INTRODUCTION:
South Africa’s move toward universal health coverage through National Health Insurance (NHI) requires robust and transparent systems for evidence informed decision making (EIDM). Yet, decision processes across the health system remain fragmented, with unaffordable or ineffective interventions adopted or retained without structured evaluation. The Evidence to Decision (E2D) Collaboration aims to advance a harmonised national evidence support system capable of producing timely, trustworthy and context relevant guidance for health and social care. Here we outline the goals, overarching methods and activities underpinning this collaboration.

METHODS:
The E2D collaboration is a 3.5-year partnership between the National Department of Health (NDoH), the South African Medical Research Council and Stellenbosch University, building on decades of collaborative work in evidence synthesis, guideline development and policymaker engagement. Its goals include strengthening methods for national decision-making, producing responsive evidence, expanding capacity to do and use evidence synthesis, optimising digital evidence tools, promoting patient and public engagement, and evaluating the collaboration. Each goal is co-led by partners and implemented in collaboration with the NDoH and its Ministerial Advisory Committees. The collaboration aligns with global standards, embedding factors crucial for institutionalising EIDM: clear governance and leadership; standardised and streamlined processes; embedding capacity building; and continuous relationship-building across partners and national stakeholders1,2.

RESULTS:
We produced national standards for EIDM3 to develop trustworthy healthcare guidance. We are producing evidence syntheses to inform national guidance, including adolopment of existing guidelines for better efficiency4. We developed a training strategy and delivered EIDM-related training to NDoH committee members, researchers, students, and health professionals. We initiated interest-holder engagement to advance our approach to engage patients and the public in national decision-making.

CONCLUSIONS:
Through the E2D Collaboration we are co-creating a system to strengthen evidence-based, transparent, efficient and context-relevant decision-making processes in South Africa to support successful NHI implementation.