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1. Read the attached peer-reviewed research paper in its entirety
2. In your own words, using the APA 6E guide, prepare a 150 words to 250 words summary about this research paper
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RESEARCH Open Access

The West African experience in establishing
steering committees for better
collaboration between researchers and
decision-makers to increase the use of
health research findings
Namoudou Keita1, Virgil Lokossou1*, Abdramane Berthe2, Issiaka Sombie1, Ermel Johnson1 and Kofi Busia1

Abstract

Background: Aware of the advantages of a project steering committee (SC) in terms of influencing the development of
evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation
of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study
was conducted to describe the process that was used to establish these committees and its findings aim to assist other
stakeholders in initiating this type of process.

Methods: This is a cross-sectional, qualitative study of the initiative’s four projects. In addition to a literature review and a
review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research
teams, WAHO and the International Development Research Center. The respondents were selected with a view
to reaching data saturation. The technique of thematic analysis by simple categorisation was used.

Results: To set up the SCs, a research team in each country worked with health authorities to identify potential members,
organise meetings with these members and sought the authorities’ approval to formalise the SCs. The SCs’ mission was
to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use
of the findings. The ‘doing by learning’ approach used by each research team, combined with WAHO’s catalytic role with
each country’s Ministry of Health, helped each SC manage its contextual difficulties and function effectively.

Conclusion: The involvement of technical and financial partners motivated the researchers and ministries of health, who,
in turn, motivated other actors to volunteer on the SCs. The ‘doing by learning’ approach made it possible to develop
strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such
an experience, a strong understanding of the local context and the involvement of strong partners are required.

Keywords: Steering, Information transfer, Committee for evaluation and dissemination of innovative technologies,
Interprofessional collaboration, Appropriation of knowledge, West Africa

* Correspondence: vlokossou@wahooas.org
1West African Health Organisation (WAHO), 01 BP 153 Bobo-Dioulasso 01,
Burkina Faso
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50
DOI 10.1186/s12961-017-0216-6

http://crossmark.crossref.org/dialog/?doi=10.1186/s12961-017-0216-6&domain=pdf

mailto:vlokossou@wahooas.org

http://creativecommons.org/licenses/by/4.0/

http://creativecommons.org/publicdomain/zero/1.0/

Background
The scientific literature has highlighted the role played
by steering committees (SCs) [1–5], monitoring commit-
tees and advisory boards in health research [6–13] and
healthcare [14, 15]. A SC is a group of actors (leaders
from among project stakeholders) who meet on a regu-
lar basis to decide on, guide and evaluate a project’s
implementation, and to recommend strategies on how
to best achieve the project’s goal and objectives. In a re-
search programme, SCs can play key roles in the devel-
opment of research, the transfer of research findings to
potential users (community, practitioners and decision-
makers) and the appropriation/use of findings by users.
Lemire et al. [16] have described the approaches, steps
and determinants of the knowledge transfer process.
The transfer or use of scientific knowledge cannot take
place without direct or indirect interaction between re-
searchers, actors/beneficiaries and decision-makers.
Close, continuous collaboration facilitates or guarantees
the success of the transfer and/or production and use of
findings. To achieve this, bringing stakeholders together
in a functional SC, in turn, supports the establishment
of dynamic collaboration. SCs have become indicators of
strong involvement in research by non-researcher actors,
which is a good strategy for establishing multiactor, mul-
tisectoral and multidimensional partnerships. Such part-
nerships allow the various parties’ needs, aspirations and
resources to be jointly taken into consideration [13].
Through the scientific literature [5], these different par-
ties and their technical and financial partnerships have
become well aware of the advantages of these commit-
tees. However, they are not aware or do not have a good
understanding of how these committees are established,
given that the same scientific literature rarely documents
the process for setting them up. According to Uneke et
al. [5], a health policy advisory committee is a mechan-
ism that can serve as an excellent platform for inter-
action between decision-makers and researchers. The
authors demonstrated that the establishment of a health
policy advisory committee can stimulate efforts by minis-
tries of health to apply evidence-based strategies to im-
prove their services. However, these authors, like many
others who discuss SCs, have not described how to estab-
lish these types of committees. This article helps make up
for the lack of scientific documentation on the process for
establishing SCs around a health research project.
In West Africa, knowing the advantages of these com-

mittees, the West African Health Organisation (WAHO)
promoted and supported their creation during the West
Africa Initiative to Strengthen Capacities through Health
Systems Research. This initiative aimed to strengthen
the capacities of researchers, actors and decision-makers
in health system research, and in the transfer and use of
health system research findings. To design this project,

WAHO started from the premise that, in West Africa,
many health indicators are low. Although numerous
health research findings exist, actors and decision-
makers make little use of them [17–19] due to limited ac-
cess to research findings, difficulties understanding the
findings, actors doubting or not accepting the findings,
findings that are contrary to the ways of thinking, acting or
being of non-researcher actors and researchers, and lack of
involvement by non-researcher actors in the process of
generating findings, among others [5, 17–20]. The different
actors in health systems research (researchers, practi-
tioners, decision-makers) are not mutually acquainted and
do not collaborate much, by profile or between profiles, by
country or between countries. Good practices in research
and/or health interventions are not visible or widely
shared. A culture of policies and practices based on scien-
tific evidence is also lacking [5, 17–21], particularly with
regard to feedback. This initiative is therefore WAHO’s
contribution to boosting, promoting and strengthening
collaboration between researchers, actors and decision-
makers through the establishment of health research pro-
ject SCs to increase the use of findings and improve equity
and governance in health systems. WAHO received finan-
cial support from the International Development Research
Center (IDRC).
At this stage of the initiative, the research teams are in

the process of analysing the findings of their research.
The SCs will utilise these findings to influence decision-
making in health policies and programmes. It is there-
fore difficult to make a statement about the effectiveness
of these SCs. A specific article will analyse the effective-
ness of these SCs 1 year after the initiative. However, a
study on how these SCs are established is possible at this
stage of the initiative’s implementation. Therefore, the
objective of this article is to describe and analyse the
process that was used to establish SCs around four re-
search projects under the West Africa Initiative to
Strengthen Capacities through Health Systems Research
to help other actors who wish to undertake this type of
collaborative tool.

Methods
This was a qualitative, descriptive, analytical study con-
ducted between February and April 2016 on the SCs or
monitoring committees of four projects under the West
Africa Initiative to Strengthen Capacities through Health
Systems Research. This initiative was implemented by
consortia of research or intervention organisations in
Burkina Faso, Nigeria, Senegal and Sierra Leone. The
consortia were made up of the research team and the or-
ganisations that the SC members came from. These con-
sortia addressed the topics of the development of a
process for assessing the performance of the district
health system (Burkina Faso); strengthening of the health

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 114 of 138

system through better, equal access to primary healthcare
(Nigeria); funding, equity and governance in the health
system (Senegal); and barriers faced by pregnant women
to free access to health institutions (Sierra Leone).
Our first step in this study was to conduct a literature

review by exploring various databases (primarily
PubMed and Cairn) using different keywords (Advisory
Committees, Professional Staff Committees, Committee
Membership; Steering; Information Transfer; Committee
for Evaluation and Dissemination of Innovative Tech-
nologies; Interprofessional Collaboration; Appropriation
of Knowledge). We also explored various documents
regarding the SCs of these four projects. We used this
review to build a better interview guide.
The target population for the collection of qualitative

data was made up of members of the SCs (referred to as
a ‘monitoring committee’ in Burkina Faso), researchers
from the research teams, and WAHO and IDRC staff
involved in this initiative. Within this population, re-
spondents were selected in a reasoned and expedient
manner. We capitalised on the peer review workshop
(meeting between the different research and intervention
consortia from the four countries) in Dakar, Senegal, in
February 2016 to collect data from participants. At least
two people (one researcher and one SC member) were
surveyed per country. This most often meant the lead re-
searcher and/or their representative and/or a researcher,
and the SC chairperson or their representative and/or an
SC member. Interviews were conducted with each respon-
dent(s) of a country until data saturation was reached. Sat-
uration was reached with a respondent when we felt we
had obtained all the information needed to satisfy the
study objective and continuing the interview would not
yield any new strategic information. However, over the
course of the analysis, email exchanges still took place
with respondents to obtain further strategic information.
The guide was administered to each respondent by the

same researcher/interviewer. This researcher/interviewer
was an independent consultant who was not a member
of either WAHO or IDRC, nor a member of one of the
research teams. However, this person was familiar with
this West African initiative. The guide was developed
around the following points: introduction of the re-
spondent, the process used to create the SC, the method
used to establish the SC, the SC’s composition, how the
SC operates, the SC’s resources and mission, strengths
and weaknesses of the process, and difficulties encoun-
tered, among others. Interviews were recorded and tran-
scribed in French. Although anonymity was maintained,
the respondents were aware that the resulting study re-
port and article would be accessible to all actors in the
initiative. It is possible that this situation prompted some
respondents to use ‘politically correct’ speech so as not
to harm any partners or stakeholders.

This study is characterised by its comprehensive ap-
proach [22], which seeks to understand the respondents
and the study topic. This approach placed a great deal of
importance on the respondents’ statements, motivations
(underlying drivers of an action or decision) and ratio-
nalities. It considered the context in which the four pro-
jects are being carried out. The study also used the
systematic approach [22], which favoured the principle
of circular causation and plural truths. From its design
through to its valorisation, this study adhered to the eth-
ical principles of scientific research in health. The position
of ethical relativism [22] in qualitative research was
adopted throughout this study. Finally, this study used
grounded theory on the data [23]. No initial hypothesis
was formulated. However, during the literature review, the
researchers were particularly interested in the findings or
explanatory models of other authors [1–4, 7, 9, 12, 13].
The data from this study was manually scrutinised as

it was collected. The technique of thematic analysis by
simple categorisation was used [22]. The selected cat-
egories included the SC’s creation, opportunities en-
countered during creation, difficulties encountered, the
SC’s composition, how the SC operates, and the SC re-
sources and mission. Each major finding was interpreted
(to give it meaning within its context) and then strength-
ened or rebutted by the writings of other authors.

Results
In total, 14 people, including four SC members, seven
researchers and three members of sub-regional (WAHO)
or international (IDRC) organisations participated in this
study. All participants had been involved in the initiative
since its inception.

Origin of the idea of establishing SCs
According to some respondents, the idea of establishing
the SCs was implicitly alluded to in the competitive call
for concept notes launched by the IDRC and WAHO in
August 2012. This call invited multipartite teams of re-
searchers, decision-makers and practitioners to present
concept notes on two eligible subjects, namely equitable
access to health systems, and health system governance
and governance structures. Moreover, Specific Objective
2 of this call specified that the initiative was aimed at
strengthening ties between multipartite groups of re-
searchers, practitioners and decision-makers charged
with tackling specific issues that they had identified
in advance. To be eligible for this call, one of the cri-
teria was that the application had to be presented on
behalf of a multipartite consortium consisting of re-
searchers, decision-makers and practitioners able to
define a problem with respect to strengthening health
systems and use the research findings to begin to
tackle that problem.

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 115 of 138

Finally, the call specified that applicant teams had to
consist of both researchers and partners and that a team’s
composition represented 20% of the selection criteria.
These factors therefore led to the idea of establishing an
SC in most of the consortia that responded to this call:

“From the project’s inception, we [Senegal’s Ministry of
Health and Social Action] were asked to first lend the
ministry’s political support, to show that this project,
by way of its formulation, could be of interest to the
Ministry of Health. So we wrote a letter of support for
the application.” (Member 1, Senegal SC)

Thus, the researchers identified the first partner organi-
sations that could or should be involved in the SCs (po-
tential partners) to establish their consortium and respond
to the call for concept notes. Around 60 West African
consortia prepared concept notes in response to this call.
Following a review process, seven proposals were prese-
lected based on strict technical criteria, namely relevance
and potential impact of the research project (40%), rele-
vance and potential scientific merit (40%), and compos-
ition of the teams and partnerships (20%).
To help the consortia better prepare their final sub-

missions for review, a protocol development workshop
was held in Bobo-Dioulasso, at WAHO headquarters, in
October 2012. During this workshop, the preselected
consortia interacted with specialists from the Regional
Advisory Committee established by WAHO and IDRC.
This time, the idea of establishing SCs was explicitly
suggested to the consortia:

“From the start of the process, at a regional dialogue
meeting organized in Dakar by IDRC in November
2011, when all participants in this dialogue chose
WAHO as the supranational institution to make a
proposal, WAHO’s main proposal was to implement
SCs around teams. This idea was well received by
IDRC. During the meeting with the seven preselected
teams in Bobo-Dioulasso, WAHO specifically included
the SC option. Beyond the research questions, research
design, methodological approach, and so on, the teams
were asked to take the SC’s establishment into account
and, therefore, be prepared to implement the SC upon
their return and involve them in the finalization of the
research questions discussed in Bobo-Dioulasso.”
(Interview with a WAHO official)

This information was confirmed by all the respondents,
who unanimously stated that the idea of establishing SCs
that bring together researchers, health practitioners and
decision-makers came implicitly and explicitly from
WAHO. By promoting and supporting the creation of
these SCs, WAHO was working from the premise that

gathering researchers, actors/stakeholders and decision-
makers within a functional framework of regular meetings
would have numerous consequences. It allowed them to
co-define a highly practical research topic based on the
needs and aspirations of actors and decision-makers, while
considering the resources, skills and capacities of re-
searchers. It promoted the co-production of evidence-
based findings and the communication of these findings.
It allowed the mutual appropriation of these findings so
they could be used or converted into action to benefit a
community or the general public.
All the researchers interviewed recognised that the

idea of establishing these SCs was explicitly expressed
during that meeting. According to one researcher, the
idea of establishing the SCs seemed “natural” in this ini-
tiative, because everything (the call for concept notes,
the recommendations from the Regional Advisory Com-
mittee specialists, the researchers’ experience) was point-
ing to these SCs being indispensable:

“The idea of setting up an SC arises out of several
concerns. First, the call for applications clearly
stipulated that applicants must clearly show how they
planned to achieve a certain degree of appropriation
and use of their research findings… But beyond all of
that, it was also a recurring concern. In general, at the
ministry here [Burkina Faso], it is fairly systematic
when we want to carry out these types of activities.
Ministry actors are closely involved from the
beginning. What we typically do is set up an SC or a
monitoring committee.” (Member of the Burkina Faso
research team)

After the meeting with the specialists, four consortia
were selected. These consortia participated in a research
protocol development workshop in Dakar in May 2013,
and each one met again with its country’s Ministry of
Health, an organisation that had to be involved in the con-
sortium to have the chance of being selected definitively.

Establishment of the SCs
In each country, the SC’s establishment truly began after
the definitive selection of the consortium. Once the re-
searchers, namely the leaders of these consortia, were
certain that they had been selected, they began by notify-
ing other potential partners of their consortium. Each
lead researcher established a list of potential SC mem-
bers and met with the country’s Ministry of Health to
discuss the SC’s establishment. In general, in addition to
email and telephone exchanges, two or three informal
meetings were needed to obtain the quasi-definitive list of
SC members and organisations. Based on the data collec-
tion area and the topic addressed, the researchers identi-
fied the organisations most affected by their research and

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 116 of 138

its findings. This list was amended by the Ministry of
Health to obtain the quasi-definitive list. In each selected
organisation, the top official designated their representa-
tive, and the choice was left to the top official’s discretion.
In most of the four countries, a document from the Minis-
try of Health or local health authority formalised the SC’s
creation. Each SC was linked to the Ministry of Health via
the organisation in charge of the said Ministry’s research;
this organisation was SC chair.
Once the SCs were established, a first official meeting

was organised to give members an opportunity to get
better acquainted, introduce themselves and amend the
research protocol. During this meeting, the SC was offi-
cially launched via a statement made before the health
authorities.

Factors that facilitated the SCs’ establishment
According to the respondents, there were certain facts,
actions or situations that facilitated the SCs’ creation.
Respondents unanimously cited the commitment, deter-
mination and support of WAHO, which, as a supra-
national organisation, directly asked each country’s
Ministry of Health to get involved at all stages of the
project in their country (the SC’s creation, design, imple-
mentation, valorisation, transfer and use of findings).
This was confirmed by a WAHO official:

“To encourage the SCs creation, the WAHO Director
General sent a letter to each Ministry of Health
concerned. In the letter, the Minister of Health was
asked to make their skilled services available to work
with the research team. WAHO introduced these
teams and their research topic and asked for the
ministry’s commitment to facilitate all the research
and the use of the findings. WAHO also travelled to
each country to support them in establishing the SCs.”
(WAHO official)

In each country, the actors recognised that the commit-
ment of the Ministry of Health on a national (Burkina
Faso and Senegal) or local (Nigeria and Sierra Leone) level
and the Ministry’s experience in establishing SCs for simi-
lar projects also facilitated the SCs’ creation:

“The Ministry of Health and Social Action is
accustomed to establishing SCs. In general, when it
wants to set up an SC, it tries to take all actors into
account from the beginning and involve them as much
as possible in the activities. This generally includes
everyone: Ministry of Finance, the Assembly, the
economic council, the environmental, schools, the
university, society, and so on. The ministry really tries
to cast a wide net. And the ministry is accustomed to
doing so.” (Member 2, Senegal SC)

According to the respondents, in addition to these com-
mitments (supranational and national), in each country,
the lead researcher was invested at several levels (tele-
phone or Skype calls, sending emails, informal meetings).
Aside from these multifaceted investments, collabor-

ation experiences between the lead researchers and the
Ministry of Health, their contacts or the extent of their
relationships within the Ministry of Health greatly facili-
tated the SC’s creation. Finally, positive perceptions of
the teams, the research topic and the logic/design of the
SC facilitated the non-financial motivation and support
of potential SC members, who agreed to be SC members
on a volunteer basis.

Size and composition of the SCs
The size of the SCs (number of members per SC, includ-
ing at least two researchers) varied from one country to
another. There were 10 members in Burkina Faso, 18 in
Sierra Leone SC, 20 in Senegal and 23 in Nigeria. Ac-
cording to the respondents, there was no quota set for
men/women per country on the SCs, but in each coun-
try, at least one-fifth of the members were women. The
actors opted more for representation by institution or
department than by sex. Each institution/department en-
rolled in the SC was free to choose the right person
from within its ranks to be on the SC. In each country,
the SC’s official charter specified that, based on the ac-
tivities, the SC members could enlist other members or
organisations. From the SCs’ establishment to the time
of the survey, the number of members per SC had not
changed. However, due to occupational mobility in the
positions or institutions, the individuals comprising the
SCs often changed. In these cases, these individuals were
replaced systematically, without this affecting the func-
tioning of the SC. For example, this was the case in
Senegal with the death of the WAHO Focal Point, and
in Sierra Leone with the transfer of the Bombali District
hospital’s chief physician.
As for the SCs’ composition, each country established

multisector SCs. This composite make-up was in line
with one of WAHO’s strong recommendations:

“WAHO insisted on the idea of setting up an SC,
making it as heterogeneous as possible, and that the
members be actors affected by the study, with the
possibility that these actors could even begin using the
intermediate findings prior to the end of the research
project.” (Interview with a WAHO official)

In all four countries, members came from the following
sectors: parliament (local representatives), communica-
tions and information (journalist), health (administrative
and operational health officers), transportation, teaching
and education, defence and security (police, gendarme),

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 117 of 138

and civil society (health protection and promotion associ-
ation). The SCs of Sierra Leone, Nigeria and Senegal,
composed of more than 10 people, were more heteroge-
neous than the SC of Burkina Faso (10 members), which
was essentially, even exclusively, made up of members
from the health sector. The fact that this study is strictly
limited to the process of establishing SCs does not allow
us, at this stage, to determine the impact of each SC’s
composition choices.

Roles/missions of the SCs
Overall, the SCs took on roles or missions in three areas.
First, to facilitate research, the SCs had the mission of
validating, amending/adjusting research projects, sup-
porting researchers in the implementation of their re-
search, and external validation of the research findings.
Second, the SCs also had the mission of facilitating the
transfer of research findings to their potential users.
Finally, the role of SCs was to facilitate the appropriation
and use of research findings.

SC operations
For operational purposes, the SCs’ creation was forma-
lised by ministerial order (Burkina Faso and Senegal) or
formal terms of reference (Nigeria and Sierra Leone).
WAHO stated that it did not insist too much on the
SCs’ formalisation because the entire West Africa Initia-
tive to Strengthen Capacities through Health Systems
Research is based on the ‘doing by learning’ strategy. For
the countries, this meant establishing their SCs by
adopting a less specific, non-pre-established process of
doing to set up their SCs and learning lessons over the
course of this action. Too much formalisation would
therefore stifle learning:

“It is truly an initiative that is based on learning by
doing. Each country had to set up its SC based on its
own context. WAHO did not want to formalize, or
impose, a standard format on the countries. Moreover,
overly administrative formalization could make the
researchers back away. Instead, the researchers had to
be encouraged to work, to approach all the
stakeholders in order to set up the SCs.” (Interview
with a WAHO official)

The SCs operated with financial resources held by the
IDRC-funded research teams. Material resources came
from the research teams or from the SC chairs’ organisa-
tions. SC meetings were led by their chairperson. Within
all the SCs, decisions were made by consensus. Members
never relied on voting to decide. There was no established
quorum to be reached to validate the SC meetings. In
practice, members attended the various meetings most of
the time. The SCs operated on a volunteer basis; over the

course of the meetings only the members’ transportation
or fuel was reimbursed. This was agreed to by the mem-
bers, who, for the most part, were accustomed to this way
of doing things with other partners. The promoters of
these SCs (WAHO, researchers and the Ministry of
Health) justified this choice out of their common concern
for ensuring the SCs’ sustainability/systematisation in the
most cost-effective manner, considering the scarcity of
financial resources. There was no formal or direct link
between the four SCs. However, annual meetings of the
initiative’s consortia provided opportunities for meetings
between the research teams, SC chairpersons, and WAHO
and IDRC specialists/experts. These meetings allowed for
the sharing of experiences and the strengthening of collab-
orations between actors within a country and from one
country to another. WAHO oversaw the monitoring and
regional coordination of the initiative.
Each SC planned two meetings a year. In 3 years, the

actual number of SC meetings varied from three in
Senegal, to four in Sierra Leone, and to five in Burkina
Faso and Nigeria. For one meeting, the researchers took
over for the SC chairperson, submitting the draft agenda
to him. After amending it, the chairperson officially con-
vened the other members of the SC.

Assessment of the SCs’ impact
The respondents had a positive impression of the SCs in
terms of composition, institutional anchoring and opera-
tions. In each country, the SC’s anchoring to the Minis-
try of Health was perceived as a strength that enabled it
to fully play its role in the three areas (facilitation of re-
search, transfer of research findings and the use of these
findings). All three parties involved (researchers, actors/
stakeholders and decision-makers) were happy to be on
an SC that would make the co-production and co-
utilisation of research findings possible. The establish-
ment of these SCs in the different countries met an im-
plicit expectation of the parties. In Nigeria, for example,
the federal Ministry of Health made an official request
to WAHO to better understand and become more in-
volved in the programme. Formal ties were established
between the Delta State Ministry of Health (which runs
the SC) and Nigeria’s Federal Ministry of Health. These
ties should provide for better co-production of policy
briefs and facilitate their appropriation and use. One in-
dicator of the SC’s acceptance by national health author-
ities is having the SC members appointed/designated by
way of an official document and agreeing to have one of
the specialised organisations head the SC. On the other
hand, the respondents regretted the lack of financial
autonomy of the SCs, which relied heavily on the re-
searchers, without whom the SCs could not meet. In
Sierra Leone, the SC operations were disrupted for a
long time (from May 2014 to November 2015) by the

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 118 of 138

Ebola virus epidemic. Some respondents lamented the
fact that the SC members’ skills were not strengthened
in terms of facilitation and operations, support for re-
search, and transfer and use of research findings. How-
ever, according to the respondents, the various regional
meetings and support visits from the WAHO team and
from technical experts in the countries provided oppor-
tunities to share ideas on potential approaches to facili-
tation, support for research, and transfer and use of
research findings by the SC members present.

Actors’ roles in the SCs’ establishment and operations
In this West African initiative, IDRC supported WAHO
financially. IDRC also directly supported the country re-
search teams in conducting their research for practical
purposes. IDRC approved WAHO’s initiative and its SC
development strategy through the ‘doing by learning’
principle. Financial support from IDRC was a way of
helping WAHO explore the SCs’ value and their capacity
to influence health policies and practices in West Africa.
WAHO played a managerial (sub-regional interface) and
technical role. Due to its status as a supranational organ-
isation, it encouraged the research teams to go to their
Ministry of Health, and it asked the ministries to sup-
port its researchers and facilitate the SC’s establishment,
operations and achievements. WAHO also oversaw the
SCs’ activities, partially from a distance and partially up
close. The mission of the Ministries of Health was to fa-
cilitate the SCs’ establishment and operation. Except for
the reimbursement of the SC members’ fuel expenses
and lunch expenses during meetings (which were cov-
ered by the researchers on IDRC funding), the ministries
hosted the SC meetings, providing meeting rooms and
covering related costs (water, power, maintenance costs,
audio-visual equipment). The role of the researchers was
to establish the SCs in close collaboration with the Min-
istry of Health, facilitate the organisation of regular SC
meetings, conduct research in close collaboration with
other SC members, regularly report on the progress of
their research and/or regularly share their findings with
other SC members. The role of the other SC members
was to participate regularly in SC meetings, guide the
entire research process to produce highly practical data,
promote and facilitate knowledge transfer, appropriate
this knowledge and use it to improve the health of the
target populations.

Difficulties encountered in the SCs’ establishment and/or
operation
The respondents from Nigeria reported that there were
no major events that significantly disrupted the establish-
ment of their SC. In Burkina Faso, the team of researchers
cited administrative formalities and staff mobility issues as
slowing down the SC establishment process.

Additionally, given that they were conducting research
in two regions of Burkina Faso, Burkinabe researchers
attempted to set up one SC and two regional commit-
tees. After a year of wavering, they realised that it would
be difficult for these regional committees to function
due to the project’s limited financial resources. However,
the research team used official and informal means of
communication to collaborate with health officials from
the two regions to collect data and hold the planned de-
liberative workshops.
In Sierra Leone, the respondents acknowledged that

they hesitated for some time on the geographic location
of their SC. For greater effectiveness and efficiency, they
debated whether it should be in Freetown or in Makeni
(capital of the Bombali district where most of the re-
search took place). In the end, the SC was set up in
Makeni, where the research team and local stakeholders
are based. The research team and WAHO then had to
maintain regular contact with national officials at the
Ministry of Health, which was made possible through
frequent WAHO visits in Sierra Leone and the research
team’s formal and informal meetings with the Ministry
of Health. Another hesitation was regarding the role or
mission to be allocated to the SC. Should the SC con-
duct the research or support the researchers in imple-
menting the research? In this case, this was mainly due
to the enthusiasm of certain SC members who wanted
to participate directly in the field data collection process.
Both the research team and WAHO, during support
visits, could provide clarifications on this issue. The
Sierra Leone consortium perceives these two forms of
hesitation as major difficulties that delayed the establish-
ment of their SC.
In Senegal, given that the research was conducted by

research professors from the Université Cheick Anta
Diop, and therefore under the auspices of the Ministry
of Higher Education, the actors hesitated about the SC’s
institutional backing – should it be anchored to that
ministry or to the Ministry of Health and Social Action?
In response to this dilemma, the Senegalese research
team first attached its SC to the Ministry of Higher Edu-
cation. Learning quickly from its mistakes, it then at-
tached itself to the Ministry of Health and Social Action:

“The initial actions were carried out by Higher
Education. This did not facilitate the mobilization of
this committee; people thought it was a university
matter.” (Member 1, Senegal SC)

WAHO sent the Senegalese Ministry of Health an offi-
cial correspondence and copied the research team on
that correspondence, ultimately facilitating the team’s
decision to collaborate mainly with the Ministry of
Health. In addition, it should be noted that, beyond the

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 119 of 138

formal meetings, there were regular telephone and email
exchanges between the research team and certain con-
tact persons from the Ministry of Health, particularly to
obtain certain evaluation documents or financial studies
that were already available at the ministry.

Discussion
Origin of the idea of establishing SCs
It is obvious that, in the four countries of this West Africa
initiative, the idea of establishing SCs was implicitly and
explicitly suggested by WAHO. Therefore, it was this or-
ganisation that promoted and supported the SCs’ opera-
tions. Various factors explain this involvement of technical
and financial partners in the promotion and support of
the SCs’ operation. In this and other contexts, researchers,
decision-makers and practitioners often lack a profes-
sional culture that is conducive to the creation of quasi-
permanent concerted action frameworks for co-decision
and co-action, but it is also often the case that there is an
objective or subjective lack of financial resources to organ-
ise a minimum number of productive meetings. The in-
volvement of a technical and financial partner has the
advantage of providing these resources, but the potential
disadvantage is the building of unsustainable SCs that op-
erate only to satisfy this partner.
The scientific literature [1, 5, 8, 13] shows that differ-

ent actors (the community, authorities, researchers, or
technical and financial partners) can collectively, or
through concerted action with others, initiate the estab-
lishment of a committee. A committee’s appropriation,
autonomy and sustainability come more easily if the idea
or need to establish it and the financial resources for it
come from the community, beneficiaries or authorities.
It becomes more difficult when these come from re-
searchers and/or their technical and financial partners.
In the latter case, the committee’s existence is perceived
as a ‘researchers’ thing’ and is very often tied to the ex-
istence of the research project [1, 8, 13]. Other non-
researcher actors take more time to appropriate it and
to mobilise the resources required for its sustainability.
In the context of this initiative, the volunteer nature of
the work [24, 25], and the reduction of the SCs’ operat-
ing costs, should facilitate their appropriation and sus-
tainability by the ministries of health concerned and
even help to export the model to the 11 other member
nations of the Economic Community of West African
States (ECOWAS). One of the originalities of this SC
model is not the SC as such, since, to varying degrees,
each country had its positive and negative experiences
with the SCs. The originality lies more in the involve-
ment of a supranational organisation (WAHO) finan-
cially supported by an international organisation (IDRC)
and the role played by the former.

Establishment of the SCs
This study shows that the availability or the guarantee of
availability of financial resources is a leverage for the
process of establishing an SC. Without a minimum of fi-
nancial resources, if only for coffee or lunch breaks at
SC member meetings, it is difficult to attract volunteers
for the committees. To establish a committee and make
it operational, a minimum of financial resources is there-
fore required. Moreover, in a committee, the one holding
the financial resources is also the one holding and/or
monopolising the strategic issues. In this West African
experience, WAHO and IDRC – as the technical and fi-
nancial partners of each country’s consortium – had a
certain power (of mobilisation, direction) over the re-
searchers, who also had power over the rest of the con-
sortium’s actors. Therefore, the researchers, as the ones
holding the financial resources, were the architects and
leaders in the establishment and operation of the four
committees. Even though they did not hold the position
of SC chairperson in each country, the fact that the re-
searchers held the financial resources meant that they
were the SCs’ invisible chairpersons. Within the SCs,
nothing strategic could be decided without their con-
sent. The SC chairs set the date, time and agenda of the
SC meetings based on the researchers’ suggestions.
Therefore, it was the other non-researcher actors who
marched to the beat of the researchers’ drum, not the
other way around. This way of doing things has advan-
tages and disadvantages, but these will not be properly
documented until after the initiative’s overall evaluation
is complete. The researchers’ leadership role was granted
to them by WAHO and IDRC through the call for con-
cept notes and through their funding of the committees.
The granting of this role illustrates the confidence that
WAHO and IDRC had in the researchers, which un-
doubtedly impacted the quality of their involvement.
Furthermore, the granting of this leadership role to

the researchers also illustrates WAHO’s vision, namely
that the SCs should ultimately be established by the re-
searchers. We are therefore in a logic of research (first)
and action (later).
These SCs were also set up through the involvement

and determination of WAHO. This supranational organ-
isation, by virtue of its status and missions, has political,
technical and financial power over the ministries of
health (taken individually) of ECOWAS member coun-
tries. Its involvement strengthens the credibility of con-
sortia that defend both national and regional causes. The
involvement of a strong partner such as WAHO facilitates
the establishment of committees insofar as each member
organisation of a country’s consortium is generally limited
to finding actors who are willing and available to fulfil the
role that is expected of them. However, in reality, re-
searchers and/or actors often need multifaceted support

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 120 of 138

(informational, emotional, material, technical or financial)
from their partner to initiate, operate and sustain their SC
or advisory committee [13]. To establish the SCs in each
country, the researchers drew heavily on their experience
and knowledge of the field.
The double selection (pre-selection from concept

notes and protocol-based selection) allowed WAHO and
IDRC to choose the best candidates. The scientific litera-
ture [7, 9, 12, 13] shows that, to establish an SC or advis-
ory committee, when the researchers are unfamiliar with
the field, they do a quick qualitative study using the par-
ticipative or classic method to identify potential mem-
bers of their committee. In the context of this West
African initiative, the research teams’ experience and the
involvement of each country’s Ministry of Health meant
that this approach was not necessary.

Factors that facilitated the SCs’ establishment
In addition to WAHO’s involvement, the involvement of
each country’s Ministry of Health also facilitated the set
up and operation of the committees. This initiative’s po-
tential benefits to these ministries explain their commit-
ment. Moreover, the experiences of ministries and the
organisations comprising the committee also facilitated
its establishment.
In general, the more naive the organisations or indi-

viduals are about something new, the more reluctant
they may be to get involved. Experience with similar ini-
tiatives strengthens self-confidence to get involved with
a new one. Anchoring the SCs to the ministries of health
(public and quasi-permanent organisations) also allowed
the SCs to be operational, and it facilitated their appro-
priation and probably their sustainability by health policy
authorities.
Certain factors associated with the lead researchers

(history of collaboration with potential committee mem-
bers, degree of penetration within the Ministry of
Health) also greatly facilitated the SCs’ creation. We re-
affirm that, through their consortium pre-selection and
selection process, WAHO and IDRC gave themselves a
double opportunity to secure consortia with the most
experienced lead researchers who were motivated to
achieve the initiative’s objectives. Additionally, after hav-
ing applied twice to be chosen, the lead researchers felt
‘responsible’ for the successes and failures of the country
project, which explains their great determination. Finally,
the enthusiasm and motivation of potential members
who became actual committee members also facilitated
the SCs’ establishment and operation.
They were motived by the commitment of the re-

searchers, health authorities, the issue being tackled and
the committee design. Often, with or without conviction,
subordinates passively or actively go along with initiatives
that are already supported by their superior because they

believe or do not want to destroy the quality of their rela-
tionship with their employer. In the context of this West
African experience, it was essentially the SC members’
motivation that led them to participate as volunteers.
In summary, a non-financial motivation system mobi-

lised all country actors, as well as WAHO, in the commit-
tees’ establishment and facilitation. Systematically, the
motivation of each actor/member drove and strengthened
the motivation of the other actors. In other words, the
motivation of IDRC motivated WAHO. This, in turn,
strengthened IDRC’s motivation. The motivation of the
technical and financial partners motivated the researchers,
ministries of health and other actors. Their motivation, in
turn, reinforced the technical and financial partners’
motivation. This motivation system is a key aspect that
fostered the creation and operation of each SC with volun-
teer members.
The ‘doing by learning’ strategy, or flexibility in the ap-

proach to the SCs’ establishment, was also beneficial,
allowing for the adoption of an approach adapted to the
contexts, strengths and obstacles of each country.

Impact assessment
According to the respondents, the strengths of this SC es-
tablishment process lie in its composition, its institutional
anchoring and its operation. This has already been
highlighted in the scientific literature [1, 3, 4, 6, 8, 10, 13,
24, 26–28], which adds that interpersonal, organisational,
human and financial factors influence the SCs’ success
and that the SCs’ institutional anchoring determines their
weight or capacity to influence policies. In the context of
this West African initiative, the SCs’ size and the mem-
bers’ profiles varied by country. While encouraging them
to establish SCs, in keeping with its ‘doing by learning’
logic, WAHO left it up to the countries to freely establish
their SC. In terms of committee establishment, there is no
set rule regarding the size or specifying its composition
[18]. The creation of an SC is like an artistic creation,
where nothing is done at random, nor is it done according
to a pre-established rule. The approach for establishing
SCs is therefore systematic; in other words, it is circular
(back-and-forth actions are possible during the process)
and adaptable to the socio-political and organisational
context, the topic explored, and the needs and aspirations
of potential SC members in each country. The approach is
also comprehensive, aware of the potential actors/mem-
bers and the context. The flexibility/adaptability of the ap-
proach also facilitated the SCs’ creation and operation.
This is why the SCs’ composition varied from one country
to another, depending on the context. For example, to
conduct research on the barriers faced by pregnant
women to free access to health institutions, Sierra Leone
established a committee consisting of officials from the
transportation, defence and security sectors.

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 121 of 138

The themes or social facts studied by the consortia in-
volved multiple sectors; therefore, the countries also
established heterogeneous, multisector SCs to obtain con-
certed, multisector responses. It is true that the four SCs
had no direct link between each other. However, there
were exchanges by affinity. Furthermore, the fact that the
four countries’ SCs adopted nearly the same mission is
proof that the country consortia communicated with one
another directly and/or through WAHO, which provided
a form of supervision over the initiative’s work.
Two major facts can be considered weaknesses of the

process, namely the lack of financial autonomy of the
SCs, which were closely dependent on the researchers;
and the lack of SC member training in the facilitation
and operation of the SCs, research support, and the
transfer and use of research findings. Granting leader-
ship of the SCs’ to the researchers was the desire of
WAHO, which wanted to test this model and learn from
it. The upcoming report on the SCs will reveal the les-
sons learned.

Actors’ roles in the SCs’ establishment and operations
Although IDRC limited itself to providing financial sup-
port to WAHO and the research teams/consortia, most
actors/researchers from this initiative perceive it as being
the sponsor of the research developed in each country.
Many things were implemented by considering the time-
frames and indicators validated by IDRC. Within some
research teams, this project is distinguished from other
projects by the IDRC project acronym. Sometimes things
are carried out as though the researchers were seeking
to satisfy IDRC first, then WAHO, and finally the Minis-
try of Health. In other words, the researchers thought
that their accountability to the financial partner and
technical partner was greater than to the collaborating
or beneficiary partners. This situation or the researchers’
sense of accountability to the financial partners is under-
standable, given the context of the scarcity of resources
allocated to research. The one who holds the financial
resources is systematically the one who controls the re-
search issues.
In this initiative, WAHO’s power was reduced by the

fact that it was not the organisation authorising the
funds for each country’s researchers/consortium. The
fact that they obtained financial resources directly from
IDRC and had to justify these funds to that organisation
made them feel more accountable to IDRC than to
WAHO.
The different countries’ ministries of health were con-

tent to play the role delegated to them by the technical
and financial partners and researchers. No ministry
made an individual contribution in terms of financial re-
sources to develop the initiative beyond the resources
granted by IDRC.

Difficulties encountered in the SCs’ establishment
Unlike the factors that facilitated the committees’ establish-
ment (factors that were common to the four countries),
the factors or situations that made their establishment dif-
ficult were country specific. Apart from Nigeria, the coun-
tries reported difficulties such as administrative formalities
and staff mobility (Burkina Faso), and hesitation regarding
institutional anchoring and/or the SC’s missions (Senegal
and Sierra Leone). Issues about belonging to an SC and/or
the control of said committee explain these difficulties.
While being members of the same consortium or com-

mittee, the actors, whether rational or strategic [29], de-
velop techniques of varying degrees of effectiveness to
control the committee and increase their power and their
gains. This led to hesitation, power struggles or increased
complexity of procedures. In this type of situation, offi-
cially, each actor tries to put their best foot forward and
help the group establish the best committee. In practice,
according to Cinq-Mars [3], various sources of influence,
including the protection and strengthening of one’s discip-
line/institution, defence of one’s interests and preference
for a particular theoretical model (that helps make their
sectoral and institutional identity the cornerstone), deter-
mine the quality of the collaboration.

Conclusion
The West Africa Initiative to Strengthen Capacities
through Health Systems Research conceived by WAHO
allowed heterogeneous SCs to be established in Burkina
Faso, Nigeria, Senegal and Sierra Leone. This required
the involvement of WAHO as a supranational structure,
the leadership of researchers, the commitment of health
authorities and committee members, and a non-financial
motivation system. The involvement of technical and fi-
nancial partners motivated the researchers and minis-
tries of health, who, in turn, motivated other actors to
participate in the SCs on a volunteer basis. The ‘doing
by learning’ approach made it possible to develop strat-
egies adapted to each context to create, facilitate and op-
erate each SC and manage its difficulties. Individual
factors (such as leadership by the researchers), collective
factors (such as the reciprocal motivation system), intra-
country factors (commitment and motivation of the
health ministries) and supranational factors (political
and technical support of WAHO, technical and financial
support of IRDC) contributed greatly to the success of
the SC establishment process. This experience shows
that, when the technical and financial partners of health
policy authorities, researchers and non-researcher actors
come together to stimulate and support the creation and
operation of SCs, these committees have a greater
chance of success. To reproduce such an experience, a
strong understanding of the local context and the in-
volvement of strong, motivated partners are required.

Keita et al. Health Research Policy and Systems 2017, 15(Suppl 1):50 Page 122 of 138

Abbreviations
ECOWAS: Economic Community of West African States; IDRC: International
Development Research Centre; SC: steering committee; WAHO: West African
Health Organisation

Acknowledgments
The authors thank the researchers and members of the Steering Committees
of Burkina Faso, Nigeria, Senegal and Sierra Leone who voluntarily agreed to
participate in this study.

Funding
This study was conducted under the IDRC grant to the WAHO Primary
Health Care Unit. Publication costs were funded by IDRC.

Availability of data and materials
All data is available from the authors.

Authors’ contributions
All authors contributed equally to this article. All authors read and approved
the final manuscript.

Competing interests
The authors declare that they have no competing interests.

Consent for publication
Not applicable.

Ethics approval and consent to participate
This study can be considered documentation of an experience with
establishing SCs in West Africa. Therefore, it is not subject to review by an
ethics committee. The study has not been submitted to any ethics
committees. However, it has remained ethical from its conception through
to its valorisation – it concerns a subject that is of interest to all stakeholders,
and is of scientific and practical use to the countries involved and to the
actors involved. Participation in the study was free and voluntary, and
anonymity and confidentiality were guaranteed; in short, basic ethical
principles were adhered to.

About this supplement
This article has been published as part of Health Research Policy and Systems
Volume 15 Supplement 1, 2017: People and research: improved health
systems for West Africans, by West Africans. The full contents of the
supplement are available online at https://health-policy-
systems.biomedcentral.com/articles/supplements/volume-15-supplement-1.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.

Author details
1West African Health Organisation (WAHO), 01 BP 153 Bobo-Dioulasso 01,
Burkina Faso. 2Muraz Centre, 01 BP 390 Bobo-Dioulasso 01, Burkina Faso.

Published: 12 July 2017

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