Facilitating the Relationship Between Researchersand Policy-Makers: Experiences from Three EcohealthProjects in West and Central Africa
Brama Kone,1,2 Mathieu Feagan,3,4 Yveline A. Houenou,1,5 Nicolas Brou,1,5,6 Pascal V. Houenou,1,7
Benjamin Fayomi,1,8 Emmanuel Ngnikam,1,9 Gueladio Cisse,1,10 Jerry Spiegel,3,11
and Edouard Kouassi3,12
1Communaute de Pratiques Ecosante pour l’Afrique de l’Ouest et du Centre (COPES-AOC), Cotonou, Benin2Centre Suisse de Recherches Scientifiques en Cote d’Ivoire, Abidjan, Ivory Coast3Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada), Toronto, ON, Canada4York University and Ryerson University, Toronto, ON, Canada5Universite de Cocody, Abidjan, Ivory Coast6Reseau pour l’Environnement et le Developpement Durable en Afrique, Abidjan, Ivory Coast7Universite d’Abobo-Adjame, Abidjan, Ivory Coast8Universite d’Abomey-Calavi, Calavi, Benin9National Polytechnic Higher School, Yaounde, Cameroon10Institut Tropical et de Sante Publique Suisse (SwissTPH) et Universite de Bale, Basel, Switzerland11School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada12Department of Medicine, Faculty of Medicine, University of Montreal, Maisonneuve-Rosemont Hospital Research Center, and Centre de Recherche
Fernand-Seguin, 5415 Boul. de l’Assomption, Montreal, QC H1T 2M4, Canada
INTRODUCTION
The complexity of today’s environmental health problems
calls for multilevel, intersectorial interventions, involving
the coordinated efforts of researchers, policy-makers, non-
governmental organizations, and affected communities
(Ndiaye 2009; Armitage 2008). The value of applying eco-
system approaches to health in framing research, action,
and policy is being increasingly documented, with exciting
and practical examples emerging (Charron 2011; Webb
et al. 2010; Carden 2009). In this article, we identify con-
cepts that are well-suited to address the gaps in commu-
nication that persist between researchers and policy-makers
in the subregion of West and Central Africa. We then
examine three novel case studies that illustrate the influence
of research on management of major public health issues
and on the overall transformation of the researcher–policy-
maker relationship.
ECOSYSTEM APPROACHES TO HEALTH AND
THE RESEARCHER–POLICY-MAKER INTERFACE
Applying an ecosystem approach to health offers a process
to systematically define and evaluate the determinants of
human and environmental health with a view toward sus-
tainability guided by the principles of (1) transdisciplina-
rity, (2) participation, and (3) social justice and gender
equity (Webb et al. 2010). While transdisciplinarity is de-
fined by some as the joint efforts of several scientific dis-
ciplines to address questions arising between areas of
expertise, others point to cooperation between society and
the academic world to generate ways of knowing that
Published online: January 31, 2012
Correspondence to: Edouard Kouassi, e-mail: [email protected]
EcoHealth 8, 413–417, 2011DOI: 10.1007/s10393-012-0740-3
Forum
� 2012 International Association for Ecology and Health
directly includes the needs and visions of affected popula-
tions. Beyond this, participation entails directly involving
communities and other stakeholders within the research
process through contractual, consultative, collaborative, or
collegial means. Finally, social justice and gender equity
demand that the dynamics between the needs and the
interests of different social groups be taken into account.
Thus, ecosystem approaches to health attempt to associate
all relevant actors within an interactive and integrative
process leading to the effective adoption and use of research
results.
THE POLITICS OF RESEARCH AND MAJOR
PUBLIC HEALTH PROBLEMS
Major development-related policy decisions often happen
outside of scientific circles. At the same time, researchers
frequently carry out their research without adequate con-
nection to the realities and needs of people in areas where
the projects occur. To address this gap in communication,
Carden (2009) has called for a ‘‘common language’’ to
highlight factors that come into play in decision making.
This is not limited to current social organization but can
include the transformation of existing knowledge–power
relations, that Armitage (2008) called ‘‘the language of
partnership, accountability, trust building and knowledge
valuation.’’ Three selected case studies of ecohealth research
in West and Central Africa that examine these themes and
their benefits for local communities are summarized in
Table 1.
Within the scope of the solid waste management
project (a) three national workshops were organized in
each West African country at the beginning, midpoint, and
final phase of the project to, respectively, (1) inform, raise
awareness and mobilize local actors, political, technical,
and financial partners interested in waste management; (2)
validate and set the groundwork for efficient national
waste-management; and (3) secure national, regional, and
local resources to ensure project implementation. Policy-
makers, researchers, the private sector, and NGOs partici-
pated. Also for the project on diarrhoeal diseases manage-
ment (b) three workshops were organized to respectively,
(1) present the project to the different stakeholders and
discuss the main activities and milestones; (2) present the
result of data collection and discuss the main strategies to
fight against diarrhoeal diseases; and (3) evaluate and close
the project. Periodic meetings between the concerned
stakeholders took place in parallel to facilitate information
exchange. In both the projects, decision makers’ partici-
pation from the beginning to the end of the projects in-
creased each party’s interests in the projects as well as the
adoption of a set of common interests. The integration of
the waste management project by the different parties in-
volved gave rise to national projects supported by
researchers and policy-makers in each country. Further-
more, the Senegal office of the NEPAD expressed interest in
using the ecohealth concept and methodology in a project
they were writing to be submitted to the African Devel-
opment Bank. Also, the United Nations Environment
Program (UNEP) retained the environment and health
topic as a priority for the program in relation to the re-
gional office of WHO in Africa.
The involvement of local decision makers (mayors,
heads of communities) and environment and health sec-
retaries in the project of diarrhoeal diseases management
led to the integration of the project by them. A water tap
and a health center for diarrhoeal diseases care were given
to the communities as requested by them. Best practices in
hygiene have been established in the management of solid
waste, household sewage, and access to clean drinking
water. At the community and municipal levels, the project
was cited as an example and the Swiss Centre for Scientific
Research in Cote d’Ivoire has been solicited several times to
help build capacity among populations affected by diar-
rhoeal diseases in lagoon shore villages of the district. At
the national level, the 1-year scope of the project has not
allowed major changes in policy to occur; however, the
ministers of environment and health have expressed a sense
of satisfaction arising from being implicated in an action-
research project based on important questions of envi-
ronmental and human health.
These two examples show that research can have a
multi-level influence on politics, from the community level
upward to the regional and national levels (Armitage 2008),
so long as it is linked to a process of communication that
allows a common language and common aspirations to
emerge within the institutional contexts that frame the
project. It seems that ecohealth is reorienting the re-
searcher–policy relationship in what looks like the right
direction. Strategic alliances between concerned parties can
lead to a common platform for action (Ndiaye 2009).
Furthermore, communication between researchers and
policy-makers must not only occur after projects are fi-
nanced but also during the project’s planning and financing
stages. In other words, projects must be built through the
414 Brama Kone et al.
Tab
le1.
Th
ree
Sele
cted
Cas
eSt
ud
ies
of
Eco
hea
lth
Res
earc
hIl
lust
rati
ng
the
Infl
uen
ceo
fth
eP
ract
ice
of
Eco
syst
emA
pp
roac
ho
nT
ran
sfo
rmat
ion
of
Res
earc
her
–P
oli
cy-M
aker
Rel
atio
nsh
ipin
Wes
tan
dC
entr
alA
fric
a
Pro
ject
nam
eSt
ud
yar
eaan
dco
un
try
Yea
rM
ain
targ
eted
stak
eho
lder
sR
esea
rch
focu
sB
enefi
tso
fth
ep
roje
ctfo
rst
akeh
old
ers
Pri
nci
pal
inve
stig
ato
rs
(a)
Soli
dw
aste
man
agem
ent
of
soli
dd
om
esti
cw
aste
inu
rban
and
per
i-u
rban
area
so
fW
est
and
Cen
tral
Afr
ica
inth
efr
amew
ork
of
the
New
Par
t-n
ersh
ipfo
rA
fric
a’s
Dev
elo
p-
men
t(N
EP
AD
),u
sin
gec
oh
ealt
hap
pro
ach
Fo
ur
Wes
tan
dC
en-
tral
Afr
ica
cou
n-
trie
s:B
enin
,B
urk
ina
Fas
o,
Cam
ero
on
,C
ote
d’I
voir
e
2007
–20
09L
oca
lac
tors
Dec
isio
nm
aker
sT
ech
nic
alp
artn
ers
Fin
anci
alp
artn
ers
Res
earc
her
sN
GO
s
To
imp
rove
soli
dw
aste
man
agem
ent
usi
ng
am
eth
od
olo
gyth
atin
tegr
ates
envi
ron
-m
ent
and
hea
lth
Th
ep
rofe
ssio
nal
so
fso
lid
was
tem
anag
emen
tin
each
cou
ntr
y(l
oca
lac
tors
)ar
etr
ain
edto
eco
hea
lth
app
roac
hes
toh
ealt
hSo
me
rese
arch
ers,
Eco
hea
lth
trai
nee
s,w
ere
inte
grat
edin
team
so
fso
lid
was
tem
anag
emen
tN
atio
nal
pro
ject
ssu
pp
ort
edb
yre
sear
cher
san
dp
oli
cy-m
aker
so
fea
chco
un
try
wer
ew
ritt
enU
sed
of
Eco
hea
lth
met
ho
do
logy
by
NE
PA
DU
NE
Pan
dth
eR
egio
nal
offi
ceo
fW
HO
inA
fric
are
tain
edth
eE
nvi
-ro
nm
ent
&H
ealt
hT
op
icas
ap
rio
r-it
yfo
rth
eir
pro
gram
s
Y.
Ho
uen
ou
(b)
Dia
rrh
oeal
dis
ease
sec
oh
ealt
hap
pro
ach
toth
em
anag
emen
to
fd
iarr
ho
eal
dis
ease
sin
ap
eri-
urb
anar
ea
Ala
goo
nsh
ore
vil-
lage
inth
ed
istr
ict
of
Yo
po
ugo
n,
Ab
idja
n,
Co
ted
’Ivo
ire
2006
–20
07C
om
mu
nit
ies
May
or
Hea
lth
secr
etar
yE
nvi
ron
men
tse
cret
ary
San
itat
ion
and
wat
ersu
pp
lyb
yN
GO
Res
earc
her
s
To
con
trib
ute
toth
ed
e-cr
ease
of
the
inci
den
ceo
fd
iarr
ho
eal
dis
ease
sin
the
stu
dy
area
Aw
ater
tap
and
ah
ealt
hce
nte
rfo
rd
iarr
ho
eal
dis
ease
sca
rew
ere
give
nto
the
com
mu
nit
ies.
Th
ew
ater
tap
was
bu
ilt
by
the
NG
OC
om
mu
nit
ies
wer
ese
nsi
tize
dfo
rb
est
pra
ctic
esin
hyg
ien
e,h
ou
seh
old
soli
dw
aste
and
sew
age
man
agem
ent
Th
em
inis
ters
of
envi
ron
men
tan
dh
ealt
hh
ave
exp
ress
eda
sen
seo
fsa
tisf
acti
on
for
bei
ng
imp
lica
ted
insu
chre
sear
ch-a
ctio
np
roje
cts
Res
earc
her
sw
ere
soli
cite
dse
vera
lti
mes
by
the
mu
nic
ipal
ity
toh
elp
bu
ild
cap
acit
yam
on
gp
op
ula
tio
ns
affe
cted
by
dia
rrh
oea
ld
isea
ses
B.
Ko
ne,
M.
Do
um
bia
,F
.X
.A
dji
(c)
Inst
itu
tion
aliz
atio
nof
eco-
hea
lth
Inst
itu
tio
nal
izat
ion
of
eco
hea
lth
app
roac
hin
Wes
tan
dC
entr
alA
fric
a
Fo
ur
Wes
tan
dC
en-
tral
Afr
ica
cou
n-
trie
s:B
enin
,B
urk
ina
Fas
o,
Cam
ero
on
,C
ote
d’I
voir
e
Fir
stp
has
e:20
07–
2010
Seco
nd
ph
ase:
2011
–20
14R
esea
rch
and
trai
nin
gin
stit
uti
on
sR
esea
rch
ers
Dec
isio
n-m
aker
sN
GO
sC
ivil
soci
ety
To
inte
grat
eec
oh
ealt
hap
pro
ach
inth
ecu
r-ri
cula
of
trai
nin
gan
dre
sear
chin
stit
uti
on
s
Fo
ur
cou
rses
syll
abi
wer
ed
evel
op
edfo
rre
sear
chan
dtr
ain
ing
inst
itu
-ti
on
sE
coh
ealt
htr
ain
ing
was
intr
od
uce
din
ton
ine
pro
gram
sin
un
iver
siti
esan
dte
ach
ing
inst
itu
tio
ns
Ad
ista
nce
e-tr
ain
ing
on
Eco
hea
lth
was
star
ted
in20
10T
wen
ty-n
ine
you
ng
rese
arch
ers
(Ph
Dan
dM
aste
rd
egre
es)
and
NG
Ore
p-
rese
nta
tive
san
dn
ine
lect
ure
rsco
mp
lete
dal
lth
etr
ain
ings
.14
5p
eop
le,
incl
ud
ing
rese
arch
ers,
po
licy
-mak
ers,
NG
Os
rep
rese
nta
tive
san
dci
vil
soci
ety
atte
nd
eda
con
fer-
ence
org
aniz
edo
nE
coh
ealt
hap
-p
roac
h
V.
P.
Ho
uen
ou
,B
.F
ayo
mi,
S.Y
on
keu
,Y
.H
ou
eno
u,
E.
Ngn
ikam
,G
.C
isse
,B
.K
on
e
Facilitating the Relationship Between Researchers and Policy-Makers 415
common aspirations of policy-makers, researchers, and
communities.
INSTITUTIONALIZING ECOSYSTEM
APPROACHES TO HEALTH IN WEST AND
CENTRAL AFRICA: SUCCESS AND CHALLENGES
Transdisciplinarity does not happen spontaneously but
rather requires experience and practice to realize itself by
inter-individual and inter-institutional relationships. Eco-
health training offers the possibility to develop the skills
and resources to help realize transdisciplinarity for
researchers, policy-makers, as well as other community
actors such as NGOs. Founded on the idea that ecohealth
training could play an important role in building capacity
to address complex problems of environment and health
while nurturing a new awareness of the researcher–policy-
maker relationship, project’s main goal was to institu-
tionalize ecohealth within different research and training
institutions in West and Central Africa. During the first
phase, the approach started to stand on solid grounds in
institutions of involved nations, but it is important to note
that these ecohealth training sessions were open to
researchers, policy-makers, and representatives from NGOs
and civil society from all the West and Central Africa re-
gion. In 3 years, four distinct course syllabi were developed.
Ecohealth training was introduced into nine programs in
universities and teaching institutions, and has also been
delivered in the form of distance training since 2010.
Twenty-nine young researchers (PhD and Master degrees)
and NGO representatives and nine lecturers completed the
training. One regional conference on the theme of climate
change, water, and health was organized and 145 people,
including researchers, policy-makers, and NGOs represen-
tatives from three continents (Africa, North America, and
Europe) took part.
These outcomes, along with responses from ten
interviews with participants in ecohealth training, suggest
that the process of institutionalizing ecohealth is on a path
toward success, both in terms of number and diversity of
participants as well as the enthusiasm expressed toward the
approach. Still, responses point to certain key challenges,
namely, that (1) barriers between disciplines and institu-
tions remain a stumbling-block for putting ecohealth into
practice; (2) currently few funders know of or are willing to
support ecohealth projects; and (3) few scientific journals
are open to publishing results from transdisciplinary or
participatory studies. Thus, the institutionalization process
needs to face those challenges to succeed and contribute to
a fundamental reorganization of institutional priorities.
CONCLUSION
If correctly implemented, ecosystem approaches to health
can help address the main constraints raised by Carden
(2009) regarding the researcher–policy-maker relationship.
Indeed, these approaches embrace the complexity of this
relationship and use it as a tool in confronting the com-
plexity of environment and health issues. As the case
studies in waste management and diarrhoeal diseases
management suggest, ecosystem approaches to health can
help facilitate a communication process that brings
researchers and policy-makers together in such a way that
communities integrate research results on multiple political
levels. Finally, in a world where institutional and disci-
plinary silos are strong, the institutionalization of ecosys-
tem approaches to health remains a realizable hope in the
mid-to-long-term transformation of the researcher–policy-
maker relationship in developing nations, particularly in
West and Central Africa. These experiences offer an
example for other nations around the world to consider.
The impact we have had in the particular cases in West and
Central Africa hold promise for application at other scales
and in different situations.
ACKNOWLEDGMENTS
This article derives from ongoing discussions of the Policy
Working Group of the International Network of Commu-
nities of Practice in Ecosystem Approaches to Health
(CoPEH-CoIN). The Policy Working Group was formed
along with others during the meetings of CoPEH-CoIN at
the Ecohealth 2010 conference in London in August 2010.
The authors are immensely debtful to all the participants of
CoPEH-CoIN, and to its Coordinator, Bob Woollard, for
helpful and challenging interactions. We thank Margot
Parkes for critical reading of the manuscript prior to
submission. We thank also Dominique Charron and
Margot Parks for providing their permission to cite their
work currently in press that is highly relevant to the topics
of researcher-policy maker relationships in the field of
environment and human health. This work was made
possible thanks to the financial support of the IDRC to the
416 Brama Kone et al.
three research projects described here and to CoPEH-CoIN,
as well as the support of the NCCR North South program
to B. Kone.
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