Key Asks from the UHC Movement UN High-Level Meeting on Universal Health Coverage (5) Implementation research

12 April, 2019

Dear HIFA colleagues,

1. One of the 'Key Asks from the UHC Movement UN High-Level Meeting on Universal Health Coverage' is ASK4: UPHOLD QUALITY OF CARE.

The ASK prioritises implementation research as one of its six components:

"6. Empower providers to undertake real-time implementation research to identify and scale best practices for achieving quality."

2. If this component is itself to be implementable, then we need a clear understanding of what implementation research means. And yet we know from previous HIFA thematic discussion on Implementation Research (sponsored by the Special Programme for Research and Training in Tropical Diseases and WHO) that many of us are confused by the concept. A poster was presented by Soumyadeep Bhaumick on behalf of HIFA at the Global Evidence Summit and a key theme is 'There is confusion about IR, particularly in relation to similar approaches like quality improvement, operational research, knowledge translation and health services research'.

3. This new paper in BMJ Global Health asks: "How is implementation research applied to advance health in low-income and middle-income countries?"

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.


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.


Implementation research (IR) in low-income and middle-income countries has mainly focused on evaluation of whether strategies for implementing evidence-informed health interventions can work; little of the IR addresses problems of scale-up and sustainability, which are key issues for health interventions.

Most of the publications on IR are not conducted under routine conditions for management and financing. If IR is to make an impact on policy and practice or inform the scale-up of programmes, more research needs to be conducted under the conditions in which interventions are expected to be implemented.

Most IR publications do not describe implementation characteristics completely; future research should more consistently provide complete descriptions of the implementation strategies, report on implementation variables and the context under which implementation occurs.

IR uses a full range of quantitative, qualitative and mixed methods approaches, but more rigorous and adaptive research designs are needed to address how to scale up and sustain interventions

Best wishes, Neil

Coordinator, HIFA Project on 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 - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: