Implementation Research: An Efficient and Effective Tool to Accelerate Universal Health Coverage

Abstract

Success in the implementation of evidence-based interventions (EBIs) in different settings has had variable success. Implementation research offers the approach needed to understand the variability of health outcomes from implementation strategies in different settings and why interventions were successful in some countries and failed in others. When mastered and embedded into a policy and implementation framework, the application of implementation research by countries can provide policy-makers and implementers with the knowledge necessary to work towards universal health coverage (UHC) with the effectiveness, efficiency, sustainability, and fidelity needed to achieve sustainable positive health outcomes for all. To achieve this goal however, work is needed by the communities of research producers and consumers to create more clarity on implementation research methodologies and to build capacity to apply them as a critical tool for countries on their path to achieving UHC.

Beyond the Science: Advancing the "Art and Craft" of Implementation in the Training and Practice of Global Health

“…In many LMICs, the universal health coverage principles, such as equity, drive how policies and programs are designed and implemented. 3 In contrast, it has been argued that profit making supersedes equity considerations in capitalist systems operated in countries like the United States. 17 Contextual variances, though well recognized in the implementation science literature, are frequently not addressed by the existing tools designed for the real world.…”

“…Poor implementation has been implicated as a key reason for this gap. 1 While some authors have called for more rigorous, equity focused science, 2,3 others opine that social science theories hold the key to practical implementation. 4 Despite this variance in opinion, there is a near consensus amongst experts that successful implementation in global health requires innovative paradigms.…”

Incorporating operational research in programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria in four sub-Saharan African countries.

“…Three of the most devastating communicable diseases in human history, HIV/AIDS, tuberculosis (TB) and malaria, are being fought by affected low-and middle-income countries with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), aiming at eventually ending those epidemics. The Global Fund disburses more than USD 4 billion a year to support programmes run by local experts in more than 100 countries, resulting in an estimated 32 million of lives saved [1]. It is the largest multilateral investor in health systems playing a leading role in global health by its contribution to nancing the pathways towards universal health coverage in bene ciary countries.…”

“…However, multiple challenges are present, especially on the path to disease elimination, including, emerging resistances along the malaria-transmission cycle (vector and agent), TB antimicrobial resistance [2,3], weak implementation capacities, de cient drug supply systems, limited quality of care or fragmented approaches to health systems strengthening, urging the implementers of disease programmes to improve their e ciency. Operational research (OR) that is designed to increase both implementation e ciency and effectiveness provides evidence on elements that either enhance or impede the performance of established processes within, for instance, disease control activities [1,[4][5][6][7].…”

“…OR can therefore support programme managers and policy makers in optimizing and scaling up activities [1,8,9]. Also, in contrast to implementation research (IR) that may need more complex data of an intervention in pre-de ned groups of patients, (e.g.…”