Funding Agencies in Low- and Middle-Income Countries: Support for Knowledge translation/Aide a la Transposition Dans la Pratique Des Connaissances Par Les Agences De Financement Des Pays a Revenu Faible Ou moyen/Organismos De Financiacion En Paises De Ingresos Bajos Y Medios: Apoyo a la Traslacion De Conocimientos

Introduction For knowledge to benefit society, it needs to be shared, communicated and translated into policy, practice or community action. (1) Increased commitment to knowledge translation is reflected by the 58th World Health Assembly's declaration in 2005, which encouraged enhanced knowledge transfer. (2) Several international initiatives focus on knowledge translation in low- and middle-income countries (LMICs) such as the Overseas Development Institute's RAPID programme (Research and Policy in Development), the WHO/ PAHO EVIPNet initiative (Evidence-Informed Policy Networks) and the WHO Knowledge Management and Sharing initiative. The WHO Department of Knowledge Management and Sharing defines knowledge translation as: The synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people's health. (3) Because of the dearth of primary research performed in their own countries and the disproportionately low research resources available, LMICs need to engage in the translation of knowledge that is cost-effective and applicable to their local settings. (4) Knowledge translation is a complex and nonlinear process, and is generally slow, particularly in LMICs. (5,6) Slow knowledge transfer can result in inappropriate care. Many examples in LMICs have shown variations in practice despite established guidelines; for example, antibiotic prophylaxis with caesarean section, (7) management of acute myocardial infarction (8) and management of pneumonia. (9) In one example, a study of Shanghai hospitals found that more than 70% of births involved clinical practices that are ineffective and should be avoided based on the best available evidence from the Cochrane Library. (10) Knowledge translation may help bridge the know--do gap, particularly in disadvantaged populations. (3) Utilization of treatments with demonstrated effectiveness, such as immunization, oral rehydration for diarrhoea and treatment for acute respiratory infection, is up to 50% lower for the poorest. (11-13) Knowledge translation interventions that enhance access, diagnostic accuracy, provider compliance or consumer adherence could enhance community effectiveness of interventions in disadvantaged populations. (14) Because research funding agencies are the gatekeepers to funds for conducting research, they may be able to encourage knowledge translation and exchange by their funding recipients. They can also actively disseminate information, involve end users in prioritizing research topics and fund implementation research. However, little is known about funding agency policies to promote knowledge translation. This project was designed as an exploratory, descriptive study to increase understanding of the knowledge translation policies and activities of applied health research funders within LMICs and international funding agencies. Methods We conducted inductive analysis of semi-structured interviews with key informants from a judgement sample of funding agencies supplemented by document analysis from the agency web sites, including strategic plans, mandate and application procedures. This method provides a richness of data that cannot be assessed using questionnaire surveys since participants could respond freely as well as illustrate concepts with examples and the interviewer could probe for more details. (15) Document analysis and findings from interviews were triangulated to present a complete picture of knowledge translation activities. We used the Lavis framework of push, pull, linkage/exchange and integrated efforts to classify knowledge translation activities. (16) Sampling We selected six LMICs, based on the presence of substantial within-country health research funding: Brazil, Colombia, India, the Philippines, South Africa and Thailand. None of these countries were among the least developed countries, where external funding agencies would be responsible for a larger proportion of health research funding (e. …