TY - JOUR T1 - Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00061 VL - 10 IS - Supplement 1 SP - e2200061 AU - African Health Initiative Partnership Collaborative for Embedded Implementation Research Y1 - 2022/09/15 UR - http://www.ghspjournal.org/content/10/Supplement_1/e2200061.abstract N2 - Key MessagesEngaging policy decision makers and implementation teams elicited critical input on root causes of implementation problems, prioritized which factors to address and how, and determined what questions to ask and answer to best guide primary health care policy implementation.Integrating decision makers in program research leadership roles allowed data collection, analysis, and dissemination to align with planning cycles during which new findings could be reflected on pragmatically and, if appropriate, used to guide program implementation.Multidisciplinary partnerships between policy decision makers, implementation leaders from district health systems, and local research institutes fostered collaboration in cocreating implementation strategies and research plans and emphasized knowledge and experience sharing.Embedded IR was influenced not just by individual leadership and local implementation climate but the overarching organizational culture in which the African Health Initiative partnerships were themselves embedded nationally.The degree to which embedded IR leads to meaningful and lasting change in health systems is affected by opportunities for, and impediments to, disseminating and absorbing new knowledge.Achieving universal health care coverage requires the adoption of primary health care policies and delivery strategies that are evidence based. Although this has been confronted by manifold challenges, particularly in the health systems of sub-Saharan Africa, there are promising approaches for accomplishing this objective. Salient among these is embedding implementation research (i.e., the study of methods to promote the systematic uptake of evidence-based interventions (EBIs) into routine practice) into policy making and implementation processes. Since 2007, the African Health Initiative of the Doris Duke Charitable Foundation supported partnerships that strengthened primary health systems and policy implementation in 7 countries in sub-Saharan Africa using the embedded implementation research as a core strategy. This programmatic review and analysis aims to identify the core features and processes that characterized how the partnerships operationalized the embedded implementation research approach and understand the factors that helped and constrained partnerships’ effective use of this approach. For this, we drew upon findings from a desk review that consisted of 30 examples of embedded implementation research conducted by 3 African Health Initiative partnerships between 2016 and 2021 in Ethiopia, Ghana, and Mozambique. In addition, we conducted and analyzed 13 in-depth interviews with embedded implementation research stakeholders of the 3 projects. Core features and processes of embedded implementation research were: (1) the leadership role of policy decision makers and implementation leaders; (2) positioning research with program implementation at multiple levels of health systems; (3) multidisciplinary and multisectoral partnerships; (4) focus on research capacity building; and (5) real-time feedback loops and knowledge translation. Factors influencing the effectiveness of the embedded implementation research experiences involved: (1) the implementation climate and leadership; (2) opportunities and capacities to circulate and absorb new information; and (3) stakeholders’ baseline knowledge and embedded scientists’ identification within their organizations. ER -