Human variables and social contexts in the institutionalisation of evidence - informed decision-making in low-resource health systems using rapid evidence synthesis platforms

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.