Implementation science in resource-poor countries and communities

Abstract

BackgroundImplementation science in resource-poor countries and communities is arguably more important than implementation science in resource-rich settings, because resource poverty requires novel solutions to ensure that research results are translated into routine practice and benefit the largest possible number of people.MethodsWe reviewed the role of resources in the extant implementation science frameworks and literature. We analyzed opportunities for implementation science in resource-poor countries and communities, as well as threats to the realization of these opportunities.ResultsMany of the frameworks that provide theoretical guidance for implementation science view resources as contextual factors that are important to (i) predict the feasibility of implementation of research results in routine practice, (ii) explain implementation success and failure, (iii) adapt novel evidence-based practices to local constraints, and (iv) design the implementation process to account for local constraints. Implementation science for resource-poor settings shifts this view from “resources as context” to “resources as primary research object.” We find a growing body of implementation research aiming to discover and test novel approaches to generate resources for the delivery of evidence-based practice in routine care, including approaches to create higher-skilled health workers—through tele-education and telemedicine, freeing up higher-skilled health workers—through task-shifting and new technologies and models of care, and increasing laboratory capacity through new technologies and the availability of medicines through supply chain innovations. In contrast, only few studies have investigated approaches to change the behavior and utilization of healthcare resources in resource-poor settings. We identify three specific opportunities for implementation science in resource-poor settings. First, intervention and methods innovations thrive under constraints. Second, reverse innovation transferring novel approaches from resource-poor to research-rich settings will gain in importance. Third, policy makers in resource-poor countries tend to be open for close collaboration with scientists in implementation research projects aimed at informing national and local policy.ConclusionsImplementation science in resource-poor countries and communities offers important opportunities for future discoveries and reverse innovation. To harness this potential, funders need to strongly support research projects in resource-poor settings, as well as the training of the next generation of implementation scientists working on new ways to create healthcare resources where they lack most and to ensure that those resources are utilized to deliver care that is based on the latest research results.

Reframing implementation science to address inequities in healthcare delivery

“…Given the underrepresentation of vulnerable populations in these trials, the generalizability of guidelines and standards of care is questionable, particularly when the EBIs are implemented in routine practice settings. The absence of these populations in the generation of evidence of intervention effectiveness is a common limitation in implementation studies as it results in the adoption of interventions that often neglect the unique needs and context of these communities [18,25].…”

“…Second, the broad implementation of EBIs often overlooks the importance of unique contextual factors that perpetuate inequities in healthcare. For instance, implementation efforts often ignore factors, such as economic, social, historical and political forces that shape the delivery of such interventions in low-resource settings and communities [8,16,18]. Third, the process of scaling up interventions developed in high-income countries to low-income countries often lacks the financial and human resources needed to implement these interventions [18,19].…”

“…For instance, implementation efforts often ignore factors, such as economic, social, historical and political forces that shape the delivery of such interventions in low-resource settings and communities [8,16,18]. Third, the process of scaling up interventions developed in high-income countries to low-income countries often lacks the financial and human resources needed to implement these interventions [18,19]. True partnerships with stakeholders from vulnerable contexts are not only ethical, but also enable the development of interventions and implementation strategies that are equitable for all [20].…”

The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples

“…Concerted, high‐quality D&IS research efforts are especially important in cancer control program and guideline implementation, owing to the unique complexity of the field 14 . Moreover, D&IS is particularly relevant in LMICs, where resource constraints require innovative approaches to evidence‐based practices, such as task shifting and mobile technology–based patient navigation, which must be systematically explored and evaluated within a given context 15,16 . D&IS has a role across the breast cancer care continuum from awareness and education to promote early detection, to targeting behavior change among treatment providers, to analysis of health care systems 3,4 .…”

Seeking Research Questions from Implementers: Considerations for Leveraging Ground Actors Research Needs in the Fight against Malaria in West Africa.

“…More than often, local social determinants of health are hidden, or just being overlooked by the funders, institutional researchers and health systems, hence slowing or reducing the program implementation and impact. In addition scores of the physical constraints that impede the regular and effective delivery of health interventions to those who need them are much more pronounced in Low-to-Middle-Income Countries (LMIC) than in resource-rich countries (1) Bridging the research divide between obligations of donors, researchers and eld actors is of paramount importance in the ght against diseases, especially malaria in Africa. This pandemic is often caught in a vicious circle, often being both cause and consequence of poverty.…”