Profile of respondents
Table 1 shows the profile of the study participants. In total, 40 researchers and policymakers participated, of whom 16 respondents were from research-producing institutes, and 24 were policymakers at two levels (Table 1). All but one of the respondents were male. Eight respondents had Ph.D. and the remaining had masters’ degrees.
Table 1
Profile of respondents included in the study
Characteristics | Categories | N (%) |
Respondent categories (N = 40) | HPSR producers | 16 (40.0) |
Policymakers | 24 (60.0) |
Policymaker decision level (N = 24) | National | 16 (66.7) |
Regional | 8 (33.3) |
HPSR organization types (N = 16) | University/academic institutes | 7 (43.8) |
| Research institutes | 3 (18.7) |
| Private research firms | 2 (12.5) |
| Professional Associations | 4 (25.0) |
Years of experience (HPSR producers N = 16) | < 5 years | 5 (31.2) |
| >=5 years | 11 (68.8) |
The study findings are organized into three broad themes: the capacity for conducting HPSR in the country, the research environment, and the uptake of evidence in the development of policy.
Capacities Of Hpsr Producers
Only approximately half of the organizations included in the assessment reported conducting health policy-related research; other health research activities focused on biomedical and clinical research. Two GRIs recently established a separate department for health system research and knowledge translation activities.
Functions and Roles of Research Institutes
All of the research-producing organizations reported offering training, workshops, and short courses to diverse audiences including postgraduate students, researchers at different levels, and sometimes experts from the health system. Almost all of the organizations also said they conduct policy and advocacy to influence decision-makers. Other functions of the institutions included offering degree programs, monitoring and evaluation of programs, and allocating funds to other organizations. Universities conducting clinical or biomedical research reported disseminating their findings mostly through publications and annual research conferences; they rarely produced policy briefs. They did report engaging in collaborative research with ministries and other stakeholders and participating in consultative workshops and meetings at regional or national levels. Private institutions also reported conducting training for the health workforce in partnership with public universities. Private institutes reported mostly conducting research based on contracts or commissions from ministries; they typically share and disseminate reports on their findings, but rarely produce policy briefs and recommendations. One respondent stated:
We conduct two types of research: small-scale, funded by [our] organization, and large-scale with a huge amount of funding from a client—FMOH or an external funder—to evaluate programs nationwide, e.g. family planning and decentralization of health services at the community level. (KII, Private Research Institute)
Professional associations conduct research mostly in collaboration with academic institutions, FMOH, or other partners. These institutions sometimes do produce policy recommendations and briefs and undertake advocacy and communications to the FMOH to influence evidence uptake. They also: support FMOH on the development of national health programs, policies, guidelines, and standards in their respective professional categories; hold conferences and workshops; conduct capacity building on research skills (including grant writing); and implement projects in collaborations with stakeholders. Three of the professional associations publish scientific journals and three provide ethical reviews and clearance letters to researchers. According to some interviewees, the FMOH trusts professional associations, which enables them to develop strong collaborations and relationships. One professional association respondent stated:
FMOH trusts us; we involve them in the majority of our activities and intervention, provide job mentorship. We participate in the training and supervision of health services. FMOH considers us as one of its departments in the ministry and as a supporting partner. (KII, Professional Association)
Human Resources for HPSR
Table 2 profiles the researchers working in research institutes and universities. The human resources situation available to HPSR producers is characterized by inadequate staff; further, they have few senior and experienced researchers, with the majority of the institutes’ staff members are early in their careers. The largest proportion of available staff with a wide variety of expertise is found in universities, followed by public research institutes. Senior researchers are concentrated in two universities, and 240 senior researchers are based in a single institution. Likewise, a larger number (87) of experts with an educational level above a master’s degree were found in universities as compared to other types of research institutes. However, professional associations and private research institutes reported that they did not have adequate permanent/regular research staff.
Table 2
Number of research staff at institutes, February 2020
Staff | Type of institution |
University (N=7) | Public Research Institute (N=3) | Private Research Institute (N=2) | Professional Associations (N=4) | Total (N=16) |
Average (Min, Max) | Average (Min, Max) | Average (Min, Max) | Average (Min, Max) | Average (Min, Max) |
Academic Rank |
Senior Researcher | 52 (10, 240) | 34 (1, 91) | 9 (3, 15) | 0.8 (1, 2) | 30.5 (1, 240) |
Researcher | 92 (30, 312) | 59 (0, 165) | 6.5 (3, 10) | 0.8 (0, 3) | 52 (0, 312) |
Research Assistant | 33 (0, 87) | 49 (0, 121) | 16.5 (3, 30) | 0 (0, 0) | 26.8 (0, 121) |
Qualifications |
Higher than master’s | 28 (3, 87) | 27 (1, 67) | 4.5 (4, 5) | 0 (0, 0) | 18 (0, 87) |
Master’s degree | 96 (30, 312) | 118 (0, 203) | 12.5 (5, 20) | 1 (0, 4) | 66 (0, 203) |
Bachelor degree | 32 (0, 162) | 87 (0, 157) | 0 (0, 0) | 0.3 (0, 1) | 30 (0, 162) |
All categories of respondents in the in-depth interviews consistently explained that insufficient experienced and qualified experts were available to meet demand in the market; in particular, lack of retention and motivation mechanisms affected the availability of qualified research staff in research institutes. Unattractive salaries, absence of staff tracking, poor staffing plans, and weak research contributed to poor human resource development, as elaborated in Table 3. Universities and other institutions described offering capacity-building opportunities to staff, including short courses, training, and workshops, mentoring internships, or fellowship programs. However, KIs consistently reported that these opportunities were not sufficient to effectively build the capacity of researchers.
Table 3
Challenges cited related to poor human resource capacity in research institutes
Category | Elaborative quote |
Lack of skilled, qualified, senior, or experienced researchers | Poor response to our vacancy announcements. We do not receive enough applications with the required qualifications. We recruit people who have less skill and work experience. We have to train them, and after getting the training and acquiring enough experience of one or years, they leave us. That’s why we say it seems [we are a] training center. (KII, Research Institute) |
Unattractive salaries, frequent staff turnover, and inadequate staffing level | In public sector health institutions, the salary for researchers may be very low. So, it will be very difficult to retain and motivate high-caliber researchers in the field; so this is also a very important part in which the civil service and the government should also think of arrangements for these calibers. (KII, National Policymaker ) |
Weak research culture among researchers | Research cultures (i.e. in terms of ethics, transparency, practical based, multidisciplinary approaches, creating synergy, designed system, terminal report regardless of who funded it, etc.) are not deep-rooted in each of the staff members. Among all these reports, project management is the main weakness (KII, University). |
Poor/lack of a plan for human resource and retention of experienced and skilled researchers | You find a human resource component is still a pressing challenge because keeping an experienced researcher in place is difficult. The retention issue we have, [there have been] some improvements currently but when the market outside the institute is lucrative, researchers go away. (KII, Research Institute) |
Availability of HPSR Funding
Key informants indicated that no health research institute had a separate core budget for HPSR. Instead, HPSR was considered to be an integral part of health research. Public research institutes received funding from the government through FMOH, and from international sources, while universities research funds were allocated to them by ministry of science and higher education (MOSHE). Five of 11 (45.5%) of the institutes reported that they obtained research funding exclusively from the government, while the remaining institutes receive funding from both government and non-government sources. Seven of the 11 institutes (63.6%) said the source of funding for their HPSR was international. Across all research institutions, most funds were obtained through competitive grant applications and collaborations at national and international levels. Key informants across institutes stated that the government allocated only a small amount of funding for health research. Universities in particular argued that the lack of adequate funds from the government is a critical bottleneck to the generation of useful evidence. Further, inadequate funds limit the institutes’ ability to engage relevant stakeholders in the research process. One university-based interviewee said:
There is a wide gap between the contextualized problems and researches being conducted by our researchers. This was due to the amount of budget allocated by the government for universities, [which] is almost nil. (KII, University)
Another challenge facing researchers seeking to do HPSR is inappropriate arrangements for and use of the available funds. This challenge comprises several factors, including excessive bureaucracy, lack of transparency, short funding periods, and poor utilization of funds at institutional levels. These were reported by interviewees as creating additional barriers to health research in universities. Except in a few instances, universities reportedly do not have departments or units dedicated to the management of earmarked research funds; rather, research fund management is treated as part of the routine management of government-allocated resources. Some universities reportedly do not apply the percentage of external funding allocated to overhead and administration to improve research processes, as one respondent said:
The projects are independent, but the salary is paid by the government budget. I do not know why the project individuals do not recruit their own professionals working on finance, why the overhead amount is not pooled, and why finance is not managed by strong professionals. (KII, University)
A GRI representative also reported receiving inadequate funds to conduct high-quality HPSR:
The quality, effectiveness and operational aspects of health system research did not mature enough due to limitations in a financial capacity. (KII, GRI)
Private research institutes can only get access to government funds through bidding on calls for proposals issued by the FMOH or RHBs. A few of them occasionally receive research grants (either directly or via the government) from bilateral or multilateral partners, such as USAID, WHO, and UNICEF, to provide support to government programs. However, these grants are often insufficient to cover the full costs of high-quality research. Further, they only support specific projects, leaving the institutions without sufficient financing to produce high-quality research evidence on topics outside program areas selected by donors. As one interviewee stated:
Unless we have really good financial support, it is difficult to do quality research. So financing, capacity, and relationships with the health policy decision-makers are areas to be improved in private institutions. (KII, Private Research Institute)
The professional associations rarely initiated HPRS as they do not have their budgets for research activities. However, they collaborate with the MOH, RHBs, universities, and other partners in conducting research. A few professional associations have responded to calls for proposals or received direct invitations from the government or NGOs to conduct research. One described:
We should underscore that lack of funds substantially limited our research activities; our funding mainly comes from international donors. (KII, Professional Association)
There are in fact strict limits to the amount of international funding that any NGO in Ethiopia can access. The Ethiopian government’s charities and societies proclamation 19 restricts organizations from having more than 10% of the total organizational budget provided by foreign funders. Finally, across the board, respondents noted that lack of research funds affects institutions’ ability to retain experienced researchers.
Context For Using Hspr To Develop Health Policy
Despite numerous challenges with producing HPSR, the environment is increasingly positive and encouraging regarding the uptake of research evidence for policy and decision making. For example, the FMOH has established a Research Advisory Council (RAC) in the Maternal and Child Health (MCH) directorate. The RAC serves as a platform to promote evidence synthesis and uptake, create demands for evidence, and link research producers with policymakers. The country’s most recent Health Systems Transformation Plan (HSTP-II) [3] which placed particular emphasis on “the information revolution”, was mentioned as fostering a positive environment for evidence-based health care policy. Key informants acknowledged that these recent efforts were designed to address the challenges noted above by creating a more supportive environment for HSPR to grow, although the efforts were still in their infancy stage with ongoing challenges. Currently, the environment still often makes it difficult for researchers to both conduct HPSR and to see results appreciated and applied. One researcher working at a university said:
The existing environment was entirely unsupportive to researchers: limited government funding; absence of capacity building, lack of learning opportunities, and poor mentorship in research; lack of robust grant management system resulted in bureaucratic procurement and financial processes; poor transparency; poor or absent of incentives and guidance to researchers; lack of awareness about research integrity due to lack of rules governing research practices; lack of research facilities and procedures to support researchers. Different departments and research centers within and between universities lack an effective and sustainable system of sharing available scarce research resources and facilities. (KII, University)
Five of the universities included in the assessment have their own scientific journals, which contributes to research dissemination. Full access to domestic peer-reviewed journals was available at three-quarters of the institutes, but less than half have full access to international peer-reviewed journals (42.9%) and statistical databases (35.7%). Universities and research institutes have more access to these supportive facilities than professional associations. University research centers on various health themes (e.g. tropical and infectious diseases, microbiology, bacteriology, and drug quality assurance), as well as established sites for field research and demographic and health surveillance, were also recognized as contributing to the enabling environment for HPSR.
Overall, we found a lack of specific policy guidance regarding the roles and responsibilities of researchers and research institutes for the generation and uptake of research evidence. This gap undermines HSPR production and utilization for policy. One key informant stated:
It is important to redefine the roles and responsibilities of research evidence suppliers and demanders [in order] to bind evidence production to utilization. (KII, partner).
Mechanisms to prioritize HPSR topics
Interviewees from research institutes were asked which topics they prioritized for HPSR, and how they arrived at their rankings. Figure 1 shows the factors that respondents reported play into prioritizing areas for HPSR. National priorities and funders’ conditions were common factors. Half of the institutes reported that they were influenced by the global HPSR agenda. The remaining factors were institutional interest and plans, and decisions from advisory boards, committees, or other internal structures. However, apart from following general thematic areas set nationally, few mechanisms exist either to systematically prioritize research areas or to engage with relevant stakeholders.
GRIs frame their thematic research areas based on their mandates—they have their own general research priorities but none specify HPSR. However, key informants from these institutions mentioned that they are well-positioned to understand the priorities of the government. None of the universities had clear HPSR prioritization mechanisms, nor did they systematically engage relevant stakeholders in the generation of evidence. While some key informants mentioned that their research addressed national and international priorities, only one university mentioned consulting with the RHB when establishing research priorities. However, a key informant reflected that this did not necessarily translate into the use of the evidence they generated:
We try to connect all our research activities in collaboration with the RHB, but could not influence the policy and health system. (KII, University)
HPSR Activities, Themes, Outputs, and Quality
Table 4 presents the average number of activities conducted by those institutions that reported HPSR activities. The average annual number of HPSR projects (from 2016 to 2018) was 12 or 13 across all institutes, but with a wide range. The top five themes of the HPSR conducted by the participating organizations in the past three years were: maternal and child health, reproductive health, service delivery, communicable diseases, and non-communicable diseases. During the in-depth interview, respondents also indicated that health human resources, road traffic and injuries, quality of services, and decentralization were also themes addressed in HPSR.
In our survey, we found that the average number of HPSR related peer-reviewed articles per institution ranged from 48 to 53 between 2016 and 2018; more were published in international peer-reviewed journals than domestic publications. This average masks wide variation among the surveyed institutions: the majority of publications were produced by six groups: two public research institutes and four universities, while the remainder did not publish at all on HPSR topics. Universities, research institutes, and some professional institutes also produced other research outputs, such as reports, policy briefs, books, opinion pieces, presentations in national and international conferences, and public events.
Table 4
Research collaboration (within and outside the country) among evidence producer organizations in Ethiopia, 2019 (n=13)
Research collaborations | Within country | Outside country |
No. of organization | Percentage | No. of organizations | Percentage |
Jointly conduct research | 13/13 | 100.0 | 12/13 | 92.0 |
Jointly author publications | 11/13 | 84.6 | 11/13 | 84.6 |
Jointly provide capacity building | 10/13 | 76.9 | 11/13 | 84.6 |
Jointly advocate policy | 6/13 | 46.2 | 1/13 | 7.7 |
No collaboration | 0/13 | 0.0 | 1/13 | 7.7 |
Others | 1/13 | 7.7 | 0/13 | 0.0 |
In terms of the perceived quality of research outputs, researchers felt they performed well, but most policymakers contested this assessment. Across five dimensions of quality (timeliness, policy relevance, feasibility, deliverables, and completeness) research organizations scored themselves an average of 4, on a scale of 1 (poor) to 5 (excellent). A large proportion also reported prioritizing their activities based on national or sub-national research agendas, although over half said they considered global priorities, and the same proportion were guided by funding conditions. However, none of the participating organizations could clearly articulate how prioritization happens in practice, for example, through formal mechanisms for selecting research themes, involving key stakeholders. Policymakers were not at all positive about the quality of locally generated research, with many reporting that studies lack quality and actionability.
Research quality assurance methods were used by most institutions; internal peer review was the most widely used (91.7%), followed by external peer review (83.3%) and consultative meetings (75%). Despite these measures, policymakers expressed concern about the quality and relevance of research outputs and partners noted that decision-makers did not have confidence in the findings. As one interviewee said:
There is enough research. I don’t think the number is an issue; of course, there is always room for change. First, we need to look at the quality of the research outputs. Nowadays everyone is complaining that the research which is done is not proper or not of good quality. This is because we have a very tiny area; we don’t involve experts from other fields; we don’t do large-scale research (projects). (KII, partner)
Factors Influencing Uptake Of Hpsr Evidence
Even when institutions produce research on relevant topics, use quality assurance measures, and disseminates their results; their findings are rarely accepted for use by policymakers. All key informants, including researchers and policymakers alike, consistently reported that HPSR represents a waste of resources because it is rarely used for policy decisions.
The failure to use HPSR evidence also seems to stem from a lack of demand on the part of the policymakers. Several key informants argued that policymakers did not have a good appetite for evidence. Instead, they tended to rely on experts’ opinions, their own “common sense,” “intuition”, or “experience,” or to make politically motivated decisions. A senior researcher described the typical approach: “Usually they establish technical advisory groups or committees of experts and get advice. They outsource the research question and get some documents and [then] mostly align with political direction.” Respondents further suggested that at regional and lower levels of the health care system HPSR is not used at all for health system policy and decision making.
An exception at the federal level was noted. Respondents cited recent efforts and a positive attitude regarding evidence use among program personnel and decision-makers: “The MCH directorate—it has [a] unique appetite for evidence use. I think this is due to the existence of research advisory council (RAC) for this directorate.” (KII, MOH Policymaker)
Mechanisms for Influencing Policy
Despite the perceived lack of use of HPSR evidence, the research institutions do try to convey their findings. Communication about research results—via reports, policy briefs and notes, presentations, and other publications—was the main mechanism to influence policy mentioned by all surveyed organizations. Formal policy platforms (e.g., technical working groups or committees) and informal policy platforms (e.g., informal communication, advocacy, or other brokering with policymakers) were the second-and third-most mentioned mechanisms. Public media, such as television, websites, social media, and news reporting, was the least used mechanism by the organizations (Figure 2).
Of the research institutions included in the assessment, 80% reported that they had strong linkages with policymakers. GRIs, which have a mandate to support MOH, reported sharing their research outputs with MOH and other relevant stakeholders in various formats, including technical summaries, abstracts, full reports, policy briefs, and policy dialogues. Private research firms and other professional organizations reported conducting research based on requests from stakeholders and Ministry officials. As a result, these agencies were more likely to communicate about the evidence they generated, and thus to influence policy, including through face-to-face discussions with the MOH or other partners.
However, our qualitative findings indicated that most university-based research institutes had either weak or no links with policymakers Indeed, key informants reported that no mechanisms or systems exist to link research institutes with policymakers to enable evidence to inform policy. Instead, research institutions were producing evidence to generate professional publications but had no systematic approach to communicating their findings to policy-makers. One informant reported,
“GRIs and universities do not share their research with policy and decisions makers. A majority of researches end with publications, where no one knows where it goes after that” (KII, Partner).
Universities tended to share research findings through publications and by organizing annual research dissemination conferences, for which they produce abstract books and conference proceedings. Universities do invite policymakers to attend the conferences; however, the conference format is unlikely to appeal to policymakers and their engagement typically only involves making remarks at the opening or closing ceremonies.
Trends in Demand for HPSR
Key informants from various categories agreed that the culture of demand for and use of HPSR was currently low or non-existent at all tiers of the health care system. Some informants underscored that use of evidence was particularly absent in decision-making processes at mid-and lower-levels of the health system. Key informants used expressive terms to describe the current lack of demand for and use of evidence for policy, including: “big problem,” “far behind,” “immature,” “limited,” “poor,” and “weak.” One policymaker echoed these opinions: “There is no strong culture of utilizing the service report, research outputs and any form of evidence to guide the policy, supportive supervision and policy recommendations” (KII, Policymaker).
Despite this situation, many informants reported that the demand for HPSR is actually improving. Eleven HPSR institutes reported an increasing trend in demand from policymakers for HPSR and ten reported improvements in the culture of evidence-based decision making. Some MOH initiatives are becoming “facilitating factors” for encouraging a culture of evidence use, such as the establishment of the RAC for maternal, nutrition, and child health, engagements with international and local universities, using technical working groups to develop and revise guidelines, allocating small budgets to evidence-uptake efforts, and the government’s effort to promote an “information revolution.” A development partner noted that changes are happening:
“Yes, there is a positive change: a positive attitude toward evidence use among policymakers. There are certain initiatives that MOH has to use evidence, to establish the structure. Still, they are trying how to get the best way” (KII, partner).
Barriers that Prevent Use of Evidence for Policy
According to the research producers, the two main barriers to the use of the evidence for policymaking were: limited capacity among policymakers to use evidence (see Figure 3); and, lack of channels to link with policymakers. Other factors mentioned included: low level of political will to use evidence in policymaking; ineffective communication by researchers; and the relevance and feasibility of the evidence produced.
Policymakers and partners also identified several barriers to the use of evidence for policy, shown in Table 5 with illustrative quotes. The barriers are presented in the table, from most to least frequently mentioned. Unlike the research producers, policymakers were not especially concerned about their capacity to understand or utilize the data. Instead, they most often cited the failure of the researchers to effectively disseminate and communicate their findings as a barrier. They also noted that because policymakers are not involved in the research, and due to concerns about the quality and relevance of research, the evidence generated is not of interest or useful to them.
Table 5
Barriers in getting evidence to policy: Insights from key informants
Ineffective dissemination and communication |
We don’t really get timely information or evidence. We just act without evidence. For instance, in the case of [the] measles outbreak, we don’t know why it occurred and what was wrong in the system, whether the cold chain system has a problem, or children were vaccinated against measles or other factors that contributed to the outbreak. We just try to manage the outbreak without understanding the factors that contributed to the ongoing outbreak. We don’t [have] timely access to information or evidence; we are in search of evidence but we don’t get it. (KII, Regional policymaker) |
Disconnection and absence of engagement of policymakers Policymakers are not part of the research from the beginning. No research institutions engage policymakers from the beginning of their research processes. For instance, if you take the practice of EPHI, they would conduct the study or the survey, write down reports and send the report to the Ministry, and finally may conduct a dissemination workshop. That is all their efforts! But this can never bring utilization of evidence. If one has to ensure the utilization of the evidence, they have to involve the decision or policymakers to ensure that the research question is relevant to policymakers. Then, they have to engage policymakers and program personnel throughout the research process. [KII, National Policymaker] |
HPSR culture and trend There are gaps in the use of the evidence that is generated. There is no strong culture of utilizing the service report, research outputs [or] any form of evidence to guide the policy, supportive supervision [or] policy recommendations. This poor utilization of evidence even [gets worse] when you go down to woreda [district]. (KII, National Policymaker) |
Lack of motivation, attitudinal and value for evidence The problem is that program personnel often do not pay attention to research findings. They usually consider research findings that are generated after many ups and down as useless. This is due to a lack of awareness about the importance of evidence in program implementation. They don’t give value to evidence! Rather they would give more attention to word of mouth from the ministry than research evidence. (KII, Regional policy maker ) |
Irrelevant and quality poor research Universities are among the major research institutes in the country; the problem is that they focus more on theory and they don’t know the current situation, our strategies. So they conduct research which is in the air, a vacuum. So we are not using it. (KII, National Policymaker) |
Lack of demand, access, and evidence selection I observed that most of the directors are heavily immersed in day-to-day routine activities. They don’t have even time to read in detail. So they need much briefer policy documents that can guide them in their activity. Whenever you start to work with them, sometimes they cannot continue with you because they are hugely involved in meetings, workshops, travels, and so on. They don’t have time even to browse evidence. So important key points and well-articulated evidence presented to their table are quite paramount. (KII, National Policymaker) |
Lack of evidence translation system, platform, and leadership There is no accountability. In our review meetings here in the Bureau and the Federal Ministry of Health, research institutes are not evaluated for their performance. How many research projects are done, what does the evidence inform? [It] is not clear to me. There is no mechanism of accountability to uptake the evidence. Sometimes what research questions are done in the research institutes, whether it is in the health sector or the agriculture sector, is not documented. This poses a challenge to the uptake of the evidence. (KII, Regional Policymaker) |
Lack of incentives or supportive environment The absence of an incentive package and lack of rewarding high impact policy change publications are some of the problems which made the staff focus only on publication and made the studies not influence policies. Our staff could do more influential researches than this—if the recognition or rewarding systems are improved. (KII, University) |
Budget limitations Unless we have really good financial support, it is difficult to do quality research. Doing quality research all depends on adequate funds. So financing, capacity, and relationships with the health policymakers or decision-makers are areas to be improved in private institutions. (KII, Private Research Institute ) |
Lack of capacity and expertise by policymakers There is a shortage of human power, as we have many different case teams and there is not enough human power that works on policy analysis and [similar] activities. So policy development was not enough. (KII, National Policymaker ) |
Political motivations and external influence/environment Decisions are made politically: someone is the boss, they make the decision, and people will follow. And this specifically has to do with, for example, how the health extension workers doing things. So, someone started it some years back, and there have been many studies about them, but do you see anything changing? No, nothing is changing! Whenever someone in the ministry wants to do some policy, there are policy moments (KII, National Policymaker) |