Implementation Research Is Needed to Achieve International Health Goals

Abstract

Health research needs to focus not just on the growing divide in health status between the world's rich and poor but also on the unacceptable gap between our unprecedented knowledge of diseases (including their control) and the implementation of that knowledge, especially in poor countries. Directed and innovative research is needed to analyse the causes of this situation and to point toward solutions at the global and local levels, both within and outside the health sector—given that inequitable economic globalisation is leading to greater disparities in wealth between and within countries [ 1]. Because interventions directed at health improvement require, for optimal implementation, infrastructure, equipment, supplies, and competent personnel in adequate numbers, together with intersectoral actions to address the underlying determinants of health, the term “health systems” is increasingly used. Health systems can broadly be described as containing the following principal components: structures, equipment and supplies, policies (technical priorities, financing), people (their numbers, distribution, and skills mix), and processes (how people function within the system and in relation to other sectors). How these components articulate with one another and the communities in which they are based, their effectiveness, and opportunities for modification are also framed by the social and political context in which they have evolved. This Essay focuses on health systems research (HSR). We begin with an overview of the crisis in health, health systems, and HSR in low-income countries, with a special focus on Africa. Then, we discuss an issue that has come to be termed the “knowledge-implementation gap”, focusing particularly on those types of HSR most concerned with implementation ( Box 1). We identify some of the key obstacles to correcting this gap, and conclude with some suggestions for actions that can be taken to increase the quantity and quality of HSR. Box 1. What Is Implementation Research? Implementation research is that subset of HSR that focuses on how to promote the uptake and successful implementation of evidence-based interventions and policies that have, over the past decade, been identified through systematic reviews. Implementation research is used as a general term for research that focuses on the question “What is happening?” in the design, implementation, administration, operation, services, and outcomes of social programmes; it also asks, “Is it what is expected or desired?” and “Why is it happening as it is?” [ 27]. In the health field, implementation research often encompasses “impact research”, which includes both research aimed at understanding what is happening during the processes of implementing changes in policy or practice, and intervention studies that are designed to compare different approaches to implementing change. Implementation research is often multidisciplinary, encompassing both quantitative and qualitative approaches that require expertise in epidemiology, statistics, anthropology, sociology, health economics, political science, policy analysis, ethics, and other disciplines.