Health PolicyImplementation research: new imperatives and opportunities in global health
Introduction
In global health, many specific interventions can be effective at low cost in relatively controlled environments, in short-term studies, or on small scales.1 However, building strong and responsive health systems that promote health and wellbeing through sustainable strategies that work on a large scale remains an important challenge, particularly in low-income and middle-income countries (LMICs).
Internationally, the need for implementation research could not be greater or more timely. The Sustainable Development Goals (SDGs) and national commitments for universal health coverage require effective implementation of proven interventions to improve health outcomes and ensure that no communities are left behind and all benefit from improved health and wellbeing. Implementation research provides a set of approaches, methods, tools, and ways of bridging research and practice to address these issues. Implementation research offers a renewed focus on how to accelerate the development and delivery of services that improve and sustain health and wellbeing for all people, including those who are most disadvantaged.
The aim of this Health Policy is to present the characteristics that define implementation research and their application in global health through case studies. We show how evidence can inform practice, and the potential of implementation research to make a positive impact on health across different contexts and implementation problems using a range of research methods in LMICs. The case studies highlight contexts in which achieving SDGs and universal health coverage presents heightened challenges.
Section snippets
Defining implementation research
Implementation research builds on several research traditions (panel 1), and each of these research traditions has developed its own set of core disciplines, primary audiences, and typical sets of research questions (table 1).1, 2, 3, 4 In part because of the so-called invisible colleges that have formed from the different traditions, the field of implementation research in health has yielded considerable debate over its scope, theories, methods, terminology, and areas of emphasis (panel 2).
Methods to synthesise learning on implementation research
We selected and analysed numerous case studies of implementation research projects in differing LMIC contexts within a framework of core characteristics of implementation research. The framework and selection of case studies was informed by a set of five structured and consultative international meetings that were held between 2012 and 2016 (panel 3), bringing together researchers, donors, and policy makers to identify problems and opportunities related to implementation research, build
Smallpox eradication
The smallpox eradication campaign remains the only successfully completed global health eradication campaign to date. One of the most dramatic and effective uses of implementation research involved testing a new implementation strategy for smallpox eradication using real-time data. The purposeful application of different research approaches was crucial to the success of the smallpox campaign. These approaches included research on different ways to deliver vaccines, such as the bifurcated needle
Ghana
The Community Health and Planning Services (CHPS) is the most local level at which public health services are delivered in Ghana. CHPS started as a family-planning research project and then transformed into an initiative aimed at locating primary care services in communities and involving them in the decision making process. The CHPS example shows the practicality of scaling up a successful pilot programme throughout the country, and what is required to put evidence into action through
District health systems strengthening
A growing body of implementation research shows that the use of participatory research processes to support learning and district health systems strengthening. In the cases described in this section, the participatory action learning strategies have been assessed using a range of qualitative, participatory, and quantitative methods, and have shown promising results, identifying the probable pathways of effect.
The Improving Health Workforce Performance (PERFORM) project43 has involved
People at risk for HIV infection and discrimination
The government of India developed the National AIDS Control Programme, which involves the implementation of targeted interventions to reduce HIV for key populations, including female sex workers (FSWs). A qualitative process evaluation was done in two Indian states, Andhra Pradesh and Karnataka, to assess the ways in which targeted interventions are appropriately adapted to FSW needs and changing contextual and programmatic factors.68 Establishing outreach activities for FSWs, many of whom were
Conclusion
The case studies show the wide range of implementation research processes in terms of scale, topics, methods, and range of impacts in global health. The effects of implementation research do not always fit neatly into the categories we have used to describe them. The same research can affect health outcomes while also informing policy, improving health management and service delivery, and empowering communities and beneficiaries. Many of the case studies illustrate how implementation research
References (76)
- et al.
Definitions of implementation science in HIV/AIDS
Lancet HIV
(2015) - et al.
Redefining global health-care delivery
Lancet
(2013) - et al.
Bridging research and practice: models for dissemination and implementation research
Am J Prev Med
(2012) - et al.
Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial
Lancet
(2015) - et al.
Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial
Lancet Glob Health
(2015) - et al.
Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: a randomised, open-label, equivalence trial
Lancet
(2015) - et al.
Maternal and child undernutrition and overweight in low-income and middle-income countries
Lancet
(2013) - et al.
The politics of reducing malnutrition: building commitment and accelerating progress
Lancet
(2013) Disease control priorities: improving health and reducing poverty
Modeling the invisible college
J Asoc Inf Sci Technol
(2006)
Welcome to implementation science
Implement Sci
Implementation research: what it is and how to do it
BMJ
A glossary for dissemination and implementation research in health
J Public Health Manag Pract
Statement on advancing implementation research and delivery science
Program science: an initiative to improve the planning, implementation and evaluation of HIV/sexually transmitted infection prevention programmes
Sex Transm Infect
Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science
Implement Sci
Active implementation frameworks
The quality implementation framework: a synthesis of critical steps in the implementation process
Am J Community Psychol
A balanced scorecard for health services in Afghanistan
Bull World Health Organ
Standards for Reporting Implementation Studi es (StaRI) statement
BMJ
Implementation research: a synthesis of the literature
Within our grasp: a world free of poverty
Developing robust, sustainable, implementation systems using rigorous, rapid and relevant science
Clin Transl Sci
Implementation research in health: a practical guide
Selective epidemiologic control in smallpox eradication
Am J Epidemiol
Guideline: Managing possible serious bacterial infection in young infants when referral is not feasible
Ongoing trials of simplified antibiotic regimens for the treatment of serious infections in young infants in South Asia and sub-Saharan Africa: implications for policy
Pediatr Infect Dis J
An innovative multipartner research program to address detection, assessment and treatment of neonatal infections in low-resource settings
Pediatr Infect Dis J
Evolution of health research essential for development in Ghana
The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival
BMC Health Serv Res
Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: management perspectives from northern Ghana
Glob Public Health
Measuring and managing progress in the establishment of basic health services: the Afghanistan health sector balanced scorecard
Int J Health Plann Manage
Improving health service delivery in developing countries from evidence to action
Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan
Health Policy Plan
Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial
Int J Epidemiol
Fifty fourth World Health Assembly: infant and child nutrition
Zero Hunger Challenge
General assembly adopts resolution on SDGs report
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