BMJ Global Health: How is implementation research applied to advance health in LMICs?

10 March, 2019

Dear HIFA colleagues,

In 2017, the HIFA Evidence-Informed Policy and Practice expert working group facilitated a major discussion on HIFA about Implementation Research, supported by WHO, TDR, and The Lancet. Soumyadeep Bhaumik presented the findings at the Global Evidence Summit in Cape Town, 13-16 September 2017. The key finding was: 'The proliferation of multiple terminologies based on epistemological and ontological variations are confusing for not only frontline health workers but also for those in academia.' Our Evidence-In http://www.hifa.org/sites/default/files/publications_pdf/HIFA_Case_Study...

This new paper sheds more light on this issue. It finds: 'There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions.'

Citation, abstract and a comment from me below.

CITATION: Alonge O, Rodriguez DC, Brandes N, et al How is implementation research applied to advance health in low-income and middle-income countries? BMJ Global Health 2019;4:e001257.

http://dx.doi.org/10.1136/bmjgh-2018-001257

ABSTRACT

This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.

Comment (NPW): The implication is that even those who identify themselves as implementation researchers are diverse (confused?) in their approaches to implementation research. This raises questions about the credibility of the implementation research community at large. All of us recognise the importance of implentation research, but we need to move beyond the current confusion.

I do not have the expertise to comment comprehensively on the paper, but it seems to me there is also a discrepancy between the title of the paper (how is IR applied? ie how are the findings of IR translated into policy?) and its content (how is IR undertaken?).

I look forward to learn from HIFA members (IR researchers and others) on this issue.

Best wishes, Neil

Coordinator, HIFA Project on Evidence-Informed Policy and Practice

http://www.hifa.org/projects/evidence-informed-policy-and-practice

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org