The Research 4 Action (R4ACT) Methodology: How Can Research Inform our Practices?

BACKGROUND

After decades of interventions, the need for improved integration of the latest available evidence into humanitarian programming is now recognised by all, including the international community. However, the quality and quantity of the current evidence on health interventions in humanitarian contexts is still limited. Many questions are still pending to bridge the gap between research and programming.

METHODOLOGY

Action Against Hunger France developed the R4ACT (Research4Action) methodology in 2017. It provides methodological support to embed scientific evidence into programming and advocacy. This method actively engages programme, research, and uptake teams in all stages of the research, from framing the research question to incorporating scientific evidence into programmes, so that the three perspectives are equally and consistently considered throughout the process. The R4ACT topic is decided collegially based on relevance, priority and possibility to have actionable results. It involves a cross-sectorial needs assessment of the programmatic areas of interest and explores the impacts of one sector on another.

The first pilot, launched in 2017, focused on the impacts of cash on Severe Acute Malnutrition while the 2019 pilot explored the impacts of Water, Sanitation and Hygiene interventions on Acute Malnutrition. This article will detail the results of the 2019 pilot and explore the various stages of the methodology.

Stage 1. What does the evidence say about the impact of Water, Sanitation and Hygiene on Acute Malnutrition? Collating programme-focused evidence.

During stage 1, Water, Sanitation and Hygiene, and Nutrition and Health technical advisors jointly defined a list of specific Water, Sanitation and Hygiene interventions, referred as indicators, on which they needed evidence in order to assess their impact on Acute Malnutrition. Engaging both sectors in this exercise is essential to ensure indicators respond to key questions of both sectors and to improve integration between Water, Sanitation and Hygiene and Nutrition.

A review of the available scientific literature was then performed by a researcher in collaboration with the uptake advisor to make sure the report was a synthetic and practical document providing a ready to use summary of the existing evidence.

KEY FINDINGS

• The review highlighted the lack of robust evidence on the majority of indicators and the crucial need for more research on the relation between Water, Sanitation and Hygiene interventions and Acute Malnutrition.
• Moderate evidence showed the positive impact of water quality at household level during the treatment phase of Acute Malnutrition.
• Consistent evidence showed no association between the presence of improved household latrines and the prevention of Acute Malnutrition.

Stage 2. Moving beyond research: paving the path to practical change

The R4ACT methodology uses a qualitative approach for stakeholder engagement. Rather than reaching a large number of actors, a limited but diversified and qualified panel of actors was invited to a one-day workshop in Paris. The panel was composed of technical advisors from a variety of NGOs and global clusters, with equal representation from Nutrition and Water, Sanitation and Hygiene sectors. The purpose of the limited but diversified audience is to keep the process flexible and dynamic while still taking into account various points of view, which fosters constructive discussion and facilitates transversal collaboration.

Based on the findings of the review, participants were requested to translate the evidence into concrete, practical actions that teams could implement to reinforce comprehensive programming on water quality. The group endorsed six key activities:

ACTIVITIES AT THE HEALTH FACILITY LEVEL
Improve water systems in health facilities
Systematically coordinate delivery of household water treatment adapted to context with Severe Acute Malnutrition management
Water, Sanitation and Hygiene experts train health centre staff to: a) run health centre water systems and b) build caregiver capacity on correct use of household water treatment products

ACTIVITIES AT THE HOUSEHOLD LEVEL
Develop behavioural change on water treatment in areas covered by Severe Acute Malnutrition treatment services
Use of participatory methodology to select the most appropriate household water treatment method
Improve information, knowledge and data sharing

At the end of the workshop, participants selected the activities that their organisation would commit to implementing in their programmes. Participants requested official sign-off of the report from senior management. Quarterly calls to follow up on the roll out of the roadmap will be organised over the year.

HOW WILL THESE FINDINGS ENHANCE OUR PROGRAMMING?

The summary of the scientific evidence complemented by the outcomes of the workshop, will allow all the relevant stakeholders to make decisions, design and implement programmes based on the best scientific evidence available, which is fundamental to increase the efficiency and effectiveness of interventions. R4ACT also reviews current gaps in knowledge and will advocate for research in programmatic sectors in which evidence is still scarce.

WHAT DID WE LEARN ABOUT THE R4ACT PROCESS?

The R4ACT pilots proved to be a very promising methodology to bridge the gap between research and action. Its main strengths are threefold:

1. Time: The process takes approx. 2 months for the literature review and report editing, followed by a one-day workshop, and regular follow-ups of the action plan roll out), inclusiveness and the fact that it is action focused.
2. Inclusive: The researcher’s input is crucial in the first stage of the process to guarantee the robustness of the approach while the technical expert ensures the programmatic relevance of the questions explored. Inclusiveness is also achieved by systematically choosing a cross-sectorial topic to improve integration.
3. Action-focused: The R4ACT process can only achieve behaviour change if efforts are made to ensure recommendations are disseminated within the teams and if they are integrated in new proposals, strategies, interventions and advocacy.

WHAT HAS ALREADY CHANGED?

• The findings of the review were presented in two international scientific conferences: University of North Carolina, and Research 4 Nutrition (R4NUT)
• The Global Nutrition Cluster and the Water, Sanitation and Hygiene cluster are kick-starting discussions on a common work plan.
• Action Against Hunger launched the TISA research project, aligned with key R4ACT findings regarding the quality of water.
• Advocacy teams in West Africa drafted their advocacy strategy based on R4ACT recommendations.
• Other R4ACT participants besides Action Against Hunger have integrated R4ACT recommendations into Health and Nutrition strategy revisions, COVID-19 response plans, new proposals, joint assessment questionnaires, etc.

WHAT STILL NEEDS TO BE DONE?

• It is important to have a person responsible for moderating the discussion at the internal level as well as with other organisations that take part in the R4ACT workshop to ensure that both sectors continue collaborating on the implementation of activities.
• Cascading the information to the field and ensuring that the people in charge of implementing the activities commit to implementing the action plan remains a challenge. Technical teams from the field should play a more active role in the process.
• The definition of indicators is important to monitor progress. Holding participants accountable to these indicators remains a challenge.

The next pilot will therefore explore ways to better engage field operations from the outset. We are planning to scale up the methodology thanks to its very simple pattern: what do we know? What should we do? How can we change? The adoption of R4ACT reinforces the overall learning culture of our organisation, which has a strong positive impact on the quality of services delivered.

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