Billions are spent on health innovations, but very little on how best to apply them in real-world settings. Despite the importance of implementation research, it continues to be a neglected field of study, partly because of a lack of understanding regarding what it is and what it offers. Intended for newcomers to the field, those already conducting implementation research, and those with responsibility for implementing programmes, this guide provides an introduction to basic implementation research concepts and briefly outlines what it involves, and describes the many exciting opportunities that it presents.
Monitoring equity and research policy
Implementation Research in Health: A Practical Guide
Alliance for Health Policy and Systems Research
Implementation research platform launched at Global Symposium on Health Systems Research
TDR News: 17 November 2010
A new platform for scaling up drugs and other health interventions to meet national and regional needs in developing countries was launched at the opening of the First Global Symposium on Health Systems Research, held from 16-19 November 2010 in Switzerland. The platform is a new collaboration of several organisations at the World Health Organization, with funding from the Norwegian Agency for Development Co-operation (NORAD) and the Swedish International Development Co-operation Agency (SIDA). The first seven projects were announced, which include projects in Kenya and Uganda. The platform is guided by an open, transparent selection of proposals and has been set up to help build evidence for the health-related Millennium Development Goals to improve child and maternal health and reduce HIV/AIDS, and to build capacity for health systems research and knowledge translation, particularly in low- and middle-income countries. The platform is intended to allow a greater degree of ‘inter-disciplinarity’ to strengthen the whole health system. It will examine the interface between scale-up and implementation of health services.
Implementation research to catalyse advances in health systems strengthening in sub-Saharan Africa: the African Health Initiative
Sherr K, Requejo J and Basinga P: BMC Health Services Research 13(Suppl 2):S1, 31 May 2013
Despite the growing focus on health systems, the largest global health initiatives continue to have a disease specific focus. In response, the Doris Duke Charitable Foundation launched the African Health Initiative (AHI) to catalyse significant advances in strengthening health systems by supporting Population Health and Implementation Training (PHIT) Partnerships in five diverse sub-Saharan African contexts. Each Partnership is addressing key health systems constraints to improve service delivery and health outcomes. The authors of this article identify a number of overarching lessons from the first three and a half years of implementation, which include the need for a multipronged approach to systems, with the result that most of the teams ultimately included activities in each of six areas identified as health system building blocks by the World Health Organisation. Despite relatively modest funds for the scope of planned activities, teams garnered substantial interest and support at high levels of the Ministries of Health, reflective of the need to plan comprehensively for health systems without the constraint of a single disease focus.
Implicit value judgments in the measurement of health inequalities
Harper S, King NB, Meersman SC, Reichman ME, Breen N and Lynch J: Milbank Quarterly Volume 88, Number 1, 2010
This study questions the assumption that the measurement of health inequalities is a value-neutral process that provides objective data that is then interpreted using normative judgments about whether a particular distribution of health is just, fair or socially acceptable. The study discusses five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Overall, it found that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, the study urges researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. Policymakers and other consumers of health inequalities data should pay close attention to the measures on which they base their assessments of current and future health policies.
Improving data use in decision making: An intervention to strengthen health systems
Nutley T: MEASURE Evaluation, August 2012
Health decision-makers need to rely more on data to inform their decision making, according to this paper. The failure to consider empirical evidence regularly before making programme and policy decisions is due primarily to the complex causal pathway between data collection, its use, and improvement in health outcomes, she argues. Further, specific and comprehensive guidance to improve data demand and use is lacking. This paper fills this gap by providing specific recommendations for how to improve data-informed decision making by suggesting domains of interventions, activities, actors, tools, and resources to involve in the process in each step. The eight activity areas listed in the conceptual framework and the further detail provided in the logic model provide a comprehensive roadmap for how to design, monitor, and evaluate interventions to improve the demand for and use of data in decision making. More experience is needed applying the comprehensive framework in different contexts, the authors warn. The factors influencing demand for and use of data are dependent on the local context and specific needs. It is probable that all of the activity areas discussed in this paper may not need to be implemented as part of an intervention to improve the demand for and use of data; and that other activity areas not listed here, will be relevant instead. Moreover, the relative importance of each activity area is unknown, as is the level of intensity of each activity area. Nonetheless, this conceptual framework and logic model should contribute to the literature on comprehensive approaches to improving the use of data in decision making.
Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative
Mutale W, Chintu N, Amoroso C, Awoonor-Williams K, Phillips J, Baynes C et al: BMC Health Services Research 13(Suppl 2):S9, 31 May 2013
In this study, researchers report on linking data with improved decision-making. Mozambique, Ghana, and Tanzania focus on improving the quality and use of the existing Ministry of Health health information, while Zambia and Rwanda have introduced new information and communication technology systems or tools. All have a flexible, iterative approach in designing and refining the development of new tools and approaches for HIS enhancement, as well as improving decision making through timely feedback on health system performance. The differences are found in the level of emphasis of data collection (patient versus health facility), and consequently the level of decision making enhancement (community, facility, district, or provincial leadership).
Improving health R&D financing for developing countries: A menu of innovative policy options
Hecht R, Wilson P and Palriwala A: Health Affairs 28(4): 974–985, 2009
New drugs, vaccines and diagnostics for the diseases of the developing world could save millions of lives and prevent enormous suffering and economic loss. Despite substantial new funding from the Gates Foundation and other donors, financing for the research and development (R&D) of these new health technologies remains inadequate. New approaches are needed to generate more resources, make funding more stable and flexible, and further engage the expertise of the pharmaceutical industry. Several new financing mechanisms have been launched recently, and others are being proposed. This paper summarises some of the most promising new ideas and offers a framework for evaluating them.
Improving Impacts of Research Partnerships
Swiss Commission for Research Partnerships with Developing Countries
"Research is a widely applied instrument for harnessing knowledge and providing insight into complex development issues. It helps in generating options for policy, management and action, and in empowering people and organizations in developing and transition countries, as well as industrialised countries. Ultimately this should make it easier to cope with the challenges of sustainable development under increasingly difficult circumstances. Research for development is therefore frequently placed in an application oriented context, in which concepts like inter and transdisciplinary research, equity, ownership, participation, etc. are widely accepted, but are not always put into practice. Research partnerships of various types and intensities, involving research institutions in industrialised and developing or transition countries, are important means for contributing to knowledge generation and capacity building."
Improving influenza surveillance in sub-Saharan Africa
C Steffen, F Debellut, BD Gessner, FC Kasolo, AA Yahaya, N Ayebazibwe et al: Bulletin of the World Health Organisation 90(4): 301-305, April 2012
Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. To address this gap, a project called Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia. It aimed to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance. Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organised. The main lesson emerging from SISA is that targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.
Improving international research contracting
Sack DA, Brooks V, Behan M, Cravioto A, Kennedy A, Ijsselmuiden C and Sewankambo N: Bulletin of the world Health Organization 87(7): 486, July 2009
As long as standards and norms governing international research partnerships remain undefined in the legal environment, contractual matters will consume excessive energy, detract from the real work of health research professionals and set up collaborating institutions as potential adversaries rather than partners with a common research agenda. Agreed standards and norms for research contracting provide a framework for guidelines for equitable partnerships that can be put into practice in low- and middle-income countries to address the needs of local populations. The recently established International Collaboration on Equitable Research Contracts is conducting a global assessment of research contracting by developing and disseminating model contracts in which the rights, responsibilities and requirements of all partners are recognised. This evidence will inform the development of practical tools to achieve more equitable results in international research partnerships.