The inherent politics of evidence use in devolved public health policymaking in Kenya
This study examines the fragmented and politically driven nature of evidence use in Kenya's devolved health policymaking in Bungoma and Busia counties, concluding that strengthening knowledge brokerage and fostering scientific citizenship are essential to align evidence with political incentives for more effective health policies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many places, making decisions about public health is a messy business. It involves politicians who want to please their voters, doctors who know what works in a clinic, and researchers who spend years gathering data. For a policy to work, these different groups need to agree on what the facts are and how to use them. This is especially tricky when power is shared between a central national government and many local regions. In Kenya, a major shift happened when the country moved to a system where local counties run their own health services, while the national government sets the rules. The challenge became clear: how do local leaders use scientific evidence to make quick, fair decisions when the data moves at a different speed than politics, and when different departments often refuse to talk to each other? Without a way to bridge these gaps, good research can sit on a shelf while urgent health crises go unaddressed, or worse, resources get spent on projects that look good on paper but do not actually help people.
A team of researchers set out to understand exactly how this plays out in two Kenyan counties, Bungoma and Busia. They wanted to see how local health officials actually use evidence to build policies, and what stops them from doing it well. Over a period of fourteen months, the researchers worked directly with fifteen technical managers in these counties. Instead of just watching from the outside, they joined forces with these managers to create a new way of working together. They used a specific approach that looked at three main things: the people and skills available to make decisions, the long-term timeline of how policies change over years, and the political relationships that either help or block progress. They also tried a new method of pairing the two counties together, treating one as a leader that tested new ideas and the other as a partner that learned from those lessons, creating a two-way street for sharing knowledge.
What they found was that the system is broken in three specific ways. First, there is a timing problem. Scientific research takes a long time to produce reliable results, but political leaders often need answers immediately to solve a crisis or before a budget deadline passes. By the time the data is ready, the window to act has often closed, forcing leaders to make guesses instead of informed choices. Second, the different parts of the government are stuck in their own silos. The health department might see a problem as a medical failure, while the finance office sees it only as a cost issue. Because they do not share their data or their understanding of the problem, they end up working on parallel tracks that never meet, paralyzing any chance of a comprehensive solution. Third, and perhaps most importantly, the use of evidence has become a bureaucratic ritual. Leaders often check boxes to say they have looked at the data, but they do not actually let that data drive their decisions. Instead, they rely on what feels right to their voters or what fits a pre-determined political story, treating scientific evidence as a formality rather than a tool.
The researchers also discovered that the people who make these decisions often feel disconnected from the communities they serve. Evidence is usually locked away in academic circles or high-level government offices, leaving local communities and even some political leaders out of the conversation. This creates a gap where the people who need the health services the most have no say in how the money is spent. The study showed that when data is not translated into simple, clear stories that politicians and the public can understand, it remains useless. The researchers observed that without a dedicated group to translate complex numbers into actionable plans, the system defaults to ad-hoc decisions driven by immediate pressure rather than long-term health needs.
To fix this, the team helped the counties build a new structure called a task force, which brought together researchers, health managers, and policymakers in one room. This group worked to break down the walls between departments and to create a shared language for discussing health problems. They found that when these groups worked together, they could turn dry data into compelling stories that aligned with political goals, making it easier for leaders to justify spending money on evidence-based solutions. However, the researchers caution that while this new structure works while it is being tested, its long-term survival is uncertain. The system is still vulnerable to the usual political shifts, election cycles, and changes in leadership that happen in a devolved government. The study concludes that for evidence to truly change health outcomes, these new ways of working cannot just be temporary projects funded by outside donors. They must become a permanent, legal part of how the government operates, with dedicated roles and budgets that survive even when the political winds change. Without this deep institutional change, the gap between what science knows and what policy does will likely remain, leaving communities without the health protections they need.
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