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A Global Evidence Synthesis Initiative
The Case for Support
Executive Summary
The Global Evidence Synthesis Initiative (GESI) brings together a number of worldwide
research organisations that are committed to the development and use of research synthesis
to enhance public policy, public service delivery and citizens’ involvement. The goal of the
GESI Consortium is to increase the capacity to undertake research syntheses by establishing
and supporting an initial ten Centres for Research Synthesis in low and middle income
countries.
Research synthesis is a family of methods for establishing the overall balance of evidence (as
opposed to using evidence selectively) on whatever topic is requiring sound evidence. By
gathering together the totality of evidence on a topic research synthesis is able to establish
what is generalisable and what is context specific. Research synthesis also separates high
quality from low quality evidence, thereby protecting against errors and biases in the evidence
that is used for decision making. Overall, research synthesis provides a solid and sound basis
of evidence that can help make better decisions and achieve better outcomes.
The case of supporting research synthesis can be summarised as follows:
 Research synthesis provides a solid and sound basis of evidence that can help make
better decisions and achieve better outcomes.
 Research synthesis already has an impressive track record in terms of helping to achieve
positive outcomes and avoid negative consequences in policy making, public service
delivery and citizens’ involvement. The GESI Consortium seeks to extend the success of
research synthesis across the world.
 The capacity to undertake research synthesis, and get high quality evidence into policy
and practice, is less developed in low and middle income countries than in other parts of
the world.
 The proposals of the GESI Consortium seeks to rectify this imbalance in research synthesis
capacity by developing an initial ten Centres for Research Synthesis in low and middle
income countries.
 The proposed Centres for Research Synthesis will undertake a range of activities,
including training and professional development, providing seminars, workshops and
conferences on research synthesis, establishing the demand for research synthesis
products, and meeting this demand by procuring, supporting and quality assuring reviews
of evidence to the highest possible standards. The proposed Centres will also be
committed to getting synthesized evidence into policy and practice.
 These Centres for Research Synthesis will be supported by the organisations that make
up the GESI Consortium, and the existing centres associated with these constituent
organisations.
An indicative budget for these Centres for Research Synthesis is provided in Annex 3.
2
A Global Evidence Synthesis Initiative
The Case for Support1
Background
Over the past three decades or so evidence-informed decision-making has been a guiding
principle of public policy and public service delivery worldwide. It has also been a period in
which evidence has been developed to help citizens make informed decisions about the
services they use. Evidence-informed decision-making is characterised by the systematic and
transparent identification, appraisal and use of evidence as an input into the policymaking
process. Because these processes are transparent, stakeholders can examine what research
evidence has informed decisions as well as the judgements made regarding this evidence
(Oxman 2009). Having been initially developed in the fields of medicine and health care,
evidence-informed decision-making has become a key feature of policy and practice in
education, social welfare, crime and justice, agriculture, environmental policy, mass media
and communications, international development and many other sectors.
Research synthesis has been a major feature of the global development of evidence-informed
policy and practice. There are a number of types of research synthesis, including statistical
meta-analysis, network meta-analysis, narrative systematic reviews, qualitative synthesis,
scoping reviews, rapid reviews, evidence mapping and, most recently, evidence gap maps.
What these synthesis methods have in common is a commitment to establishing the overall
balance of evidence (as opposed to using evidence selectively) on whatever topic requires
sound evidence, based on identifying, critically appraising and analysing the totality of
available evidence from scientific research and evaluation. Such evidence provides decision
makers and citizens with a sound and strong knowledge base upon which to make decisions
about policy and public services.
A number of organizations and collaborations have been established worldwide to advance
the preparation, quality assurance, dissemination and promotion of research syntheses.
These include the Cochrane Collaboration, the Campbell Collaboration, the EPPI-Centre, 3ie,
the Alliance for Health Systems and Policy Research, and the Joanna Briggs Institute. These
organizations have formed a global consortium – the GESI2 Consortium – to enhance the
capacity for research synthesis worldwide, and especially in low- and middle-income countries
(LMICs). The Consortium believes that by building capacity for research synthesis worldwide,
better decisions will be made about agriculture, economic development, education, crime and
justice, food security, health and healthcare, social protection, water sanitation and hygiene
and many other areas of public policy and public service delivery.
What is Research Synthesis?
Research synthesis covers a range of methods for searching systematically and
comprehensively for all the evidence on a specific topic or question; using systematic and
explicit methods to identify, select, and critically appraise the relevant research; and collecting
and analysing data from the studies that are included in the synthesis or review. Synthesized
evidence has the key advantage over single research studies of providing evidence from more
1
This document was prepared by Phil Davies (3ie), Jeremy Grimshaw (Cochrane) and Simon Lewin
(Cochrane) for the GESI Consortium, with significant contributions from the GESI drafting team and
other partners. A list of the GESI drafting team members is provided in Annex 4.
2
Global Evidence Synthesis Initiative
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than one sample, context and time period, thereby providing a much broader and robust
evidence base for, for example, understanding the impacts of interventions and programmes,
and for knowing what is generalisable and what is context specific.
Research synthesis draws together evidence from many sources and types of research and
evaluation. For policy questions about the likely impact of a policy initiative, compared with
other options, research synthesis may draw upon evidence that is based on experimental or
quasi-experimental studies.
For questions that ask about people’s experiences or understanding of policy interventions,
research synthesis may gather data from qualitative studies including those using in-depth
interviews, focus groups analysis, observation, ethnography, documentary analysis, oral
histories and case studies.
Questions about the effectiveness of implementation and delivery mechanisms usually
require synthesized evidence from a combination of experimental and qualitative evaluation
methods. Questions about the costs, cost-effectiveness and cost-benefits of policies require
economic appraisal methods, which can draw upon quantitative, experimental, quasiexperimental and qualitative evidence.
Many research syntheses also analyse the theory of change underlying a policy or practice
intervention. These syntheses examine how a policy initiative is supposed to work, and what
activities, mechanisms, people and resources need to be in place in a particular context for
the desired outcomes to be achieved. Such information is clearly very important for policy
making and the successful planning and delivery of public services.
Evidence of demand for syntheses within LMICs
Groups involved in producing and disseminating evidence syntheses are seeing growing
demand for these products from government departments and other agencies within LMICs,
and from international organisations. For example, the Department for Environmental Affairs
in South Africa has shown strong interest in both systematic reviews and rapid evidence
assessments, and has recently sent a delegation to the UK Department for Environment, Food
and Rural Affairs to learn more about how that organisation uses evidence and commissions
reviews. In Sri Lanka, the Medical Association has requested the South Asian Cochrane Centre,
based in India, to serve as a resource to help develop the process and methods for revising
eighty clinical practice guidelines in Sri Lanka, using the best available evidence. This guideline
revision process is currently underway. The South Asian Cochrane Centre was also recently
invited by the Indian National Neonatology Forum to train members of the National Neonatal
Guidelines revision committee in understanding and undertaking systematic reviews and
meta-analysis in their efforts to revise their national neonatology guidelines. Coming back to
South Africa, the Programme to Support Pro-Poor Policy Development (part of the National
Department for Planning, Monitoring and Evaluation) has started to run courses for senior
civil servants on evidence-informed decision-making, including the importance of evidence
syntheses. In addition, the Department has developed guidance for other departments on
how to synthesise the findings from more than one evaluation. The Department has also
considered commissioning systematic reviews across South Africa but has expressed concerns
about local capacity to conduct evidence syntheses. These examples speak to the urgent need
to rapidly scale up capacity to conduct high quality evidence syntheses in LMICs.
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How Research Synthesis Can Inform Policy Making and Other Decisions
Research synthesis has made considerable contributions to helping people make better
decisions about public policy and public service delivery. It does this by identifying not only
which policy and practice interventions are effective and which are not, but also by indicating
which interventions work for which groups of people, under what circumstances and contexts,
and over what time period.
Better and more extensive use of evidence from research syntheses can help to reduce the
use of interventions that are not effective, or cost-effective, or not acceptable to users within
a particular setting. Another important advantage of syntheses based on systematic and
transparent processes is that they can help to protect against errors and bias in the selection
and appraisal of evidence, and help to ensure that conflicts of interest do not influence these
judgements. An evidence-informed approach also enables decision makers to manage their
own use of research evidence, including asking critical questions about the evidence available
for a particular decision; showing that a decision has been informed by the best available
evidence; and acknowledging where decisions are informed by imperfect or limited
information (Oxman 2009).
There is already a body of research synthesized evidence that can inform policy and practices
globally. This covers a wide range of sectors and substantive areas including agriculture,
climate change, crime and justice, disability and rehabilitation, economic development,
education, energy, environment, governance, gender empowerment, health and health care,
HIV/AIDS, infrastructure, labor markets, maternal and child health, micro-finance, poverty,
public health, slum upgrading, street children, and water, sanitation and hygiene. Within each
of these areas, however, the evidence is patchy or there are important gaps in the evidence
base, particularly in relation to priority questions for LMICs (Snilstveit, et al, 2013), that the
GESI Consortium seeks to fill. We present below several substantive areas in which
synthesized evidence is already contributing to evidence-informed decision making. Other
examples are presented in Annexes 1 and 2.
Water supply, sanitation and hygiene in poorer settings
Illness and death from water-borne diseases, and from poor sanitation and hygiene, is a major
public health challenge in many low and middle income countries. A number of systematic
reviews have been undertaken on the effectiveness of WASH interventions (Fewtrell and
Colford, 2004; Clasen et al, 2007; Aiello, et al, 2008; Waddington, et al, 2009; Cairncross, et al,
2010), especially in terms of preventing diarrheal diseases in adults and children.
The combined evidence from these reviews indicates that hand washing (particularly with
soap), improving water supply and quality at the household level rather than at source,
improving drinking water quality, and sanitation interventions such as provision or
improvement of latrines and sanitation hardware, are all effective in reducing diarrheal
diseases and, to a lesser extent, respiratory infections. The review by Waddington et al (2009;
Snilsveit and Waddington, 2009) also suggests the importance of behavioural factors in
determining uptake and sustainable adoption of WASH interventions. Changing peoples’
behaviour in relation to sanitation and hygiene, when combined with these proven water and
sanitation supply interventions, will produce a significant improvement in the public health of
low and middle income countries.
A number of key recent policy documents in the field of water supply, sanitation and
hygiene have based guidance and recommendations on these and other systematic reviews.
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For example, the UK Department for International Development’s (DfID) WASH Evidence
Paper (2013) draws on synthesized evidence to provide a conceptual framework for
understanding how water supply, sanitation and hygiene impact on health and well-being
and to assess the benefits and cost-effectiveness of different water supply, sanitation and
hygiene interventions. Similarly, the UNICEF/World Health Organisation’s (2009) seven-point
plan for comprehensive diarrhoea control draws on systematic reviews of interventions to
reduce diarrhoea in less developed countries (Fewtrell 2005), as do policy documents on
water supply, sanitation and hygiene from the World Bank, the OECD and World Vision
(OECD, 2012; World Bank, 2013; World Vision, 2011).
Organisation of health services for people living with HIV and AIDS
Research syntheses are increasingly used by organisations such as the World Health
Organization (WHO) to inform the development of guidelines on health systems and the
organisation of services. Two recently published Cochrane HIV reviews on task shifting and
decentralisation of antiretroviral therapy delivery (Kredo et al 2013, Kredo et al 2014)
informed the update of WHO HIV treatment guidelines (WHO 2013). Task shifting from
doctors to non-doctors and decentralisation of HIV therapy delivery from hospitals to clinics
or the community are strategies intended to increase access to HIV therapy for high burden
settings with health care workers shortages. The reviews were commissioned by the WHO and
led by researchers at the South African Cochrane Centre, with additional funding from the
Effective Healthcare Research Consortium. The reviews informed recommendations in the
WHO guidelines that these task shifting strategies are feasible and safe. These
recommendations support the approach taken by programmes already underway in many
LMIC settings, and also encourage other high burden settings to consider implementation.
Crime and justice
Systematic reviews are having important impacts in the field of crime and justice. For example,
preventing and reducing juvenile delinquency is an important policy concern in many settings.
In response to this, a number of countries implemented programmes that involved organized
visits to prison facilities by juvenile delinquents or children at risk for becoming delinquent.
Sometimes called ‘Scared Straight’, the programmes are intended to deter participants from
future offending by showing them prison life and allowing them to interact with adult inmates.
A systematic review produced in 2002 and updated in 2013 (Petrosino 2013) clearly
demonstrated the potential for harm, showing that these programmes increase delinquency
relative to doing nothing at all. The review findings, which received considerable policy and
media attention, were an important factor in reducing further diffusion of ‘Scared Straight’
programmes.
How best to organise policing is another critical policy concern. Two recent systematic reviews
on ‘hot spots’ policing (Braga 2012) and the diffusion or displacement of crime (Bowers 2011)
supported new policing strategies which have since been adopted widely. Further, there are
indications that these strategies may have contributed to a reduction in crime rates in some
areas of the USA (Weisburd 2014). These and other reviews have led to a much greater focus
on evidence-based approaches to policing in recent years.
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Microfinance interventions for low income groups
Microfinance interventions are a form of financial services implemented where formal
banking is largely absent, and that include small loans for individuals who are generally unable
to obtain loans through traditional banks. They have been hailed by many institutions as a
solution to poverty and a mechanism for female empowerment. However, systematic reviews
of research on microfinance interventions have found that impact evaluations of these
programmes are weak. Clients who receive these interventions save more, but also spend
more. Health and housing generally improve, and education and women’s empowerment
sometimes improve. However, children’s education can suffer and microfinance can make the
poorest poorer, through these groups incurring greater debts, being unable to invest in
savings and through increased reliance on further cycles of credit (Duvendack 2011, Stewart
2012). Following these reviews, the Norwegian Overseas Aid Agency, Norad, took a decision
to stop supporting new microfinance institutions and rather to focus on improving the
microfinance industry as a whole.
Household energy sources – uptake of cleaner energy technologies
Nearly 3 billion people worldwide rely on biomass fuels (2.4 billion) and coal (0.4 billion) burnt
inefficiently on open fires or simple stoves. These traditional household energy practices have
dramatic negative consequences for health, the environment and socioeconomic
development. Cleaner and more efficient household energy sources are available, but large
scale uptake of these has been slow. A recent review looked at the factors affecting the uptake
by households of cleaner energy technologies (Puzzolo 2013). This led to the development by
the Global Alliance for Clean Cookstoves of a checklist for designing the roll out of cleaner
energy technologies for households. The review also influenced the decision by the UK DFID
to invest £7 million in further research in this area, including into new reviews on which
behaviour change approaches are effective in ensuring that clean cooking practices are
sustainably adopted (Goodwin 2014).
Improving child health in Kenya through evidence-based guidelines
Research syntheses can also play a critical role in informing decisions at the national level. In
2010, a group of clinicians and policymakers in Kenya utilized research syntheses during a
“Child Health Evidence Week” organized by the KEMRI-Wellcome Trust Research Programme,
in partnership with the Ministry of Health, the University of Nairobi, and the Kenya Paediatric
Association. On that occasion, 70 participants deliberated the evidence and formulated
recommendations around 11 priority topic areas. Building on that first experience, the same
partnership, with some additional methodological input from the Effective Health Care
Research Consortium, convened three guideline panels on priority topics identified by the
Kenya Paediatric Association: rapid fluid bolus for children with septic shock; hospital
umbilical cord care; and hydroxyurea in sickle cell disease. Using research syntheses, evidence
summaries were produced for debate and guideline development in April 2014. This process
followed best practice for transparent global guideline development. In particular, the panel
made clear recommendations about stopping bolus fluids in shocked children based on a new
research synthesis (Opiyo 2014). This and the other recommendations will improve clinical
care and save lives in Kenya.
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Research Synthesis Capacity Globally and in LMICs
A recent report by Bangpan et al (2013) identified considerable variation worldwide in the
capacity to undertake and disseminate research synthesis evidence. Low and middle income
countries generally have much less research synthesis capacity than higher income countries.
In high income countries there are currently approximately 21,292 authors associated with
the Cochrane Collaboration, which is the largest research synthesis network globally. The
contrast with low and middle income countries can be seen by the bar graphs in Figures 1, 2
and 3. These graphs present the number of systematic review authors from low and middle
income countries affiliated with the Cochrane Collaboration. Altogether, this number
amounts to 5,526 authors, approximately one-quarter of the Cochrane research synthesis
authorship in high income counties. Similar data on the limited research synthesis capacity in
low and middle income countries have been identified by the Joanna Briggs Institute, the EPPICentre, the Alliance for Health Policy and Systems Research, and the International Initiative
for Impact Evaluation (3ie). These data confirm that there is also considerable variation across
low and middle income countries in the capacity to undertake research synthesis.
Figure 1 – Number of Review Authors from Low and Middle Income Countries in the
Cochrane Collaboration, by Country (for countries with >100 review authors)
Figure 2 - Number of Review Authors from Low and Middle Income Countries in the
Cochrane Collaboration, by Country (for countries with 11-100 review authors)
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Figure 3- Number of Review Authors from Low and Middle Income Countries in the
Cochrane Collaborationby Country (for countries with <10 review authors)
Bangpan et al. also point out that increasing the capacity for research synthesis is closely
linked to increasing the demand for research-based evidence, and to making such evidence
‘close to policy’. By this they mean “that practitioners and policy makers are more likely to
engage in research if they see its relevance to their own decision making” (Bangpan et al,
2013:31). Strengthening capacity to undertake research syntheses in LMICs may therefore
contribute to making evidence-informed decision making in those settings more sustainable.
Furthermore, research syntheses help to maximize returns from existing investments in
primary research globally and in LMICs, by drawing together findings from this research and
identifying evidence gaps, thereby informing priorities for new research.
In addition, DfID has recently commissioned six projects under its Building Capacity to Use
Research Evidence (BCURE), which aims to ensure that there is a demand for evidence use by
policy makers and practitioners in LMICs. These BCURE projects take capacity building for high
quality evidence beyond medicine and health care and into the broader substantive and
sectoral areas of international development. At least one of these projects, directed by
Professor Ruth Stewart at the University of Johannesburg in South Africa, includes building
capacity to understand and use synthesized research evidence. Members of the GESI
consortium are providing professional development support to this BCURE initiative.
These developments to increase the demand for high quality evidence, including synthesized
evidence, require increased capacity on the supply-side. Currently there are both human and
infrastructural capacity problems. The former refers to the lack of an adequate number of
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people with the required knowledge, skills and experience to undertake high quality research
syntheses. Outside of the areas served by the Cochrane Collaboration and the Alliance for
Health Policy and Systems Research there are few centres of excellence in LMICs that train
and support social, political, agricultural and environmental scientists in research synthesis.
The GESI Consortium proposes to create and develop such centres of excellence around those
institutions in where there already is some degree of expertise and experience in research
synthesis. Such centres will develop scientists’ skills in problem identification, scoping
research syntheses, searching for evidence, critical appraisal of evidence, data extraction,
statistical meta-analysis, narrative and qualitative synthesis, and influencing policy and
practice. The support of experienced information scientists is especially lacking in many LMICs,
though proximity to major universities and national research centres can often increase such
provision.
Infrastructural resources for undertaking research synthesis include: adequate and
appropriate connectivity/bandwidth to the internet; access to essential electronic databases,
libraries of evidence and full-text downloading facilities; access to knowledge management
services, review management services and statistical services and software. The GESI
Consortium proposes to increase these infrastructural resources by working with
governments, research funding organisations and higher education institutions to build upon
what already exists in LMICs. This strategy, however, will require additional core funding over
and above what is currently available through these existing organizations and funding
sources.
Evidence-informed decision making in LMICs requires a large and sustained supply of both
global and local synthesized evidence. By focusing on the most robust evidence, and including
evidence that has high external validity, researchers become more discerning about what
counts as evidence. This, in turn, will raise the quality and conduct of primary research, as has
been demonstrated in high income countries over the past three decades.
Capacity building in research synthesis will also inform research priorities in ways that will
increase the alignment between the work of researchers, on the one hand, and the demands
for evidence from policy makers and public service delivery personnel, on the other hand.
Over time, this capacity to produce better and more aligned evidence will enhance the
sustainability of evidence-informed policy and practice across LMICs, and is likely to increase
within-country primary research capacity.
Reviews of evidence will be more likely to focus on topics of national, regional and local
interest, and will be more relevant if they are undertaken by people who are grounded in the
reality of these environments. This may broaden the range of questions that need to be
addressed to answer the many challenges facing LMICs, and to set agendas, take action and
bring about change. This, in turn, is likely to draw upon a broader range of research methods
and types of evidence, including contextualized knowledge that is often missing in the existing
research synthesis community.
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What is required to build capacity for research synthesis in LMICs?
The GESI Consortium proposes to establish an initial ten Research Synthesis Centres3 in low
and middle income countries. These centres may be developed with a single sector focus, a
multi-sector focus, a general synthesis-generating focus, or some combination of these
alternatives. Each centre will be undertake the following tasks and activities:
 Provide training and professional development in research synthesis methods for existing
researchers and analysts in low and middle income countries;
 Provide seminars, workshops and conferences to develop the capacity to undertake
research synthesis, and a culture of research-based evidence;
 Work with policy makers and development practitioners in low and middle income
countries, and initiatives such as the BCURE projects, to establish the demand for
research synthesis products;
 Develop research synthesis projects and programmes across the whole range of policy
and practice sectors and substantive topic areas, drawing on the social, economic,
political, agricultural, environmental and health sciences;
 Manage Calls for Research Syntheses, drawing on their GESI seed funds (see below), and
ensure that review grants are contracted and managed efficiently with contractors that
have the required skills to deliver on time and within budget;
 Undertake in-house reviews and other research synthesis products to the highest
possible standard;
 Provide technical support to grantees in research synthesis methodologies;
 Quality assure research protocols, draft reports and final reports to ensure they meet the
standards required by the research synthesis and the policy and practice communities;
 Disseminate the findings of research synthesis products in a range of formats, and in
language that is easy to comprehend by a non-researchers;
 Establish realistic and implementable plans for research syntheses products to influence
policy and practice.
It is proposed to launch each of the Research Synthesis Centres with a core staff of seven
people, consisting of:
 1 x Senior Research Synthesis Specialist/Centre Director
 1 x Researcher with quantitative and experimental/QED synthesis skills and experience
 1 x Researcher with qualitative synthesis skills and experience
 2 x Paid Interns (who will change annually)
 1 x Information specialist
 1 x 0.5 Administrative Assistant
This combination of staff will provide the required expertise and experience to undertake the
range of tasks and activities required of each centre. The proposal to include two paid interns
3
While this number of Centres is aspirational, it is seen by the GESI Consortium as representing the
magnitude of scale up of review production capacity that is required to begin to meaningfully address
the need for evidence synthesis products in LMICs. Furthermore, funding for the Centres may include
ongoing support for some of the pilot centres established by the Alliance for Health Policy and
Systems Research and the Cochrane Collaboration.
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each year will allow the centre to train and develop graduate level/post-doctoral students in
the skills of research synthesis. This will enhance the capacity building within each centre, in
addition to the capacity building work that will be undertaken in the wider research and policy
communities.
The inclusion of a full time information specialist – one of the essential components of the
research synthesis process – will allow each centre to undertake its own in-house review work,
and provide technical support to grantees in searching and appraising evidence using
electronic, print and grey literature sources.
It is also proposed that seed funding should be raised for each Research Synthesis Centre to
support three systematic reviews (or other research synthesis products) within their region
each year. This will provide each centre with the necessary resources to procure, manage and
technically support an initial stream of reviews that will develop local and regional expertise
in research synthesis, and demonstrate to policy makers and practitioners the value of this
work. This, in turn, should help to generate the demand and future funding for more research
synthesis products from the policy making and practitioners communities.
Indicative Budget
An indicative budget for each Research Synthesis Centre, and for the establishment of a single
co-ordination service, is presented in Annex 3. As an indicative budget it provides an indication
of the types of costs that will be involved in developing GESI Centres across LMICs. It is
anticipated that different funders may want to fund different types of activity, or different
parts of the indicative budget (e.g. staff costs, or the seed funding for synthesis studies). Some
funders may be willing and able to provide all of the part of this indicative budget.
The location of the Centres will be decided later by the GESI Governance Group, together with
funders and other stakeholders. Each of the proposed Research Synthesis Centres will be
supported by the members of the GESI Consortium, which will constitute a support network.
The GESI Consortium will contribute both financially and in kind to the establishment, running
and support of the Centres, including a combination of coordination, technical, grant
management, quality assurance, and policy influencing support, and some co-funding of
projects. The GESI Consortium represents a broad and deep resource of expertise and
experience in research synthesis methods, procurement, grant management, quality
assurance, dissemination and policy/practice influence. Each of the GESI Consortium
members has some existing capacity and/or funded research synthesis projects in LMICs, as
well as centralized administration and support structures in different parts of the world. These
local, regional and global services of the GESI Consortium, and their respective networks of
expertise, will be made available to the proposed Research Synthesis Centres, thereby helping
to sustain and develop them. In addition, the GESI Consortium will play a key oversight role
through helping to implement and sustain quality assurance and performance management
systems across the Centres. To support these functions, a GESI Coordination Service (or
Secretariat) will be established and will be hosted in a LMIC by one of the GESI Consortium
members4. A indicative budget for this coordination service is included in Annex 3.
4
The location of the GESI Secretariat will be decided later by the GESI Governance Group.
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Governance of the GESI Consortium
The founding organisations of the GESI Consortium (The Alliance for Health Policy and Systems
Research, the Campbell Collaboration, Cochrane, the EPPI Centre and 3ie) will constitute a
Governance Group for GESI. GESI’s Governance Group may be joined by any organisation,
agency or funding body providing an annual financial or in-kind contribution and accepted for
voting membership by a majority of the founding members.
The Governance Group will meet twice a year either virtually or in a face-to-face meeting and
will take decisions on the functioning of the GESI Consortium. To help support and sustain the
work of GESI, a GESI Coordinator will be appointed. S/he will be physically located in the GESI
Secretariat in a LMIC. The GESI Coordinator will – on behalf of the Governance Group –
oversee on a daily basis all GESI-related projects and funding initiatives, including the work of
the Centres for Research Synthesis funded through GESI; though accountability for the
efficient and effective delivery of individual projects and initiatives will rest with the Centres
for Research Synthesis and other organisation(s) managing them.
A GESI ‘Advisory & Support Group’ will also be established and will be open to any
organisation, agency or funding body that supports GESI’s goals and ambitions.
A Memorandum of Understanding establishing GESI will be developed and signed by the
founding organisations.
Summary
Research synthesis is now a well developed and core method for establishing the balance of
evidence to help policy makers and public service delivery personnel make better decisions.
It is increasingly being seen as the highest quality evidence for decision making in both policy
and practice. Research synthesis is now undertaken across the range of substantive and
sectoral areas. There is, however, a shortage of capacity to undertake and disseminate
research syntheses in low and middle income countries, and to ensure that high quality
evidence is used to influence policy and practice.
This paper presents the case for supporting investments to expand and develop research
synthesis, and a culture of using research based evidence in policy and public service delivery.
It proposes the establishment of an initial ten Centre of Research Synthesis in developing
countries, and a range of tasks and activities that these centre will undertake. An indicative
budget is also proposed.
13
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18
19
Annex 1
Examples of how evidence from research syntheses has addressed key policy questions
and / or informed policy making and practice in LMICs
Agriculture
Farmer field schools (FFS) are adult education interventions that are used to improve the
quantity and quality of agricultural production. FFS aim to curb the over-use of pesticides and
other harmful practices, improve agricultural and environmental outcomes, and empower
disadvantaged farmers such as women. A recent systematic review of the effectiveness of
farmer field schools (Waddington et al, 2012) found that these types of agricultural extension,
generally have a positive impact on farmers’ knowledge, pesticides use and other adoption
measures, and on outcomes relevant for farmers’ standards of living such as crop yields,
revenues, environmental outcomes and empowerment. Further, “the impacts on agricultural
outcomes were in the region of a 10 percent increase in yields and 20 percent increase in
profits (net revenues), at least in the short term” (Waddington et al, 2012:10). The size of
these impacts, however, varied considerably across projects and locations, and the authors of
the reviews noted that the effects on profits were particularly large when FFSs were
implemented alongside complementary upstream or downstream interventions, such access
to seeds and other inputs and assistance in marketing produce.
The Farmer Field Schools review, however, found little evidence of diffusion of successful
farming knowledge and practices from FFS participants to neighbouring farmers. This was
contrary to the expectations and claims of those who support FFSs as an agricultural
intervention. The qualitative evidence from the FFS review, and the analysis of project
implementation documents, found that the barriers to successful diffusion included: the
complexity of the curriculum, the nature of the training offered, the observability of FFS
practices and their relative advantage compared to other farming practices, existing levels of
social capital, access to seeds and social networks, assistance in marketing produce, and the
ways in which FFS programmes are targeted. The top-down transfer of technology for an
intervention that is intended to be a ‘bottom-up’ participatory-transformative approach to
empowerment may also hinder successful implementation and effectiveness. This review,
then, not only identified the positive features of farmer field schools but also the barriers to,
and facilitators of, successful outcomes of this type of agricultural intervention. The FFS review
also demonstrated the value of a combination of quantitative and qualitative evidence for
understanding what works, for whom, and under what economic and social conditions.
Maternal and newborn health policy at the international level
Improving the delivery of effective interventions to improve maternal and newborn health is
another priority area globally, and particularly in low and middle income countries. While a
large number of effective interventions to improve maternal and newborn health are
available, in many settings their delivery is impeded by inadequate human resources. Recent
WHO guidance has attempted to address this issue through developing evidence-based
recommendations on optimizing health worker roles through shifting tasks from health care
providers with higher levels of training to those with lower levels of training (WHO 2012).
These recommendations were informed by a number of Cochrane and non-Cochrane reviews,
including on the effectiveness of task shifting to different health care providers and the
acceptability and feasibility of such strategies (Colvin 2013; Glenton 2013; Lewin 2010; Sibley
20
2012). This included the first qualitative evidence synthesis published by the Cochrane
Collaboration (Glenton 2013).
Educational Policy and Practice
Research synthesis studies have also increased knowledge of effective and ineffective
interventions in educational policy and practices. A systematic review of the effectiveness of
educational interventions in LMICs (Petrosino et al, 2012) found that interventions such as
conditional cash transfers, grants to communities, school breakfasts or lunches, school
building programmes, remedial education and tutoring are generally effective in getting
children to enroll in and attend school. The absolute increase in school enrollment, when
compared with non-intervention areas, was in the region of 3%-9%, but there was
considerable variation in the magnitude of effects across the 73 studies reviewed.
A follow-up review by Krishnaratne and White (2012) confirmed positive impacts of most
educational interventions in LMICs on school enrolment and attendance, but no overall
impact of these interventions of learning outcomes. Krishnaratne and White also found that
factors such as the availability of teaching resources, the quality of teaching and other supplyside interventions contributed to the variation in the impact of educational interventions on
enrolment and attendance. An update of these reviews on the effectiveness of educational
interventions in LMICs is currently being undertaken by 3ie (Snilstveit et al, 2014)
Other research syntheses in education have identified the optimal school size for secondary
schools (Garrett et al, 2004), what schools can do to maximise the participation of all students
in their cultures, curricula and communities (Dyson et al 2002), effective strategies (using ICT)
for raising students’ motivational effort in mathematics (Kyriacou and Goulding, 2006), and
that investment in human capital does have a positive and genuine effect on growth in lowincome countries (Hawkes and Ugur, 2012).
Use of health evidence briefs in Chile
The Ministry of Health of Chile has established a group to assemble evidence on urgent health
policy issues. Using an approach promoted by WHO’s Evidence Informed Policy Network
(EVIPNet), the group produces evidence briefs that bring together evidence from systematic
reviews about a policy problem and the options to address the problem. A recent evidence
brief examined the impact of placing Automated External Defibrillators (AEDs) – devices that
diagnose and treat abnormal and potentially fatal heart rhythms – in public places. The
evidence brief was based on six systematic reviews and was incorporated into a briefing note
used by the Minister of Health in a public talk about the issue.
Mental health in the Lebanon
There is growing acknowledgement globally of both the substantial burden of mental illness
and the inadequacies of services to treat and support people living with mental illness. The
Knowledge to Policy (K2P) Center at the American University of Beirut in Lebanon was
requested by the Ministry of Health to prepare an evidence brief for policy on “Securing
Access to Quality Mental Health Services in Primary Health Care in Lebanon.” The brief was
developed and disseminated in a policy dialogue meeting with key policymakers and
stakeholders. Based on the brief and the dialogue, a mental health programme has been
established at the Ministry of Health and a campaign is being conducted to advocate for
promulgating a Mental Health Act.
21
Ensuring that refugees in Lebanon have access to essential health services
Civil wars in neighbouring countries have resulted in large numbers of refugees seeking
residence in Lebanon. This, in turn, has placed enormous pressure on existing health services
and prompted the Ministry of Health of Lebanon to request evidence on how best to provide
health services in this context. The Center for Systematic Review on Health Policy and Systems
Research (SPARK) and the Knowledge to Policy (K2P) Center at the American University of
Beirut are collaborating with the Ministry of Health and international agencies to produce
systematic reviews on coordination mechanisms for financing of refugee health. In addition,
the Centres produced an evidence-based briefing note on “Promoting Access to Essential
Health Care Services for Syrian Refugees in Lebanon” and facilitated a policy dialogue on the
problem, options to address it and implementation considerations. This resulted in a number
of key actions by the Ministry of Health and some international agencies, including
strengthening the information systems on refugee health and appointing a national
coordinator to help implement the recommendations and next steps from the dialogue
meeting.
Using evidence to inform health decisions in Nepal
Recent efforts to promote systematic approaches to priority setting and the use of reliable
evidence to inform the development of health policies have had important impacts within the
Nepal Health Sector Programme (NHSP). For example, discussion of evidence from a recent
Cochrane review on deworming (Taylor-Robinson 2012) led to a decision that Nepal would
work towards phasing out the policy of routine deworming of school children since there is no
convincing evidence to support this. These policy impacts are the consequence of
collaborative efforts between the Nepal Health Research Council; the South Asian Cochrane
Network & Centre, India; the Effective Health Care Research Consortium, UK; and the Institute
of Population Health at the University of Ottawa in Canada, highlighting the importance of
global collaboration to conduct systematic reviews and promote the use of their findings.
Annex 2
Summary of further examples of how Research Synthesis Can Inform Policy Making and Other Decisions
Field
Topic
Research syntheses
Relevance and impacts of the research
synthesis/es on policy making and other
decisions
Agriculture
Farmer field schools: adult
education interventions that
are used to improve the
quantity and quality of
agricultural production. FFS
aim to curb the over-use of
pesticides and other harmful
practices, improve
agricultural and
environmental outcomes,
and empower disadvantaged
farmers such as women.
Effectiveness of farmer field schools
(Waddington 2012)

Crime and
Justice
Drug Courts
Effectiveness of Drug Courts compared to
ordinary courts in preventing recidivism
(Wilson, 2006)
 Found positive effects of drug courts,
compared with ordinary courts, in terms of
preventing recidivism of drug involved
offenders.
Crime and
Justice
Structured therapeutic
community interventions for
drug users in prisons
Effectiveness of interventions with
persistent/prolific offenders in reducing reoffending (Perry et al, 2009)
 Structured therapeutic community
interventions produced a greater reduction in
offending behaviour than standard treatment.
Crime and
Justice
Personal Skills Training
Interventions to reduce the risk of reoffending (Newman et al 2012)
 ‘Personal Skills Training Plus’ interventions
reduced the risk of re-offending in first

Identified the positive features of farmer
field schools and the barriers to, and
facilitators of, successful outcomes of this
type of agricultural intervention
Demonstrated the value of a combination
of quantitative and qualitative evidence for
understanding what works, for whom, and
under what economic and social conditions.
23
time/non-serious offenders when compared
to a standard diversion intervention
comprising of warning and monitoring.
Crime and
Justice
Hot-Spots Policing
Effectiveness of Policing (Braga 2005)
 ‘Focused Police Action’ (sometimes referred
to as ‘hot-spots policing’) has significant
positive effects in terms of reducing when
compared with more thinly spread police
activity (Braga, 2005).
Crime and
Justice
Juvenile Awareness
Programmes
Effectiveness of Junvenile Awareness
Programmes [Scared Straight
Interventions] (Petrosino et al, 2012)
 Found that juvenile awareness interventions
aimed as scaring young offenders away from
criminal activity not only fails to deter crime
but actually leads to more offending
behaviour.
Economic
Development
and Poverty
Reduction
Micro-Finance
Effectiveness of micro-finance in terms of
reducing poverty and empowering women
(Duvendak et al, 2011, 2014)
 Only small positive outcomes on both
poverty and the empowerment of women.
 Factors that enhanced women’s
empowerment included the household
income prior to receiving credit, the number
of children in a household, spousal
cooperation, and the level of credit granted.
Economic
Development
and Poverty
Reduction
Access to economic assets
and skills development
Effectiveness of providing girls and young
 Found that access to economic assets and
women with access to economic assets and
skills development may improve young
developing their skill sets (Dickson and
women’s ability to generate an income,
Bangpan, 2012)
increase the amount they can save, support
their participation in school, and increase
their sexual health knowledge.
24
 Little evidence that these measures increase
the economic standing of women in society
overall, lead to better further educational or
career choices, or improve long-term sexual
health outcomes.
Medicine and
health care
Optimizing health worker
roles for maternal and
newborn health through
shifting
Barriers and facilitators to the
implementation of lay health worker
programmes (Glenton 2013)
Barriers and facilitators to the
implementation of task-shifting in
midwifery services (Colvin 2013)
Contributed to the development of new WHO
evidence-based recommendations on
optimizing health worker roles through shifting
tasks from health care providers with higher
levels of training to those with lower levels of
training (WHO 2012)
Effectiveness of lay health worker
interventions for maternal and child health
and infectious diseases (Lewin 2010)
Traditional birth attendant training for
improving health behaviours and
pregnancy outcomes (Sibley 2013)
Medicine and
Health Care
Use of corticosteroids in late
pregnancy
Effectivess of corticosteroid in preventing
respiratory distress syndrome and
neonatal mortality (Crowley, 1990:12;
Roberts and Dalziel, 2006).
 Corticosteroids given prior to preterm birth
are effective in preventing respiratory
distress syndrome and neonatal mortality
 The continued use of a single course of
antenatal corticosteroids to accelerate fetal
lung maturation in women at risk of preterm
birth” as a treatment option in late
pregnancy
25
Medicine and
Health Care
Specialist units for the care
of stroke patients
Effectiveness of multi-disciplinary specialist
stroke units (Stroke Unit Trialists’
Collaboration, 2013)
 People who receive organised inpatient care
in a stroke unit are more likely to be alive,
independent, and living at home one year
after the stroke.
Medicine and
Health Care
Treatment of croup in
children
Effectiveness of glucocorticoids for the
treatment of croup in children (Russell et
al, 2011)
 Found that glucocorticoids can reduce the
swelling and make it easier for the child to
breathe within six hours of administration.
 The effect lasts about 12 hours, lessens the
need for other drugs, and shortens hospital
stays by 12 hours
Medicine and
Health Care
General Health Checks
Effectiveness of general health checks in
adults for reducing morbidity and mortality
from disease (Krogsbøll et al, 2012)
 Found that no evidence of reduced morbidity
or mortality, neither overall nor for
cardiovascular or cancer causes, although
the number of new diagnoses was increased.
Medicine and
Health Care
Screening for breast cancer
with mammography
Effectiveness of routine screening for
breast cancer with mammography
(Gøtzsche et al, 2013)
 Found that more women will receive
unnecessary treatment than the number
who will be prevented from dying
 Women invited to screening should be fully
informed of both the benefits and harms.
Annex 3
Indicative Annual Budget for each GESI Centre, for Seed Funding for research syntheses
and for the cross-Centre GESI Coordination service
Centre Staff Costs per year
Cost in GBP£*
Cost in US$*
Centre Director/Senior Evaluation Specialist
£50,000
$80,000
1 x Research Assistant (Quantitative/Experimental)
£30,000
$48,000
1 x Research Assistant (Qualitative)
£30,000
$48,000
2 x Paid Interns
Information Specialist
Administrative Assistant (0.5 FTE)
£20,000
£30,000
£10,000
$32,000
$48,000
$16,000
£170,000
$272,000
£34,000
$54,400
£204,000
$326,400
£10,000
$16,000
£50,000
$80,000
£30,000
$48,000
£20,000
$32,000
B. Total Non-Staff Costs per year
£110,000
$176,000
B
Total Annual GESI Staff, Admin and Indirect Costs
per Centre
£314,000
$502,400
A+B
Seed Funding for 3 x Reviews Annually @ £60K per
review
£180,000
$288,000
C
Total Annual Budget for each Centre + Seed Funding
£494,000
$790,400
A+B+C
GESI Single Coordination Service [Cross Centre] per
year**
1 x full time Programme Coordinator
£30,000
$48,000
£5,000
$8,000
£35,000
$56,000
Total Staff Costs
Indirect costs @ 20% of staff costs
A. Total Staff Costs per year - Direct and Indirect
Sub-Totals
A
Centre Non-Staff Costs per year
Scientific database subscription (where open access
not available)
Technical support and training costs for each GESI
Centre
Office accommodation costs
Travel and subsistence for
conference/workshops/training
C. Seed Funding For Research Syntheses
Office costs for Programme Coordinator
D. Total Annual Cost for GESI Coordination Service
D
Total Annual Budget for Each Centre + Seed Funding
£529,000
$846,400
A+B+C+D
+ Cross Centre Coordination
*Based on Global Development Network salary scales plus on-costs (health insurance, pension
contributions)
** This will be a cross-centre service. Initial funding to establish a GESI Programme Co-ordination
Service in a southern country will be raised by the constituent groups of the GESI initiative. Funding is
sought for the continuation of this vital service over the next five years.
27
Annex 4
GESI Drafting Team members
Philip Davies, International Initiative for Impact Evaluation [3ie], London, UK
Jeremy Grimshaw, Director, Cochrane Canada, University of Ottawa, Ottawa, Canada
Tamara Kredo, Deputy Director, South African Cochrane Centre, Cape Town, South AFrica
John Lavis, McMaster Health Forum and McMaster University, Toronta, Canada
Simon Lewin, Norwegian Satellite of the Cochrane Effective and Practice and Organisation of
Care (EPOC) Group, Norwegian Knowledge Centre for the Health Services, Oslo,
Norway
Lawrence Mbuagbaw, Centre for the Development of Best Practices in Health, Yaoundé,
Cameroon
Sandy Oliver, Social Science Research Unit and EPPI-Centre, UCL Institute of Education,
University of London, UK
Tomas Pantoja, Pontificia Universidad Católica de Chile, Department of Family Medicine,
Santiago, Chile
Prathap Tharyan, Director, South Asian Cochrane Centre, India
Peter Tugwell, Campbell International Development Coordinating Group, University of
Ottawa, Ottawa, Canada