Implementation research approaches to promoting universal health coverage in Africa: a scoping review

12 May, 2021

Implementation research has been variously defined, and one of the most recent definitions (2013) is from WHO’s Alliance for Health Policy and Systems Research (AHPSR): 'the scientific study of the processes used in the implementation of initiatives as well as the contextual factors that affect these processes.'

There can be no doubt of its importance, but my take on IR (from observicing HIFA discussions) is that planning and undertaking of implementation research, how the findings are interpreted, and how this in turn leads to improvements in service delivery - are highly challenging issues (more so than other kinds of research).

This paper sheds more light. Citation, abstract and comment from me below.

CITATION: BMC Health Serv Res. 2021 May 3;21(1):414. doi: 10.1186/s12913-021-06449-6.

Implementation research approaches to promoting universal health coverage in Africa: a scoping review.

Nnaji et.

BACKGROUND: Implementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a growing number of initiatives promoting the uptake of implementation research in Africa, its role and effectiveness remain unclear, particularly in the context of universal health coverage (UHC). Hence, this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa.

METHODS: The review protocol was developed based on the methodological framework proposed by Arksey and O'Malley, as enhanced by the Joanna Briggs Institute...

RESULTS: The database search yielded 2153 records... 26 studies were included in the review. Implementation research was used within ten distinct UHC-related contexts, including HIV; maternal and child health; voluntary male medical circumcision; healthcare financing; immunisation; healthcare data quality; malaria diagnosis; primary healthcare quality improvement; surgery and typhoid fever control. The consolidated framework for implementation research (CFIR) was the most frequently used framework. Qualitative and mixed-methods study designs were the commonest methods used. Implementation research was mostly used to guide post-implementation evaluation of health programmes and the contextualisation of findings to improve future implementation outcomes. The most commonly reported contextual facilitators were political support, funding, sustained collaboration and effective programme leadership. Reported barriers included inadequate human and other resources; lack of incentives; perception of implementation as additional work burden; and socio-cultural barriers.

CONCLUSIONS: This review demonstrates that implementation research can be used to achieve UHC-related outcomes in Africa. It has identified important facilitators and barriers to the use of implementation research for promoting UHC in the region.


A global thematic discussion on HIFA in 2016, supported by WHO/TDR, found:

1. There is confusion about IR, particularly in relation to similar approaches like quality improvement, operational research, knowledge translation and healthservices research.

2. IR provides an opportunity to better understand the health system and policy perspective.

3. Difficulty in locating implementation research articles for policy making, program planning and research is a challenge.

and made the following conclusions:

1. The proliferation of multiple terminologies based on epistemological and ontological variations are confusing for not only frontline health workers but also for those in the academia. This confusion may be limiting academic,

political and financial commitment to IR and needs to be addressed as a priority.

2. Global health workers have a positive outlook about IR and there is a demand to learn and understand about IR. It is seen as an essential step towards implementation of research evidence in the real world.

3. Locating IR resources and articles is a major challenge on account of major indexing databases like PubMed not having indexing terms for it. This is compounded by the proliferation of multiple terminologies. Indexing agencies

should consider retrospective indexing of IR to facilitate easy retrieval of IR articles and resources.

An overview of the HIFA discussion is here:


Neil Pakenham-Walsh, HIFA Coordinator,