The use of evidence synthesis in the humanitarian field

Authors: Zahra Saad & Tamara Lotfi

The UNHCR has reported that Lebanon’s refugee population increased from just over 250,000 people in early April 2018, to nearly one million by the end of October. Contrast this with the fact that the Lebanese population itself consists of only six million nationals. The increase through this year has made Lebanon the country with the highest per capita concentration of refugees in the world. It has made it especially important that decisions about humanitarian actions make best use of evidence, including evidence syntheses and systematic reviews.

For example, while international organizations were investing in aid programs in Lebanon to respond to the crisis, Lebanon’s Ministry of International Affairs identified the need for a coordination model between these agencies. In response to this, members of the Global Evidence Synthesis Initiative (GESI) team of researchers at the American University of Beirut published two systematic reviews that identified various models and explored their effectiveness. This serves as an example of the use of systematic reviews to inform decision-making in the humanitarian field, but it was not easy. Elie Akl, senior author on these systematic reviews[1]^,[2], commented that “the work was challenging specially in the earliest stages of identifying research and reports that answer our research question, and then making sense out of what is published”.

The GESI Secretariat at the American University of Beirut aims to enhance the capacity to produce and use cross-sectoral evidence synthesis in low- and middle-income countries across the world. They have identified some local practitioners who are able to identify or produce evidence to inform decision-making in non-health fields; and the current regional conflict and influx of refugees to Lebanon has pushed the GESI Secretariat to talk to stakeholders in the field about their views on evidence. They have produced a video blog “The Use of Evidence Synthesis in the Humanitarian Field” to present the experience with evidence of two of the GESI Secretariat’s main national stakeholders in the humanitarian field.

One of these is Mr Hussein Ismail, a humanitarian expert who, after four years of field work, was interested in focusing on the “evidence part of the humanitarian field”. He noticed the gap between what is implemented and what is published online by academic researchers. In his opinion, humanitarian practitioners need to learn more about humanitarian evidence and be more exposed to methods such as systematic and scoping reviews. He believes that this will help them to take better strategic decisions when planning interventions, and to identify those areas for which evidence is needed but lacking.

This is reflected in the actions discussed by the other stakeholder in the video blog. In 2016, the Lebanese Red Cross took a decision to shift from an experience-based to an evidence-based approach, hoping to “improve effectiveness and efficiency of their services”, decrease the response time, measure their performance, and implement changes. They are now working on implementing this across their activities and one of their volunteers, Dr Shawky Amine Eddine, highlights how “it takes a system to save a life, not any system but one that relies on solid evidence”.

[1]  http://currents.plos.org/disasters/article/coordinating-the-provision-of-health-services-in-humanitarian-crises-a-systematic-review-of-suggested-models/

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0137159

About the authors:

Zahra Saad is a Research Assistant in the Global Evidence Synthesis Initiative (GESI) Secretariat hosted by the Center for Systematic Reviews on Health Policy and Systems Research (SPARK) at the American University of Beirut. She has completed her Master’s in Food Technology and Quality Assurance from University of Reading in the United Kingdom after graduating with a bachelor’s degree in Environmental Health and minor in Public Health from the American University of Beirut. She recently joined the world of evidence synthesis and is leading a mapping of the evidence in the humanitarian field along more focused work related to refugees.

Tamara Lotfi is the Coordinator of the Global Evidence Synthesis Initiative (GESI) Secretariat. She was a post-doctoral research fellow at the Clinical Research Institute at the American University of Beirut (AUB), a Research Associate at the Faculty of Health Sciences at AUB, and currently a Research Associate at the Faculty of Medicine. She is a Medical Doctor (2013) and has completed her Master’s in Public Health concentrating in Epidemiology & Biostatistics (2016). She has been involved in the development of one clinical practice guideline, nine systematic reviews and led four of them, led three overviews of reviews and co-authored three observational studies. Her research interests are in methods for conducting, reporting and appraising cross-sectoral evidence synthesis, clinical epidemiology, health systems, public health and clinical practice guideline development. Outside academia, she is the cofounder of the Non-Governmental Organization “4allcauses” that aims to enhance access to primary health care services and information in Lebanon.