities were addressed through a cost-effective method of content analysis in selected documents. The study collected thirty (33) documents, including policy documents, strategies, project reports, annual reports, manuals and guidelines, which offered an intimate perspective of the ministry’s operations. These documents provided details on methods and frameworks for generating, synthesizing, and applying evidence in decision-making. The content of these documents and methodologies used to gather evidence within them, including associated institutional processes and human variables, were examined in relation to the institutionalisation of EIDM within the MoHCC. The included documents were produced between 2014 and 2023 by the MoHCC in collaboration with various government agencies, embassies, international development organizations, and national and international civil society organizations involved in the health sector. The analysis aimed to reconcile discordant findings and obtain nascent insights into complex social phenomena. Data Analysis Thematic content analysis was employed to analyse interviews and documents, involving transcribed data, coding, and theme identification processes. These themes were assigned codes and labels, and the data was categorized into topics. Excel was used to organize and analyse the data, with codes added to cells and comments added for context. The process involved reviewing interview transcripts and documents, assigning codes to themes, and identifying sub-themes within each category. The data was sorted and filtered based on these codes and themes, and tables and charts were created to visualize the data. This method allowed for quick identification of trends, patterns, and correlations within the data. Strengths and Limitations of the Study Weak tools and the possibility of bias are two of the main challenges facing qualitative researchers that utilise interviews as a data collection strategy in their research. 20 The researcher conducted the study as an insider, having interacted with some key informants during a capacity development project in a ministry. This allowed for easier interaction and access to policy and strategic documents, resulting in rich, trustworthy data. At the same time, the author was aware of potential bias, ethical concerns, and the influence of the inside researcher's role on coercion, compliance, and access to privileged information. To avoid bias where necessary, the author asked another independent researcher to conduct interviews and used control procedures to minimize bias. An impartial third party coded the data and participants confirmed the findings. Document analysis also had its own drawbacks, such as diverse formats, government procedures, and subjective content creation. The language of some documents was sometimes too technical to comprehend. Validity and Reliability The study adhered to scientific principles and was validated by a second researcher second researcher with pertinent experience also examined the research design, data collecting, and analytic procedure. 22 The study used a coding procedure, semantic validity tests, content consistency assessments, peer review, to ensure the validity and reliability of the results. 21 The procedure tested codes and insights, confirmed codes for consistency, and assessed data correctness and stability. These techniques improved the overall integrity of the research, ensuring the findings are reliable and valid for future research, policy, and practice. Results The key informants pointed out various human resources and associated challenges that face institutionalising EIDM using rapid evidence synthesis platforms. For instance, Respondent Official 6 remarked that the MoHCC faces staffing issues, high turnover, political polarization, and budget constraints, leading to a shortage of personnel with some critical functions remaining unfilled for over 2 decades. The ERAZ project introduced new skill sets, causing further challenges in integrating EIDM staffing requirements within existing roles, especially without appropriate incentives. This makes it difficult to sustain the project beyond external funding. “If current staff members are not given incentives, EIDM cannot be institutionalised. Remember that this initiative came with a great deal of new roles, responsibilities, and skills to employees who were already demotivated by the hyper-inflationary economy.” Respondent Official 6, MoHCC The Zimbabwe Health Sector Public Expenditure Review of 2022 points out that staff shortages, which impact the provision and quality of services, are primarily attributed to the ongoing recruitment freeze and the outdated staff establishment's inadequacy to meet nursing and midwifery requirements. 23 The increasing workload resulting from staff shortages affects job satisfaction and motivation, which may lead to higher attrition rates in the future. According to the same review by the World Bank, 23 there are still factors to take into account, such as the intrinsic and extrinsic motivators for the health workforce that can be identified through effective mechanisms like online surveys, even though unfavourable compensation and working conditions—which have been further impacted by inflation and COronaVIrus Disease of 2019 (COVID-19)—have contributed to rising rates of attrition in human resources since 2019. Such surveys can be used to improve short- to medium-term staff retention and motivation plans. The personnel issues facing Zimbabwe's health sector were also mentioned by Parliament of Zimbabwe First Report of the Portfolio Committee on Health and Child Care on State of Affairs of the Health Delivery System in Zimbabwe 24 The portfolio committee investigated the state of the country's healthcare delivery system. According to their report, the government stopped hiring new medical staff ten years ago. Following the President's 2015 proclamation, the government was tasked to unfreeze all frozen positions in the health sector and re-evaluate the establishment upward in light of the growing morbidity and population. In the document analysis, the Comprehensive national human immunodeficiency virus (HIV) communications strategy for Zimbabwe 2019-2025 further explains the need to examine the issue of incentivising and motivating health staff critically. It notes that healthcare providers, comprising physicians, nurses, and medical staff, encounter numerous obstacles and tedious responsibilities that impede their efficiency 25 The necessity to accomplish remarkable outcomes amid staff migration and the exhaustion associated with their labour frequently strains the health of staff. The complexity of these circumstances and the inadequacy of proficiency and expertise create obstacles for them to deliver optimal results that facilitate evidence-informed decision-making. Respondent Official 5, who was also a member of the ERAZ core team observed that as a team created for ERAZ, they already had their roles and responsibilities, and these did change after being co-opted. They performed ERAZ project duties, including their previous commitments, without extra money from the additional functions. Without incentives, the ERAZ team lacked the motivation to effectively execute some of the ERAZ-related responsibilities. The member noted, \"There was a need to engage with the high-level human resources management to integrate the project within the Ministry's organisational structure and provide appropriate incentives. This way, there would have been proper institutionalisation of the project.\" Respondent Official 5, MoHCC Respondent Official 2 observed that the ERAZ team's evidence synthesis process is hindered by a lack of coordination, capacity gaps, diverse expertise and that incentives are critical factors affecting project sustainability. Prioritizing development partner-supported programs over monetary incentives is essential but these projects bring extra responsibilities, therefore civil servants require incentives due to underpaid salaries. When incentives tied with projects cease, implementation also ceases. Addressing human resources issues and ensuring incentivised personnel with the necessary skill sets is thus critical for EIDM sustainability. “In addition to other incentives like workshops and conferences, the majority of projects funded by development partners like the United Nations Development Programme (UNDP) or World Health Organisation (WHO) provide incentives for ministry staff in the form of per diems. Without a sound sustainability plan, employees quit performing the tasks related to that specific project as soon as these incentives stop being offered when it is finished.” Respondent Official 2, MoHCC. An Independent Evaluation of the Health Transition Fund in Zimbabwe assessed the impact of the Health Transition Fund's practices, methods, and intervention strategies on improving the health status of the general populace, with a specific emphasis on maternal, neonatal, and paediatric healthcare. Additionally, the assessment sought to ascertain whether the Ministry optimally utilised resources to produce desirable outcomes. This evaluation revealed that training, mentoring, and supportive supervision are necessary to build the capacity of healthcare workers, especially those working at the primary level of care, implementing a programme to bolster morale and secure the continued employment of vital healthcare employees. 26 Healthcare's retention program faces challenges like uneven allowance distribution, unclear eligibility requirements, and insufficient information. Revision of strategy, recruitment, performance assessment, motivation enhancement, and performance incentives is recommended. The Quality Assurance and Quality Improvement Policy addresses poor human resources performance by implementing evidence-driven practices and in-service training curricula. Strengthening health worker performance includes improving clinical skills, supportive supervision, peer-to-peer evaluation, self-evaluation, and clinical decision support. The availability of appropriate technology, such as e-learning platforms, allows improvement in these areas. 27 The policy links performance improvement interventions to facility-wide human resources management, developing accountability systems to hold health workers and managers responsible for their performance. During the ERAZ project, a Mentorship Programme Strategy for Embedding Rapid Reviews in Health Systems Decision Making aimed to build staff's capacity and motivate them to improve EIDM through sensitization workshops, online and physical training programs. The strategy's goal was to have a long-term impact on the Ministry by fostering a group of individuals who can sustain evidence-based decision-making practices. 28 The programme aimed to establish a group of experts with extensive experience in developing rapid evidence products, forming a core of skilled and knowledgeable advocates for EIDM. The Results-Based Financing in Health Programme: Strengthening the health delivery system in Zimbabwe outlines the MoHCC initiatives to incentivise staff. The study revealed that one of the biggest obstacles to institutionalising and sustaining EIDM is the lack of well-skilled and motivated employees, hence the study produced a tool for equitable rewarding and incentivising health workers. It focused on sustainable incentives and motivation of health workers based on seniority and performance under the Health Development Fund with funding and technical support from various partners, including United Kingdom Agency for International Development (UKAID), European Union (EU) and WHO. Employee commitment and productivity may rise as a result of the staff incentive programme to enhance health worker outcomes. 29 Such an approach offers flexible parameters that let those who work harder get bigger rewards, and there are fixed parameters based on job responsibilities within the hierarchy. Seniority determines the designated responsibility allowance. As a result, the entire incentive package for their facilities will be distributed equally among all senior technical staff members. The scheme offers fair compensation for employees, with flexible parameters for those exceeding expectations and performance evaluated quarterly. It enhances decision-making skills, promotes transparency, and fosters trust among stakeholders, ensuring the sustainability of fundamental skills and values ensuring the sustainability of fundamental skills and values. In countries with few resources, the loss of workers is destroying already fragile health systems. Using a systematic review, Willis-Shattuck et al. 30 (2008) investigated the impact of both monetary and non-monetary incentives on retaining and motivating health workers. The study emphasises that the success of health systems and the realization of universal health care hinges on effective motivation and retention of health workers. The Zimbabwean ERAZ project staff got additional roles but continued fulfilling their original duties without additional compensation, despite prevailing economic challenges and the Covid-19 pandemic. Staff turnover and financial restrictions impacted the Ministry's capacity to fill open posts. This pattern is common in EIDM capacity-development programs in low-resource situations, where staff members lack incentives to participate effectively. In an investigation to determine what motivates health staff members in Malawi to fully enhance their welfare and work possible, the study revealed that demotivation, especially from lack of monetary incentives, has led to a decline in worker performance in the health sector. 31 The ensuing inefficiency affects the quality of health and information service delivery. Considering the above situation, should development partners provide monetary incentives when implementing capacity development programmes or not? This is a question that civic society always grapples with. An empirical study of how public service and social welfare programmes' performance measurement and incentive frameworks work, as well as how workers and institutions respond over time and evolve alongside them established that the connection between incentives and public sector success raises concerns about the moral fibre and humanity of those who work for public sector organisations. 32 The authors argue that incentives are crucial for organizational change, as they help individuals align their moral goals with the institution's objectives. They balance individual interests and organizations, initiating motivating responses and changes in behaviour to promote better performance. Case studies for UNESCO whose goal was to pinpoint effective strategies for capacity development in Benin, Ethiopia, and Vietnam revealed that while recent research has concluded that incentives are important, incentive programmes do not always lead to increased capacity and can even stand in the way of capacity growth. 33 The limited effectiveness of many incentive programmes is partly related to competing disincentives that, in some situations, cause capacity loss. According to the same author, this issue is made worse by a lack of data on the effective use of non-financial incentives and instruments for managing human resources, as well as the inconsistent approaches of different development partners when dealing with the issue, which adds yet another reason for failure. An evaluation of the effectiveness of an institution-wide knowledge translation strategy to support health policy decisions in a Canadian public health institution that has successfully integrated an embedded evidence synthesis platform argues that monetary incentives themselves are insufficient to motivate staff in health policy and health systems decision-making. 34 Along with accountability, teamwork, and other softer organisational elements, financial incentives, professional development, and acknowledgement of effort are important motivators for health professionals. Other important factors in incentivising them include recognition, proper infrastructure, and attitude. Discussion Despite having robust strategies guiding it in this area, the ERAZ project struggled to stimulate high-level decision-makers desire and demand for evidence. Encouraging high-level policymakers to demand evidence in their decision-making process ensures that EIDM institutionalisation initiatives will be successful. 35 Historically, most low-resource countries, including Zimbabwe's policymaking institutions, have been known for having excellent strategies but poor execution due to lack of evaluation evidence. 36 For example, the problem with policy implementation in Zimbabwe, as in other African countries, is not with the effectiveness of the policies themselves, but rather with the inability or unwillingness to implement them. This challenge is also related to the political polarisation corruption in most African countries, which appear to promote ineffective policy execution. 37 According to Zvoushe and Zhou, 38 the majority of public- private partnerships are similarly problematic since the stakeholders do not have trust in the evidence produced by the different parties. As a result, there is disagreement over which evidence is authentic or intended to deceive or influence the other side. These observations are particularly typical of today’s 'post-truth' politics. In an era of rising populism and political contestation, trustworthy information is essential for well-informed policy decisions that are based on facts rather than just emotions and values, let alone disinformation and fake news. Disagreements over whether or not evidence should be stripped of social values characterise EIDM in political contexts. Maintaining the perceived objectivity that supports scientific authenticity grows harder when evidence enters the policy domain. 39 Any political system's ability to produce positive, targeted results based on openly available evidence is therefore a key factor in determining its level of public legitimacy. To make political decisions clear, measurable, and lasting, these results must be grounded in trustworthy facts. 40 An article discussing the capacities underlying evidence demand stimulation among decision-makers, Newman et al. (2013) warns that understanding the meaning of the phrase ‘demand stimulation’ is essential to avoid mistaking it for policy-influencing goals, especially considering the growing emphasis on increasing demand for research. 41 Here, the authors argue that to effectively combine awareness with research, decision-makers, and the organisations they work for must consider larger settings, factors that facilitate or restrict participation in research, and actions to increase both demand and capacity to supply. Co-production and co-creation through active participation of decision makers and other stakeholders in agenda formulation, framing of research questions, evaluation of evidence, and other pertinent stages of the synthesis process are some of the strategies to increase demand for evidence among decision-makers. Locally led evidence and demand-driven results from investments in research that are in line with national research priorities result in the growth of local policy institutions' research capacities. This demand-driven approach offers the benefits of customising research questions to local needs, strengthening institutional and individual capacities, and offering a realised framework on which EIDM is most likely to produce favourable decision outcomes. 42 Promoting evaluative thinking and capacity in public institutions requires allowing for some flexibility in terms of programme aims in addition to understanding the larger political economy of the use and adoption of evidence. 43 This observation is particularly crucial when working with institutions like health ministries that require a diversity of evidence to plan and implement their programmes, and focusing on a single type of evidence may also produce negative incentives and ignore more important considerations, such as minor programmatic adjustments and improving implementation. The rapid evidence synthesis approach to EIDM institutionalisation tends to emphasise the more ‘tangible’ individual, institutional and systemic level factors in institutionalising EIDM, such as skills, systems and procedures and puts less emphasis on the ‘softer’ and less ‘tangible’ factors such as leadership, political dynamics, interpersonal relationships, and social networks. At the same time in complex health decision making environments the latter play a more significant role in incentivising staff and embedding these platforms for long-term EIDM sustainability. A social network analysis study on the implementation of EIDM in Canada, which has some of the most effective health evidence synthesis platforms reveals that the process of routinely putting evidence into practice involves dialogue and communication and that health professionals frequently look to their colleagues for crucial information. 44 Therefore, interpersonal interactions between technical staff, decision-makers, and pertinent stakeholders involved in various processes are crucial for removing social and cultural barriers to implementing EIDM as well as for fostering the growth of close relationships that support the entrenchment of a more pervasive and well-established EIDM culture. Good leadership is also crucial for rapid evidence platforms, as it establishes legitimacy, allocates resources, and demonstrates relevance. A public health department achieved its goal of making evidence-based decisions within two years of a decade-long initiative, thanks to a clear governance structure and committed leadership. 45 According to Rousseau and ten Have, 46 Good governance and leadership practices result in transformative change, the development of trust in technical personnel and implementation procedures, and the active engagement of members at all levels. 46 The same authors also note that as members become more self-reflective, critical, and inquisitive about the institution, its procedures, and the experiences of its stakeholders, leadership actions help to create learning organisations. This way EIDM can then become ingrained in the culture of the organisation. Institutionalising EIDM using rapid evidence synthesis platforms causes a fundamental change in systems and practices, which in turn affects the duties and responsibilities of technical staff. Even if existing departments, structures, and even the same personnel may be used as part of various capacity building efforts, in most situations these changes may not necessarily lead to more benefits or incentives for the workforce. Demotivation has therefore been a major factor in some these initiatives’ failure. A study to identify context-based policy options for strengthening motivations among health researchers and policymakers to support EIDM revealed that current incentive programmes are insufficient for EIDM actors because they are primarily focused on primary research generation, rather than synthesis and use. 47 This situation creates a challenge for the different players in the evidence-to-practice mix to fulfil their responsibilities for sustaining EIDM. In order to ensure that all actors support routine evidence synthesis and utilisation in health policy and health systems decision making, it is crucial to identify different incentive structures that can be employed in integrating these platforms. Conclusion Human and social context factors must be given equal weight when using rapid evidence synthesis platforms to institutionalise EIDM, with diversity, equality, and inclusion (DEI) being an integral component of the process. The \"adhesive\" that holds EIDM systems together is these \"soft variables.\" Disregarding the DEI values in health policy and health systems EIDM institutionalisation interventions fragments decision-making and results in ineffective health information and service outcomes due to the exclusion of key stakeholders like researchers, policymakers, and service providers. 48 When analysing EIDM institutionalisation using rapid evidence synthesis platforms, DEI lenses must be constantly utilised in order to lower barriers, increase access, align platforms to contextual realities, and reduce inequality. 49 The Canada Research Coordinating Committee developed a guide on equity, diversity, and inclusion in research and knowledge translation practices in 2019 with subsequent revisions in 2022 to support the New Frontiers in Research Fund (NFRF) projects. The Guide notes that Diversity, Equity and Inclusion (DEI) barriers include attitudes, policies, practices, or systems that cause individuals from certain population groups to receive unequal access to or be excluded from participation in employment, services, or programmes, for example, through discrimination, racism, sexism, homophobia, transphobia, and ableism. 50 From this definition, it is apparent that these obstacles are systemic in nature, implying that they stem from personal, cultural, or institutional norms, customs, traditions, and/or values that may go unnoticed or unacknowledged by individuals who do not experience them. A study conducted with stakeholders who had taken part in the national level health research priority setting activities in Zambia found out that the alignment of research programmes to national priorities is negatively impacted by the marginalisation of many important stakeholders and the undue influence of development partners. 51 The study highlights the lack of effective stakeholder engagement–central to overcoming human and social context barriers in EIDM processes, despite commitment from various actors in low resource settings. Consequently, these barriers negatively impact emotional stability, physical and mental health financial security, career advancement, overall health and well-being. Increasing equitable and inclusive participation in the evidence synthesis processes, facilitating equitable access to opportunities for capacity development, and actively and purposefully integrating DEI and related considerations in platform design and practices are some ways to sustain the institutionalisation of EIDM using rapid evidence synthesis platforms. The majority of EIDM capacity development programmes in low resource countries are neither inclusive nor administered fairly so proponents of EIDM must now shift from empty rhetoric and take decisive action to eliminate these inequalities through legal and policy implementation frameworks. 52 Based on this investigation, it may be concluded that solid systems and procedures, a skilled human resource base, clear governance structure, and sound leadership are all necessary to institutionalise EIDM using evidence synthesis platforms. But to be more sustainable, an organisation's culture must be prioritised, and it is crucial to develop strategies to encourage and reinforce the 'soft' human and social context aspects that have been such as, political dynamics, interpersonal relationships, and social networks. Organisations typically underestimate the role that incentives and reinforcement play in influencing organisational culture. Institutional incentives and reward systems lead to inclusive discussions and fair access to knowledge. These incentive or reward systems can be implementing through award programmes, gamification strategies, or just saying \"thank you\" to those that help, coach, and mentor their peers. 53 Various incentive models can be explored and employed to sustain an EIDM culture in the institution as they facilitate the integration of a knowledge sharing culture into the overall performance management system. Abbreviations EIDM: Evidence-informed decision-making NHS: National Health Services MoHCC: Ministry of Health and Child Care ERAZ : Embedding Rapid Reviews in Health Systems in Zimbabwe WHO/ AHPHSR World Health Organisation Alliance for Health Policy and Systems Research KIIs: Key informant interviews COVID-19: COronaVIrus Disease of 2019 HIV: Human immunodeficiency virus WHO: World Health Organisation UNDP: United Nations Development Programme UKAID: United Kingdom Agency for International Development. EU: European Union UNESCO: United Nations Educational, Scientific and Cultural Organization DEI: Diversity, Equity and Inclusion NFRF: New Frontiers in Research Fund Declarations Acknowledgements The author would like to sincerely thank Professor Ruth Stewart for her invaluable advice and support during the research, as well as Professor Sandy Oliver for her insightful comments on the development of this article. Funding This work received no specific grant from any funding agency, commercial or not for-profit sectors. Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Author Information R. Munatsi Department of Anthropology and Development Studies, Faculty of Humanities, University of Johannesburg, APK Campus Auckland Park, Johannesburg, South Africa Contributions The author is solely responsible for all aspects of the work, including conception, design, data collection, analysis, interpretation, and manuscript preparation. Ethics Declarations Competing Interest: I do not have any conflict of interest. Ethical Clearance: Ethical clearance to conduct this study was sought from and provided by the University of Johannesburg Research Ethics Committee under ethical clearance number REC-01-049-2022 . Informed Consent: Informed written consent to take part in the research was obtained prior to the commencement of the study References Stewart, R. Langer, L. & Erasmus, Y. (2018): An integrated model for increasing the use of evidence by decision-makers for improved development, Development Southern Africa, 2018.DOI: 10.1080/0376835X.2018.1543579 Kuchenmüller, T., Boeira, L., Oliver, S. et al. Domains and processes for institutionalizing evidence-informed health policy-making: a critical interpretive synthesis. Health Res Policy Sys. 2022. 20, 27. https://doi.org/10.1186/s12961-022-00820-7 Haby, M.M., Chapman, E., Clark, R. et al. Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and casestudies. Implementation Sci. 2015, 11, 117. https://doi.org/10.1186/s13012-016-0472-9 Kozioł-Nadolna, K., & Beyer, K. Determinants of the decision-making process in organizations. Procedia Computer Science, 192, 2375-2384. doi:10.1016/j.procs.2021.09.006 Jessani NS, Hendricks L, Nicol L, Young T. University Curricula in Evidence-Informed Decision Making and Knowledge Translation: Integrating Best Practice, Innovation, and Experience for Effective Teaching and Learning. Front Public Health. 2019 Dec 3;7:313. doi: 10.3389/fpubh.2019.00313. PMID: 31850294; PMCID: PMC6901672. Borst RAJ, Wehrens R & Bal R. Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis. Int J Health Policy Management. 2022 Dec 19;11(12):2793-2804. doi:10.34172/ijhpm.2022.6424. Epub 2022 Feb 21. PMID: 35279039; PMCID: PMC10105179. Oronje, R.N., Murunga, V.I. & Zulu, E.M. Strengthening capacity to use research evidence in health sector policy-making: experience from Kenya and Malawi. Health Res Policy Sys. 2019, 17, 101. https://doi.org/10.1186/s12961-019-0511-5 Pluye P, Grad R, M. Granikov V, Theriault G, Frémont P, Burnand B. et al. Feasibility of a knowledge translation CME program: Courriels Cochrane. The Journal of Continuing Education in the Health Professions. 2012. 32(2), 134–141. https://doi.org/10.1002/chp Maher, L. Gustafson, D & Evans, A. Sustainability Model and Guide. London: NHS Institute for Innovation and Improvement, 2010. ISBN: 978-1-907045-36-3. [Internet] [cited 2024 Sep 3] Available from: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/NHS- Sustainability-Model-2010.pdf Kothari A, Cameron J. A New Perspective on Emerging Knowledge Translation Practices Comment on \"Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis\". Int J Health Policy Manag. 2023;12:7545. doi: 10.34172/ijhpm.2022.7545. Epub 2022 Dec 12. PMID: 37579457; PMCID: PMC10125046. Clark, E.C., Burnett, T., Blair, R. et al. Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review. 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[Internet] [cited 2024 Oct 2] Available from: https://www.veritaszim.net/sites/veritas_d/files/First%20Report%20of%20The%20Portfolio%20Committee%20on%20Health%20%26%20Child%20Care%20on%20State%20of%20Affairs%20of%20the%20Health%20Delivery%20System%20in%20Zim.pdf/ Ministry of Health and Child Care. Comprehensive national HIV communications strategy for Zimbabwe 2019- 2025. Harare: Ministry of Health and Child Care.2017 [Strategy] https://www.prepwatch.org/wp-content/uploads/2022/07/Zimbabwe- National-HIV-Communications-Strategy-2019-2025.pdf The Liverpool School of Tropical Medicine. Independent Evaluation of the Health Transition Fund in Zimbabwe: Final Report. London: The Liverpool School of Tropical Medicine, 2016 [Internet]. [cited 2024 July 11. Available from: https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/zi mbabwe/mohcw_national_health_information_system_strategy.pdf/ Ministry of Health and Child Care. 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BMC Health Serv Res. 2014, 14, 486. https://doi.org/10.1186/s12913- 014-0486-4/ Heinrich, C.J. & Marschke, G. \"Incentives and their dynamics in public sector performance management systems,\" Journal of Policy Analysis and Management, John Wiley & Sons, Ltd. 2010, vol. 29(1), pages 183-208. Ulleberg, I. Incentive structures as a capacity development strategy in public service delivery: a literature review and annotated bibliography on the role of incentives for civilian servants within capacity development policies. Paris: UNESCO. 2009. ISBN 978-92-803-1344-4.https://unesdoc.unesco.org/ark:/48223/pf0000186569/ Dobbins, M., Robeson, P., Ciliska, D., Hanna, S., Cameron, R., O’Mara, L., Decorby, K., &Mercer, S. A description of a knowledge broker role implemented as part of a randomized controlled trial evaluating three knowledge translation strategies. Implementation Science. 2009, 4(1), 1–9. https://doi.org/10.1186/1748-5908-4-23/PEER-REVIEW/ Abdullahi L, Hara H, Kahurani E, Kamthunzi V, Nthakomwa L, Oronje R, Madise N. EIDM training as a key intervention among researchers to enhance research uptake and policy engagement: an evaluation study. Wellcome Open Res. 2023 Dec 8;8:52. doi: 10.12688/wellcomeopenres.18018.2. PMID: 38716047; PMCID: PMC11074692. Zvoushe, H.,& Zhou, G. Public Policy Making in Zimbabwe: A Three Decade Perspective. International Journal of Humanities and Social Science. 2012, Vol. 2 No. 8 [Special Issue – April 2012] Chigudu, D. Navigating policy implementation gaps in Africa: The case of Zimbabwe. Risk governance & control : Financial markets & Institutions. 2015, 5(3). Zvoushe, H., & Zhou, G. Public-Private Partnerships for Infrastructural Development in Africa: Prospects and Pitfalls. Journal of Public Policy in Africa. 2014, 2(1), 18-33. Akerlof, K; Lemos, M. C; Cloyd, E.T; & Heath, E. Who Isn’t Biased? Perceived Bias as a Dimension of Credibility in Communication of Science with Policymakers. Kathleen P. Hunt (Ed.). Exploring the Role of Trust and Credibility in Science Communication: Insights from the Sixth Summer Symposium on Science Communication. [Internet] 2018. [cited 2024 Aug 28] Available from:: http://works.bepress.com/shuyang-qu/10/ Communication. https://doi.org/10.31274/sciencecommunication-181114-18/ Umbach, G., Guidi, C.F, & Russo, M. Evidence-Based PolicyMaking: From Data To Decision-Making. Executive Training Seminar Global Governance Programme & School of Transnational Governance. 2018. Issue 2018/15 July 2018. Italy:EUI. https://cadmus.eui.eu/bitstream/handle/1814/57324/PB_2018_15.pdf?sequence=/ Newman, K., Capillo, A., Famurewa Akin, Nath Chandrika.,& Siyanbola Willie. What is the evidence on evidence-informed policy making? Lessons from the International Conference on Evidence-Informed Policy Making. [Internet] 2013. [cited 2023 Nov 15] Avaialable from: www.inasp.info/ Erismann, S., Pesantes, M. A., Beran, D., Leuenberger, A., Farnham, A., Berger Gonzalez de White, M., Labhardt, N. D., Tediosi, F., Akweongo, P., Kuwawenaruwa, A., Zinsstag, J., Brugger, F., Somerville, C., Wyss, K., &and Prytherch, H. (2021). How to bring research evidence into policy? Synthesizing strategies of five research projects in low-and middle- income countries. Health Research Policy and Systems. 2021, 19(1). https://doi.org/10.1186/s12961-020-00646-1/ Witter, S., Kardan, A., Scott, M., Moore, L., & Shaxson, L. Generating demand for and use of evaluation evidence in government health ministries: lessons from a pilot programme in Uganda and Zambia. Health Research Policy and Systems. 2017, 15(1). https://doi.org/10.1186/s12961-017-0250-4/ Yousefi Nooraie, R., Marin, A., Hanneman, R., Lohfeld, L., & Dobbins, M. Implementation of evidence-informed practice through central network actors; a case study of three public health units in Canada. BMC Health Services Research.2017. 17(1), 1–11.https://doi.org/10.1186/s12913-017-2147-x/ Peirson, L., Ciliska, D., Dobbins, M., & Mowat, D. (2012). Building capacity for evidence informed decision making in public health: A case study of organizational change. BMC Public Health. 2012. 12(1). https://doi.org/10.1186/1471-2458-12-137/ Rousseau, D. M., & ten Have, S. Evidence-based change management. Organizational Dynamics. 2022, 51(3). https://doi.org/10.1016/j.orgdyn.2022.100899/ Yazdizadeh, B., Sajadi, H. S., Mohtasham, F., Mohseni, M., & Majdzadeh, R. Systematic review and policy dialogue to determine challenges in evidence-informed health policy- making: findings of the SASHA study. Health Research Policy and Systems. 2021, 19(1). https://doi.org/10.1186/s12961-021-00717-x/ Ruzycki, S. M., & Ahmed, S. B. Equity, diversity and inclusion are foundational research skills. In Nature Human Behaviour. 2022. (Vol. 6, Issue 7, pp. 910–912). Nature Research. https://doi.org/10.1038/s41562-022-01406-7/ Practices Comment on “Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis.” In International Journal of Health Policy and Management .2022, (Vol. 12, Issue 1). Kerman University of Medical Sciences. https://doi.org/10.34172/ijhpm.2022.7545 Beaudry, Catherine & Larivière, Vincent. 'Which gender gap? Factors affecting researchers' scientific impact in science and medicine', Research Policy, Elsevier, 2016, vol. 45(9), pages 1790-1817/ Kapiriri, L., Schuster-Wallace, C. & Chanda-Kapata, P. Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia. Health Res Policy Sys. 2018, 16, 105. https://doi.org/10.1186/s12961-018-0384-z/ Boulware, L. E., Corbie, G., Aguilar-Gaxiola, S., Wilkins, C. H., Ruiz, R., Vitale, A., & Egede, L.E. Combating Structural Inequities — Diversity, Equity, and Inclusion in Clinical and 205 Translational Research. New England Journal of Medicine. 2022, 386(3), 201–203.https://doi.org/10.1056/nejmp2112233/ Ritala, P. Vanhala M & Järveläinen, K. The role of employee Incentives and motivation on organisational nnovativeness in different organisational cultures. managing knowledge, absorptive capacity and innovation \" International Journal of Innovation Management (ijim), World Scientific Publishing Co. Pte. Ltd. 2019, vol. 24(04), pages 1-32, December. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6679660\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":471261834,\"identity\":\"c41370c2-0e20-4143-be18-1874de428a5a\",\"order_by\":0,\"name\":\"Ronald Munatsi\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3PsQqCQBjAcY8DXYLWG+odAsF6l5b7cO3WcLBwssX2hqhXsMVoUwRbRFfBxfAFbHPssqbArC3o/sPdN9yP45MkkehXK+TnQA1+YGx1E9oQzIf4fqNvCLLvQwcZr9ZBReceHJU0rC67xbS/4qQ2vFYyiBOd0CSHk6PLBLwz24TIQk6ctxJCZiMCdg6ur8sSeBGzOMHIfkvUuiFpiSvYRmz/AdEev2S6RMAymdtJerE24buoblZqhEY+O3ASvN1FcdSsmudDN4XyWptLtkvDoKiNdvJa2Jz+x+95y28ei0Qi0Z90A/MiYVjc/Du1AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"University of Johannesburg\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ronald\",\"middleName\":\"\",\"lastName\":\"Munatsi\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-05-16 10:08:06\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6679660/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6679660/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":91611416,\"identity\":\"59c5ccc7-606f-4a63-bc58-0bac5c798e98\",\"added_by\":\"auto\",\"created_at\":\"2025-09-18 09:55:38\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":559243,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6679660/v1/7a4ef831-bb7e-4779-9d06-f6b3b82660c6.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Human variables and social contexts in the institutionalisation of evidence - informed decision-making in low-resource health systems using rapid evidence synthesis platforms\",\"fulltext\":[{\"header\":\"Contributions to the literature\",\"content\":\"\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eThe study shows that while the rapid evidence synthesis model is viable \\u0026nbsp;in institutionalising evidence-informed decision-making, the process is unsustainable if focus is mainly centred on classic elements like processes and procedures while not giving the same emphasis to human factors and social contexts .\\u003c/li\\u003e\\n \\u003cli\\u003eWhile there is a need to enhance technical procedures and associated individual-level skills, the research established that policymaking institutions\\u0026apos; personnel linked to vibrant networks play a crucial role in sustaining EIDM institutionalisation. However, current intervention strategies, like rapid evidence synthesis platforms, are insufficient in providing incentives and creating social networks, including reorienting systems and practices that impact technical staff responsibilities.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBy determining how, when, and why human factors and social settings impact sustainable EIDM institutionalisation, these findings fill in acknowledged gaps in the literature and offer a more nuanced understanding of these components\\u0026apos; roles in institutionalising EIDM in low resourced health systems.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eThe use of evidence in public institutions' decision-making processes has received tremendous interest within the last one and half decade.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Since evidence-based decision-making (EIDM) first emerged in the health sector, the aim has been for EIDM to be the norm in its policy and practice settings, and there has been substantial growth towards this end.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Even though decision-makers in health policy and health systems have always used EIDM in one form or another, the past 20 years have been marked by an increase in programs to develop their institutional capacities to use robust evidence.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e This trend may be attributed to the increased demand for transparency and accountability, including equity and inclusion in policy and other decision-making processes.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e While some academic institutions are incorporating the EIDM concept into their degree program curriculum, others who support EIDM are going further and advocating for it to be recognised as a distinct study area that is not currently integrated into other disciplines.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Research and capacity development programs supporting EIDM in Africa and the Global South primarily focused on academic and research institutions, but now focus has shifted to policymaking organizations.\\u003c/p\\u003e \\u003cp\\u003eThe majority of EIDM institutionalisation programs are typically established as a component of research and development projects and operate in areas where national policy aims and interests in international development may not necessarily align.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Likewise, these efforts are usually a component of local, regional, or international networks that strive to promote EIDM and depend on the efforts of proponents of EIDM who are committed to improving the use of evidence in decision-making. As much as this combination is usually necessary for the EIDM systems to function, feasibility and sustainability are not always easy to attain for various reasons.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e These factors include connections deteriorating, support structures collapsing, and expounders' priorities shifting, which results in little to no involvement. Subsequently, if appropriate feasibility studies and strong sustainability strategies are lacking, the operations of established EIDM processes may easily come to an end and become inactive. The ability of the programme\\u0026rsquo;s providers to carry out the planned activities, the focus audience's, stakeholders', and beneficiaries' participation, as well as the approach's intended results, are all considered aspects of feasibility.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Institutionalisation refers to the sustained integration of practices, systems, networks, and relationships to support EIDM in health systems and policy institutions, achieving desired outcomes over time.\\u003c/p\\u003e \\u003cp\\u003eA number of sustainability models have been proposed. One such model is the United Kingdom National Health Service (NHS) developed for the National Health Services (NHS). It offers a weight-based scoring system and a predetermined evaluation questionnaire. The three main components of this model are personnel, processes, and organisation.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Nevertheless, there have not been many thorough analyses of most of these models to determine how well they can forecast the sustainability of the results and the sustainability of the actual implementation of EIDM initiatives. The actor-network theory can also be used to explain the sustainability of EIDM institutionalisation approaches by arguing that EIDM practices are sustained by the ongoing construction and rebuilding of networks between researchers, knowledge users, and their environments.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Institutionalisation involves adopting new approaches and methods in an organization, with networks playing a crucial role in maintaining EIDM practices by establishing valuable and accessible knowledge within relationships. Therefore, more attention should be paid to the ways in which these networks are fostered in connection to routine EIDM practice, such as the ways in which the relationships that shape the social context produce expert practitioners or the ways in which the interactions elevate the perspectives of marginalised groups.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e This moulding of the social context suggests that upholding EIDM practice calls for redefining the organisation as a political system and acknowledging that having strong evidence to back up decisions is not enough. Comprehending the initial perspectives of organisations regarding evidence and knowledge is crucial for shaping the institutionalisation and sustainability of EIDM, regardless of the model employed.\\u003c/p\\u003e \\u003cp\\u003ePolicy institutions and implementing agencies\\u0026rsquo; personnel is now an important target of EIDM capacity development in policymaking institutions, including other ecosystem players.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e This focus to enhance EIDM has resulted the need to also strengthen the institutional and broader evidence systemic environments. Institutionalising EIDM has become more innovative as a result of the expansion in capacity development strategies and partnership models. Stakeholders and employees do not always see these developments favourably, though. Employees at policy institutions, for example, can see these programs as additional obligations that go without rewards. This qualitative case study of Zimbabwe examines social and human context variables in institutionalising EIDM. To understand the socio-political and economic imperatives and how to prioritise and manage them for the sustainable institutionalisation of EIDM in low-resourced health systems it is essential to investigate these variables.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThe Zimbabwe Ministry of Health and Child Care (MoHCC) was used as a case study to examine the impact of human variables and social contexts in institutionalising EIDM. The research used a qualitative methodology - key informant interviews and document analysis. The study focused on the Embedding Rapid Reviews in Health Systems in Zimbabwe (ERAZ) project supported by World Health Organisation Alliance for Health Policy and Systems Research (WHO/AHPHSR) and used rapid evidence synthesis platforms to institutionalise EIDM in low resourced settings.\\u003c/p\\u003e\\n\\u003cp\\u003eQualitative research places a strong emphasis on the socially constructed form of reality, the close relationship between the researcher and the subject of the study, and the situational limitations that guide the investigation.\\u003cstrong\\u003e\\u003csup\\u003e13\\u003c/sup\\u003e\\u003c/strong\\u003e Such research highlights the investigation\\u0026apos;s beneficial nature and aims to provide answers to questions that highlight the creation and meaning-giving processes of social experience.\\u003cstrong\\u003e\\u003csup\\u003e14\\u003c/sup\\u003e\\u003c/strong\\u003e Thus, the \\u0026quot;what, how, and why\\u0026quot; were investigated by the technique. By analysing which project components have and have not been successful, the outcome was extensive and intricate data on human variables and social contexts in affecting the institutionalisation of EIDM in practice.\\u003cstrong\\u003e\\u003csup\\u003e15\\u003c/sup\\u003e\\u003c/strong\\u003e The method\\u0026apos;s capacity to produce nuanced data allowed me to collect specific information to answer the study objectives. To ensure appropriate conclusions about the role of these human and social variables in the sustainable institutionalisation of EIDM, and transferability to other similar low resource contexts, this approach added more rigour to the collection, synthesis, and reporting of multiple factors around the same.\\u003cstrong\\u003e\\u003csup\\u003e16\\u003c/sup\\u003e\\u003c/strong\\u003e Despite the design\\u0026apos;s benefits, there are limitations related to generalizability, primarily stemming from the small sample size.\\u003c/p\\u003e\\n\\u003cp\\u003eKey informant interviews (KIIs) were conducted with purposefully selected participants and these provided qualitative data on staff motivation, incentives, and other variables, as well as insights into the construction and interpretation of social experience. The key informant interview guide with open ended questions allowed focused responses and flexibility. As such, the interviews provided nuanced evidence, particularly in a complex programme such as ERAZ where there could be many factors with potential to influence change.\\u003cstrong\\u003e\\u003csup\\u003e17\\u003c/sup\\u003e\\u003c/strong\\u003e The interviews comprised seventeen (17) respondents with an average experience of five (5) years in government service, nine (9) of whom were male and eight (8) female. These participants were policymakers, important project personnel, and other stakeholders. The key informants came from the MoHCC\\u0026apos;s various departments and agencies, affiliated governmental or quasigovernmental institutions, and partner civil society organisations.\\u003c/p\\u003e\\n\\u003cp\\u003eThe study also utilized document analysis, specifically content analysis, to triangulate data from key informant interviews. This technique systematically assesses documented evidence to answer specific research questions. Document analysis is like other qualitative research methods as it requires consistent data review, analysis, and construal to gain meaning and experiential knowledge of the paradigm under study.\\u003cstrong\\u003e\\u003csup\\u003e18\\u003c/sup\\u003e\\u003c/strong\\u003e Document analysis is a practical and cost-effective research methodology that converges and substantiates evidence through different data sources, bringing about credibility and integrity of findings\\u003cstrong\\u003e\\u003csup\\u003e19\\u003c/sup\\u003e\\u003c/strong\\u003e As a result, EIDM institutionalisation problems like policy, strategic priorities, organisational cultural background, and activities were addressed through a cost-effective method of content analysis in \\u0026nbsp;selected documents.\\u003c/p\\u003e\\n\\u003cp\\u003eThe study collected thirty (33) documents, including policy documents, strategies, project reports, annual reports, manuals and guidelines, which offered an intimate perspective of the ministry\\u0026rsquo;s operations. These documents provided details on methods and frameworks for generating, synthesizing, and applying evidence in decision-making. The content of these documents and methodologies used to gather evidence within them, including associated institutional processes and human variables, were examined in relation to the institutionalisation of EIDM within the MoHCC. The included documents were produced between 2014 and 2023 \\u0026nbsp;by the MoHCC in collaboration with various government agencies, embassies, international development organizations, and national and international civil society organizations involved in the health sector. The analysis aimed to reconcile discordant findings and obtain nascent insights into complex social phenomena.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThematic content analysis was employed to analyse interviews and documents, involving transcribed data, coding, and theme identification processes. These themes were assigned codes and labels, and the data was categorized into topics. Excel was used to organize and analyse the data, with codes added to cells and comments added for context. The process involved reviewing interview transcripts and documents, assigning codes to themes, and identifying sub-themes within each category. The data was sorted and filtered based on these codes and themes, and tables and charts were created to visualize the data. This method allowed for quick identification of trends, patterns, and correlations within the data.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStrengths and \\u0026nbsp;Limitations of the Study\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWeak tools and the possibility of bias are two of the main challenges facing qualitative researchers that utilise interviews as a data collection strategy in their research.\\u003cstrong\\u003e\\u003csup\\u003e20\\u003c/sup\\u003e\\u003c/strong\\u003e The researcher conducted the study as an insider, having interacted with some key informants during a capacity development project in a ministry. This allowed for easier interaction and access to policy and strategic documents, resulting in rich, trustworthy data. At the same time, the author was aware of potential bias, ethical concerns, and the influence of the inside researcher\\u0026apos;s role on coercion, compliance, and access to privileged information. To avoid bias where necessary, the author asked another independent researcher to conduct interviews and used control procedures to minimize bias. An impartial third party coded the data and participants confirmed the findings. Document analysis also had its own drawbacks, such as diverse formats, government procedures, and subjective content creation. The language of some documents was sometimes too technical to comprehend.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eValidity and Reliability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study adhered to scientific principles and was validated by a second researcher second researcher with pertinent experience also examined the research design, data collecting, and analytic procedure.\\u003cstrong\\u003e\\u003csup\\u003e22\\u003c/sup\\u003e\\u003c/strong\\u003e The study used a coding procedure, semantic validity tests, content consistency assessments, \\u0026nbsp;peer review, to ensure the validity and reliability of the results.\\u003cstrong\\u003e\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003csup\\u003e21\\u003c/sup\\u003e\\u003c/strong\\u003e The procedure tested codes and insights, confirmed codes for consistency, and assessed data correctness and stability. These techniques improved the overall integrity of the research, ensuring the findings are reliable and valid for future research, policy, and practice.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe key informants pointed out various human resources and associated challenges that face institutionalising EIDM using rapid evidence synthesis platforms. For instance, Respondent Official 6 remarked that the MoHCC faces staffing issues, high turnover, political polarization, and budget constraints, leading to a shortage of personnel with some critical functions remaining unfilled for over 2 decades. The ERAZ project introduced new skill sets, causing further challenges in integrating EIDM staffing requirements within existing roles, especially without appropriate incentives. This makes it difficult to sustain the project beyond external funding.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u0026ldquo;If current staff members are not given incentives, EIDM cannot be institutionalised. Remember that this initiative came with a great deal of new roles, responsibilities, and skills to employees who were already demotivated by the hyper-inflationary economy.\\u0026rdquo;\\u003c/p\\u003e\\n\\n\\u003cp\\u003eRespondent Official 6, MoHCC\\u003c/p\\u003e\\n\\n\\u003cp\\u003eThe Zimbabwe Health Sector Public Expenditure Review of 2022 points out that staff shortages, which impact the provision and quality of services, are primarily attributed to the ongoing recruitment freeze and the outdated staff establishment\\u0026apos;s inadequacy to meet nursing and midwifery requirements.\\u003cstrong\\u003e\\u003csup\\u003e23\\u003c/sup\\u003e\\u003c/strong\\u003e The increasing workload resulting from staff shortages affects job satisfaction and motivation, which may lead to higher attrition rates in the future. According to the same review by the World Bank,\\u003cstrong\\u003e\\u003csup\\u003e23\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003csup\\u003e \\u003c/sup\\u003e\\u003c/strong\\u003ethere are still factors to take into account, such as the intrinsic and extrinsic motivators for the health workforce that can be identified through effective mechanisms like online surveys, even though unfavourable compensation and working conditions\\u0026mdash;which have been further impacted by inflation and COronaVIrus Disease of 2019 (COVID-19)\\u0026mdash;have contributed to rising rates of attrition in human resources since 2019. Such surveys can be used to improve short- to medium-term staff retention and motivation plans. \\u003c/p\\u003e\\n\\n\\u003cp\\u003eThe personnel issues facing Zimbabwe\\u0026apos;s health sector were also mentioned by Parliament of Zimbabwe First Report of the Portfolio Committee on Health and Child Care on State of Affairs of the Health Delivery System in Zimbabwe\\u003cstrong\\u003e\\u003csup\\u003e24\\u003c/sup\\u003e\\u003c/strong\\u003e The portfolio committee investigated the state of the country\\u0026apos;s healthcare delivery system. According to their report, the government stopped hiring new medical staff ten years ago. Following the President\\u0026apos;s 2015 proclamation, the government was tasked to unfreeze all frozen positions in the health sector and re-evaluate the establishment upward in light of the growing morbidity and population. \\u003c/p\\u003e\\n\\n\\u003cp\\u003eIn the document analysis, the Comprehensive national human immunodeficiency virus (HIV) communications strategy for Zimbabwe 2019-2025 further explains the need to examine the issue of incentivising and motivating health staff critically. It notes that healthcare providers, comprising physicians, nurses, and medical staff, encounter numerous obstacles and tedious responsibilities that impede their efficiency\\u003cstrong\\u003e\\u003csup\\u003e25\\u003c/sup\\u003e\\u003c/strong\\u003e The necessity to accomplish remarkable outcomes amid staff migration and the exhaustion associated with their labour frequently strains the health of staff. The complexity of these circumstances and the inadequacy of proficiency and expertise create obstacles for them to deliver optimal results that facilitate evidence-informed decision-making. Respondent Official 5, who was also a member of the ERAZ core team observed that as a team created for ERAZ, they already had their roles and responsibilities, and these did change after being co-opted. They performed ERAZ project duties, including their previous commitments, without extra money from the additional functions. Without incentives, the ERAZ team lacked the motivation to effectively execute some of the ERAZ-related responsibilities.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eThe member noted, \\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026quot;There was a need to engage with the high-level human resources management to integrate the project within the Ministry\\u0026apos;s organisational structure and provide appropriate incentives. This way, there would have been proper institutionalisation of the project.\\u0026quot; \\u003c/p\\u003e\\n\\n\\u003cp\\u003eRespondent Official 5, MoHCC \\u003c/p\\u003e\\n\\n\\u003cp\\u003eRespondent Official 2 observed that the ERAZ team\\u0026apos;s evidence synthesis process is hindered by a lack of coordination, capacity gaps, diverse expertise and that incentives are critical factors affecting project sustainability. Prioritizing development partner-supported programs over monetary incentives is essential but these projects bring extra responsibilities, therefore civil servants require incentives due to underpaid salaries. When incentives tied with projects cease, implementation also ceases. Addressing human resources issues and ensuring incentivised personnel with the necessary skill sets is thus critical for EIDM sustainability.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u0026ldquo;In addition to other incentives like workshops and conferences, the majority of projects funded by development partners like the United Nations Development Programme (UNDP) or World Health Organisation (WHO) provide incentives for ministry staff in the form of per diems. Without a sound sustainability plan, employees quit performing the tasks related to that specific project as soon as these incentives stop being offered when it is finished.\\u0026rdquo; \\u003c/p\\u003e\\n\\n\\u003cp\\u003eRespondent Official 2, MoHCC.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eAn Independent Evaluation of the Health Transition Fund in Zimbabwe assessed the impact of the Health Transition Fund\\u0026apos;s practices, methods, and intervention strategies on improving the health status of the general populace, with a specific emphasis on maternal, neonatal, and paediatric healthcare. Additionally, the assessment sought to ascertain whether the Ministry optimally utilised resources to produce desirable outcomes. This evaluation revealed that training, mentoring, and supportive supervision are necessary to build the capacity of healthcare workers, especially those working at the primary level of care, implementing a programme to bolster morale and secure the continued employment of vital healthcare employees.\\u003cstrong\\u003e\\u003csup\\u003e26\\u003c/sup\\u003e\\u003c/strong\\u003e Healthcare\\u0026apos;s retention program faces challenges like uneven allowance distribution, unclear eligibility requirements, and insufficient information. Revision of strategy, recruitment, performance assessment, motivation enhancement, and performance incentives is recommended.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eThe Quality Assurance and Quality Improvement Policy addresses poor human resources performance by implementing evidence-driven practices and in-service training curricula. Strengthening health worker performance includes improving clinical skills, supportive supervision, peer-to-peer evaluation, self-evaluation, and clinical decision support. The availability of appropriate technology, such as e-learning platforms, allows improvement in these areas.\\u003cstrong\\u003e\\u003csup\\u003e27\\u003c/sup\\u003e\\u003c/strong\\u003e The policy links performance improvement interventions to facility-wide human resources management, developing accountability systems to hold health workers and managers responsible for their performance. \\u003c/p\\u003e\\n\\n\\u003cp\\u003eDuring the ERAZ project, a Mentorship Programme Strategy for Embedding Rapid Reviews in Health Systems Decision Making aimed to build staff\\u0026apos;s capacity and motivate them to improve EIDM through sensitization workshops, online and physical training programs. The strategy\\u0026apos;s goal was to have a long-term impact on the Ministry by fostering a group of individuals who can sustain evidence-based decision-making practices.\\u003csup\\u003e28\\u003c/sup\\u003e The programme aimed to establish a group of experts with extensive experience in developing rapid evidence products, forming a core of skilled and knowledgeable advocates for EIDM. \\u003c/p\\u003e\\n\\n\\u003cp\\u003eThe Results-Based Financing in Health Programme: Strengthening the health delivery system in Zimbabwe outlines the MoHCC initiatives to incentivise staff. The study revealed that one of the biggest obstacles to institutionalising and sustaining EIDM is the lack of well-skilled and motivated employees, hence the study produced a tool for equitable rewarding and incentivising health workers. It focused on sustainable incentives and motivation of health workers based on seniority and performance under the Health Development Fund with funding and technical support from various partners, including United Kingdom Agency for International Development (UKAID), European Union (EU) and WHO. Employee commitment and productivity may rise as a result of the staff incentive programme to enhance health worker outcomes.\\u003cstrong\\u003e\\u003csup\\u003e29\\u003c/sup\\u003e\\u003c/strong\\u003e Such an approach offers flexible parameters that let those who work harder get bigger rewards, and there are fixed parameters based on job responsibilities within the hierarchy. Seniority determines the designated responsibility allowance. As a result, the entire incentive package for their facilities will be distributed equally among all senior technical staff members. The scheme offers fair compensation for employees, with flexible parameters for those exceeding expectations and performance evaluated quarterly. It enhances decision-making skills, promotes transparency, and fosters trust among stakeholders, ensuring the sustainability of fundamental skills and values ensuring the sustainability of fundamental skills and values.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eIn countries with few resources, the loss of workers is destroying already fragile health systems. Using a systematic review, Willis-Shattuck et al.\\u003cstrong\\u003e\\u003csup\\u003e \\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003csup\\u003e30\\u003c/sup\\u003e\\u003c/strong\\u003e (2008) investigated the impact of both monetary and non-monetary incentives on retaining and motivating health workers. The study emphasises that the success of health systems and the realization of universal health care hinges on effective motivation and retention of health workers. The Zimbabwean ERAZ project staff got additional roles but continued fulfilling their original duties without additional compensation, despite prevailing economic challenges and the Covid-19 pandemic. Staff turnover and financial restrictions impacted the Ministry\\u0026apos;s capacity to fill open posts. This pattern is common in EIDM capacity-development programs in low-resource situations, where staff members lack incentives to participate effectively.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eIn an investigation to determine what motivates health staff members in Malawi to fully enhance their welfare and work possible, the study revealed that demotivation, especially from lack of monetary incentives, has led to a decline in worker performance in the health sector.\\u003cstrong\\u003e\\u003csup\\u003e31\\u003c/sup\\u003e\\u003c/strong\\u003e The ensuing inefficiency affects the quality of health and information service delivery. Considering the above situation, should development partners provide monetary incentives when implementing capacity development programmes or not? This is a question that civic society always grapples with. An empirical study of how public service and social welfare programmes\\u0026apos; performance measurement and incentive frameworks work, as well as how workers and institutions respond over time and evolve alongside them established that the connection between incentives and public sector success raises concerns about the moral fibre and humanity of those who work for public sector organisations.\\u003cstrong\\u003e\\u003csup\\u003e32\\u003c/sup\\u003e\\u003c/strong\\u003e The authors argue that incentives are crucial for organizational change, as they help individuals align their moral goals with the institution\\u0026apos;s objectives. They balance individual interests and organizations, initiating motivating responses and changes in behaviour to promote better performance.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eCase studies for UNESCO whose goal was to pinpoint effective strategies for capacity development in Benin, Ethiopia, and Vietnam revealed that while recent research has concluded that incentives are important, incentive programmes do not always lead to increased capacity and can even stand in the way of capacity growth.\\u003cstrong\\u003e\\u003csup\\u003e33\\u003c/sup\\u003e\\u003c/strong\\u003e The limited effectiveness of many incentive programmes is partly related to competing disincentives that, in some situations, cause capacity loss. According to the same author, this issue is made worse by a lack of data on the effective use of non-financial incentives and instruments for managing human resources, as well as the inconsistent approaches of different development partners when dealing with the issue, which adds yet another reason for failure.\\u003c/p\\u003e\\n\\n\\u003cp\\u003eAn evaluation of the effectiveness of an institution-wide knowledge translation strategy to support health policy decisions in a Canadian public health institution that has successfully integrated an embedded evidence synthesis platform argues that monetary incentives themselves are insufficient to motivate staff in health policy and health systems decision-making.\\u003cstrong\\u003e\\u003csup\\u003e34\\u003c/sup\\u003e\\u003c/strong\\u003e Along with accountability, teamwork, and other softer organisational elements, financial incentives, professional development, and acknowledgement of effort are important motivators for health professionals. Other important factors in incentivising them include recognition, proper infrastructure, and attitude.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eDespite having robust strategies guiding it in this area, the ERAZ project struggled to stimulate high-level decision-makers desire and demand for evidence. Encouraging high-level policymakers to demand evidence in their decision-making process ensures that EIDM institutionalisation initiatives will be successful.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Historically, most low-resource countries, including Zimbabwe's policymaking institutions, have been known for having excellent strategies but poor execution due to lack of evaluation evidence.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e For example, the problem with policy implementation in Zimbabwe, as in other African countries, is not with the effectiveness of the policies themselves, but rather with the inability or unwillingness to implement them. This challenge is also related to the political polarisation corruption in most African countries, which appear to promote ineffective policy execution.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e According to Zvoushe and Zhou, \\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e the majority of public- private partnerships are similarly problematic since the stakeholders do not have trust in the evidence produced by the different parties. As a result, there is disagreement over which evidence is authentic or intended to deceive or influence the other side. These observations are particularly typical of today\\u0026rsquo;s 'post-truth' politics.\\u003c/p\\u003e \\u003cp\\u003eIn an era of rising populism and political contestation, trustworthy information is essential for well-informed policy decisions that are based on facts rather than just emotions and values, let alone disinformation and fake news. Disagreements over whether or not evidence should be stripped of social values characterise EIDM in political contexts. Maintaining the perceived objectivity that supports scientific authenticity grows harder when evidence enters the policy domain.\\u003csup\\u003e\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e\\u003c/sup\\u003e Any political system's ability to produce positive, targeted results based on openly available evidence is therefore a key factor in determining its level of public legitimacy. To make political decisions clear, measurable, and lasting, these results must be grounded in trustworthy facts.\\u003csup\\u003e\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eAn article discussing the capacities underlying evidence demand stimulation among decision-makers, Newman et al. (2013) warns that understanding the meaning of the phrase \\u0026lsquo;demand stimulation\\u0026rsquo; is essential to avoid mistaking it for policy-influencing goals, especially considering the growing emphasis on increasing demand for research.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Here, the authors argue that to effectively combine awareness with research, decision-makers, and the organisations they work for must consider larger settings, factors that facilitate or restrict participation in research, and actions to increase both demand and capacity to supply. Co-production and co-creation through active participation of decision makers and other stakeholders in agenda formulation, framing of research questions, evaluation of evidence, and other pertinent stages of the synthesis process are some of the strategies to increase demand for evidence among decision-makers. Locally led evidence and demand-driven results from investments in research that are in line with national research priorities result in the growth of local policy institutions' research capacities.\\u003c/p\\u003e \\u003cp\\u003eThis demand-driven approach offers the benefits of customising research questions to local needs, strengthening institutional and individual capacities, and offering a realised framework on which EIDM is most likely to produce favourable decision outcomes.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Promoting evaluative thinking and capacity in public institutions requires allowing for some flexibility in terms of programme aims in addition to understanding the larger political economy of the use and adoption of evidence.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e This observation is particularly crucial when working with institutions like health ministries that require a diversity of evidence to plan and implement their programmes, and focusing on a single type of evidence may also produce negative incentives and ignore more important considerations, such as minor programmatic adjustments and improving implementation.\\u003c/p\\u003e \\u003cp\\u003eThe rapid evidence synthesis approach to EIDM institutionalisation tends to emphasise the more \\u0026lsquo;tangible\\u0026rsquo; individual, institutional and systemic level factors in institutionalising EIDM, such as skills, systems and procedures and puts less emphasis on the \\u0026lsquo;softer\\u0026rsquo; and less \\u0026lsquo;tangible\\u0026rsquo; factors such as leadership, political dynamics, interpersonal relationships, and social networks. At the same time in complex health decision making environments the latter play a more significant role in incentivising staff and embedding these platforms for long-term EIDM sustainability. A social network analysis study on the implementation of EIDM in Canada, which has some of the most effective health evidence synthesis platforms reveals that the process of routinely putting evidence into practice involves dialogue and communication and that health professionals frequently look to their colleagues for crucial information.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Therefore, interpersonal interactions between technical staff, decision-makers, and pertinent stakeholders involved in various processes are crucial for removing social and cultural barriers to implementing EIDM as well as for fostering the growth of close relationships that support the entrenchment of a more pervasive and well-established EIDM culture.\\u003c/p\\u003e \\u003cp\\u003eGood leadership is also crucial for rapid evidence platforms, as it establishes legitimacy, allocates resources, and demonstrates relevance. A public health department achieved its goal of making evidence-based decisions within two years of a decade-long initiative, thanks to a clear governance structure and committed leadership.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e According to Rousseau and ten Have,\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Good governance and leadership practices result in transformative change, the development of trust in technical personnel and implementation procedures, and the active engagement of members at all levels.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e The same authors also note that as members become more self-reflective, critical, and inquisitive about the institution, its procedures, and the experiences of its stakeholders, leadership actions help to create learning organisations. This way EIDM can then become ingrained in the culture of the organisation.\\u003c/p\\u003e \\u003cp\\u003eInstitutionalising EIDM using rapid evidence synthesis platforms causes a fundamental change in systems and practices, which in turn affects the duties and responsibilities of technical staff. Even if existing departments, structures, and even the same personnel may be used as part of various capacity building efforts, in most situations these changes may not necessarily lead to more benefits or incentives for the workforce. Demotivation has therefore been a major factor in some these initiatives\\u0026rsquo; failure. A study to identify context-based policy options for strengthening motivations among health researchers and policymakers to support EIDM revealed that current incentive programmes are insufficient for EIDM actors because they are primarily focused on primary research generation, rather than synthesis and use.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e This situation creates a challenge for the different players in the evidence-to-practice mix to fulfil their responsibilities for sustaining EIDM. In order to ensure that all actors support routine evidence synthesis and utilisation in health policy and health systems decision making, it is crucial to identify different incentive structures that can be employed in integrating these platforms.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eHuman and social context factors must be given equal weight when using rapid evidence synthesis platforms to institutionalise EIDM, with diversity, equality, and inclusion (DEI) being an integral component of the process. The \\\"adhesive\\\" that holds EIDM systems together is these \\\"soft variables.\\\" Disregarding the DEI values in health policy and health systems EIDM institutionalisation interventions fragments decision-making and results in ineffective health information and service outcomes due to the exclusion of key stakeholders like researchers, policymakers, and service providers.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eWhen analysing EIDM institutionalisation using rapid evidence synthesis platforms, DEI lenses must be constantly utilised in order to lower barriers, increase access, align platforms to contextual realities, and reduce inequality.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e The Canada Research Coordinating Committee developed a guide on equity, diversity, and inclusion in research and knowledge translation practices in 2019 with subsequent revisions in 2022 to support the New Frontiers in Research Fund (NFRF) projects. The Guide notes that Diversity, Equity and Inclusion (DEI) barriers include attitudes, policies, practices, or systems that cause individuals from certain population groups to receive unequal access to or be excluded from participation in employment, services, or programmes, for example, through discrimination, racism, sexism, homophobia, transphobia, and ableism.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e From this definition, it is apparent that these obstacles are systemic in nature, implying that they stem from personal, cultural, or institutional norms, customs, traditions, and/or values that may go unnoticed or unacknowledged by individuals who do not experience them.\\u003c/p\\u003e \\u003cp\\u003eA study conducted with stakeholders who had taken part in the national level health research priority setting activities in Zambia found out that the alignment of research programmes to national priorities is negatively impacted by the marginalisation of many important stakeholders and the undue influence of development partners.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e The study highlights the lack of effective stakeholder engagement\\u0026ndash;central to overcoming human and social context barriers in EIDM processes, despite commitment from various actors in low resource settings. Consequently, these barriers negatively impact emotional stability, physical and mental health financial security, career advancement, overall health and well-being. Increasing equitable and inclusive participation in the evidence synthesis processes, facilitating equitable access to opportunities for capacity development, and actively and purposefully integrating DEI and related considerations in platform design and practices are some ways to sustain the institutionalisation of EIDM using rapid evidence synthesis platforms. The majority of EIDM capacity development programmes in low resource countries are neither inclusive nor administered fairly so proponents of EIDM must now shift from empty rhetoric and take decisive action to eliminate these inequalities through legal and policy implementation frameworks.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eBased on this investigation, it may be concluded that solid systems and procedures, a skilled human resource base, clear governance structure, and sound leadership are all necessary to institutionalise EIDM using evidence synthesis platforms. But to be more sustainable, an organisation's culture must be prioritised, and it is crucial to develop strategies to encourage and reinforce the 'soft' human and social context aspects that have been such as, political dynamics, interpersonal relationships, and social networks. Organisations typically underestimate the role that incentives and reinforcement play in influencing organisational culture. Institutional incentives and reward systems lead to inclusive discussions and fair access to knowledge. These incentive or reward systems can be implementing through award programmes, gamification strategies, or just saying \\\"thank you\\\" to those that help, coach, and mentor their peers.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Various incentive models can be explored and employed to sustain an EIDM culture in the institution as they facilitate the integration of a knowledge sharing culture into the overall performance management system.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003e\\u003cem\\u003eEIDM:\\u003c/em\\u003e\\u0026nbsp; Evidence-informed decision-making\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNHS: \\u0026nbsp;\\u003c/em\\u003e National Health Services\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMoHCC:\\u003c/em\\u003e Ministry of Health and Child Care\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eERAZ :\\u003c/em\\u003e Embedding Rapid Reviews in Health Systems in Zimbabwe\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWHO/ AHPHSR\\u0026nbsp;\\u003c/em\\u003e World Health Organisation Alliance for Health Policy and Systems Research\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eKIIs:\\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/em\\u003e Key informant interviews\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eCOVID-19:\\u003c/em\\u003e COronaVIrus Disease of 2019\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eHIV:\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/em\\u003e Human immunodeficiency virus\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWHO:\\u0026nbsp;\\u003c/em\\u003e World Health Organisation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eUNDP:\\u003c/em\\u003e United Nations Development Programme\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eUKAID:\\u003c/em\\u003e United Kingdom Agency for International Development.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eEU:\\u003c/em\\u003e European Union\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eUNESCO:\\u003c/em\\u003e United Nations Educational, Scientific and Cultural Organization\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eDEI:\\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/em\\u003e Diversity, Equity and Inclusion\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNFRF:\\u0026nbsp;\\u003c/em\\u003e New Frontiers in Research Fund\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe author would like to sincerely thank Professor Ruth Stewart for her invaluable advice and support during the research, as well as Professor Sandy Oliver for her insightful comments on the development of this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;This work received no specific grant from any funding agency, commercial or not for-profit sectors.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of Data and Materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eR. Munatsi\\u003c/p\\u003e\\n\\u003cp\\u003eDepartment of Anthropology and Development Studies, Faculty of Humanities, University of Johannesburg, APK Campus \\u0026nbsp;Auckland Park, Johannesburg, \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;South Africa\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eContributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe author is solely responsible for all aspects of the work, including conception, design, data collection, analysis, interpretation, and manuscript preparation.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics Declarations\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interest:\\u003c/strong\\u003e I do not have any conflict of interest.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Clearance:\\u003c/strong\\u003e Ethical clearance to conduct this study was sought from and provided by the University of Johannesburg Research Ethics Committee under ethical clearance number REC-01-049-2022\\u003cstrong\\u003e.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eInformed Consent:\\u003c/strong\\u003e Informed written consent to take part in the research was obtained prior to the commencement of the study\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eStewart, R. 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BMC Health Services Research.2017. 17(1), 1\\u0026ndash;11.https://doi.org/10.1186/s12913-017-2147-x/ \\u003c/li\\u003e\\n\\u003cli\\u003ePeirson, L., Ciliska, D., Dobbins, M., \\u0026amp; Mowat, D. (2012). Building capacity for evidence informed decision making in public health: A case study of organizational change. BMC Public Health. 2012. 12(1). https://doi.org/10.1186/1471-2458-12-137/\\u003c/li\\u003e\\n\\u003cli\\u003eRousseau, D. M., \\u0026amp; ten Have, S. Evidence-based change management. Organizational Dynamics. 2022, 51(3). https://doi.org/10.1016/j.orgdyn.2022.100899/\\u003c/li\\u003e\\n\\u003cli\\u003eYazdizadeh, B., Sajadi, H. S., Mohtasham, F., Mohseni, M., \\u0026amp; Majdzadeh, R. Systematic review and policy dialogue to determine challenges in evidence-informed health policy- making: findings of the SASHA study. Health Research Policy and Systems. 2021, 19(1). https://doi.org/10.1186/s12961-021-00717-x/\\u003c/li\\u003e\\n\\u003cli\\u003eRuzycki, S. M., \\u0026amp; Ahmed, S. B. Equity, diversity and inclusion are foundational research skills. In Nature Human Behaviour. 2022. (Vol. 6, Issue 7, pp. 910\\u0026ndash;912). Nature Research. https://doi.org/10.1038/s41562-022-01406-7/\\u003c/li\\u003e\\n\\u003cli\\u003ePractices Comment on \\u0026ldquo;Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis.\\u0026rdquo; In International Journal of Health Policy and Management .2022, (Vol. 12, Issue 1). Kerman University of Medical Sciences. https://doi.org/10.34172/ijhpm.2022.7545\\u003c/li\\u003e\\n\\u003cli\\u003eBeaudry, Catherine \\u0026amp; Larivi\\u0026egrave;re, Vincent. \\u0026apos;Which gender gap? Factors affecting researchers\\u0026apos; scientific impact in science and medicine\\u0026apos;, Research Policy, Elsevier, 2016, vol. 45(9), pages 1790-1817/\\u003c/li\\u003e\\n\\u003cli\\u003eKapiriri, L., Schuster-Wallace, C. \\u0026amp; Chanda-Kapata, P. Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia. Health Res Policy Sys. 2018, 16, 105. https://doi.org/10.1186/s12961-018-0384-z/\\u003c/li\\u003e\\n\\u003cli\\u003eBoulware, L. E., Corbie, G., Aguilar-Gaxiola, S., Wilkins, C. H., Ruiz, R., Vitale, A., \\u0026amp; Egede, L.E. Combating Structural Inequities \\u0026mdash; Diversity, Equity, and Inclusion in Clinical and 205 Translational Research. New England Journal of Medicine. 2022, 386(3), 201\\u0026ndash;203.https://doi.org/10.1056/nejmp2112233/\\u003c/li\\u003e\\n\\u003cli\\u003eRitala, P. Vanhala M \\u0026amp; J\\u0026auml;rvel\\u0026auml;inen, K. The role of employee Incentives and motivation on organisational nnovativeness in different organisational\\u003cbr\\u003ecultures. managing knowledge, absorptive capacity and innovation \\u0026quot; International Journal of Innovation Management (ijim), World Scientific Publishing Co. Pte. Ltd. 2019, vol. 24(04), pages 1-32, December.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"evidence-informed decision-making, institutionalisation, rapid evidence synthesis platforms, health staff, networks, incentives, human variables, social contexts\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6679660/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6679660/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cb\\u003eBackground\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003ePolicy institutions, particularly those in the health sector, have been increasingly involved in forging networks with key stakeholders and developing the capacity to sustainably institutionalise evidence-informed decision-making (EIDM) over the past 20 years. Aspects of sustainability include the capacity development intervention's ability to carry out planned activities, the involvement of the target audience, stakeholders, and beneficiaries, as well as the expected outcomes of the strategy. However, this sustainability is threatened by problems including weak relationships, broken support networks, and changing responsibilities or involvement in the collaborations.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eMethods\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe role human and social variables in the process of institutionalising EIDM using rapid evidence synthesis platforms was examined through a qualitative case study of Zimbabwe entailing 17 key informant interviews and an analysis of 33 strategic documents.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eResults\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe study highlighted that, policymaking institutions' personnel linked to vibrant networks play a crucial role sustaining EIDM. Institutionalising EIDM using rapid evidence synthesis platforms requires a fundamental change in systems and practices, affecting responsibilities of technical staff. Current intervention programs are also insufficient in offering incentives and establishing social networks. Finding different human incentive structures in the integration of these platforms to encourage regular evidence synthesis and utilisation in health policy and health systems decision making is crucial in sustaining EIDM. The rapid evidence synthesis approach to EIDM institutionalisation tends to put less emphasis on the \\u0026lsquo;softer\\u0026rsquo; and less tangible elements like leadership, political dynamics, interpersonal relationships, and social networks, and more emphasis on the more concrete individual, institutional, and systemic level factors, such as skills, systems, and procedures.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eConclusions\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eInterventions for capacity-development must be systematic, comprehensive, and deliberate in order to result in long-lasting change. Addressing structural and value issues is also necessary to improve current capacities. Such an approach calls for the provision of equal weighting to classic elements like systems and procedure as well as human factors and social settings. Evidence ecosystem actors must aim for professionalism in collaborations, open communication, and the advancement of social justice, equity, and inclusivity in order to promote intentional, methodical, and active multi-stakeholder engagement that is characterised by balanced power dynamics.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Human variables and social contexts in the institutionalisation of evidence - informed decision-making in low-resource health systems using rapid evidence synthesis platforms\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-06-16 08:41:26\",\"doi\":\"10.21203/rs.3.rs-6679660/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"99088229-5b30-44f6-a683-13f5c14dacc1\",\"owner\":[],\"postedDate\":\"June 16th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-18T09:54:41+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-06-16 08:41:26\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6679660\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6679660\",\"identity\":\"rs-6679660\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}