Implementation Research

Implementation Research (IR) is research that addresses implementation bottlenecks in order to deliver effective health care interventions. It aims to identify solutions to overcome implementation problems. This later may inform policy decisions and scale-up effective interventions, which can generate better health outcomes and strengthen the overall health system. Network Medicus Mundi Switzerland presents this IR guide, which is designed to support NGOs interested in applying IR within their projects. It includes the conceptual definition of IR and a practical step-by-step guide from the design to the dissemination of an IR study.

“Without implementation research we are at best committing valuable resources to implementation in the hope that things will work out.”

MMS IR_guide_Final Version_281020.pdf

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MMS/ISPM The study provides a qualitative overview of existing strategies, practices and capacities on how Implementation Research (IR) is done by members of the network Medicus Mundi Switzerland (MMS). MMS’s strategy describes the importance of IR for its network. MMS initiated a study about IR to provide (i) a qualitative overview and (ii) a learning process to promote NGO led research. IR is a scientific inquiry into questions concerning the act of fulfilling or carrying out a practice or an intervention. IR is a young, ambitious research field gaining importance in the context of the Sustainable Development Goals.

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MMS The network Medicus Mundi Switzerland mandated a qualitative study on the existing practices and capacities regarding implementation research by Swiss NGOs (MMS members) working in in the field of international health cooperation. The results of this study identified challenges, bottlenecks and possible solutions on how to overcome them. At the MMS Workshop the implementation research concept and the findings of the study were discussed.

• Implementation Research in Switzerland: The Way Forward…

MMS In 2015 MMS established an implementation research platform. Part of the platform are: Enfants du Monde, FAIRMED, Fondation Terre des hommes, Institute of Social and Preventive Medicine, Medicus Mundi International, SolidarMed, Swiss Red Cross, Swiss TPH. For more information on the IR Platform please contact mleschhorn@medicusmundi.ch or +41 (0)61 383 18 14

MMS Measurement and evaluation as well as looking for evidence: Implementation Research on projects and programmes is of increasing importance within health cooperation. But how does good Implementation Research look like? What are the obstacles for health NGOs in doing Implementation Research? This MMS Bulletin deals with an issue of practical and political relevance.

• Gesundheitszusammenarbeit unter der Lupe: Implementation…

Medicus Mundi International (MMI) Sind unsere Methoden und Herangehensweisen in der internationalen Gesundheitszusammenarbeit noch zeitgemäss? Warum gelingt es uns nicht, die gesundheitliche Lage von Millionen von Menschen zu verbessern? Die im letzten Jahr von Medicus Mundi International (MMI) gegründete Arbeitsgruppe zum Thema "Effective Health Cooperation" hat zum Ziel, die eigene Arbeit zu reflektieren und kritisch zu hinterfragen und den Dialog zwischen den Akteuren in der internationalen Gesundheitszusammenarbeit zu fördern.

• www.medicusmundi.org

MMI The MMI discussion paper on health cooperation and its relevance, legitimacy and effectiveness was discussed at the workshop “Health cooperation beyond aid” in Berlin, on 29 September 2016, and published afterwards: “The document is not intended to be a position paper representing a homogeneous view of the Network. It is a discussion paper that feeds a core activity of the MMI Network; to serve as a platform for critical reflection on the role and future direction of development cooperation for health. We invite the members of the MMI working group on Effective Health Cooperation (MMI EHC) and other Network members and partners to engage in this process.” (pdfI

• bit.ly

Swiss Red Cross “What are facilitators and what are barriers to use Ante Natal Care (ANC), safe delivery and Post Natal Care (PNC) services in Laos, Bangladesh, Pakistan and Nepal? Are men bottle-necks to decision-making? What role does the health provider play? Is lack of money really the reason why a home delivery is the preferred option? Check out the findings from the Laos country study on community perceptions of facilitators and barriers in Maternal, Neonatal & Child Health (MNCH) use, conducted by Heather Gulliver (previous health delegate in Laos; Cara Stephenson (previous AUSAid volunteer in Laos) and the Laos team and partners. This is the first out of four implementation research studies. Watch this space for more to follow!”

• Swiss Red Cross

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Calcutta Rescue "Calcutta Rescue (CR) is a medium-sized NGO based in Kolkata, India that focuses on supporting the residents of the city’s slums. CR present the results of its first large-scale study of the poverty experienced by Calcutta Rescue’s service users. It is the largest and most detailed research of its kind conducted in Kolkata in the last two decades. The primary aim of the study was to generate information that would enable CR to rank different slum areas relative to each other in terms of overall, multidimensional impoverishment, and levels of deprivation in specific indicators. This ranking is already helping CR’s management to prioritize resources, and target interventions according to need. The study’s secondary objective was to provide CR with a template methodology that can be repeated and used to capture improvement over time, or after specific interventions."

• Calcutta Rescue
• Journal of Poverty and Social Justice •
• Poverty Research

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MMS Das Netzwerk Medicus Mundi Schweiz hat sich in einer Studie und an einem Workshop damit auseinandergesetzt, wie Schweizer Organisationen der internationalen Gesundheitszusammenarbeit die Umsetzung ihrer Programme mit wissenschaftlichen Fragestellungen begleiten. Das Ergebnis: Es geht nichts ohne Neugier. (Foto: Realizing the agricultural potential of inland valleys in sub-Saharan Africa/AfricaRice/flickr, CC BY-NC-ND 2.0)

• www.medicusmundi.ch

MMS Um die gesundheitliche Situation weltweit zu verbessern, braucht es in der internationalen Gesundheitszusammenarbeit auch den selbstkritischen Umgang mit der eigenen Arbeit und mehr Wissen. (Foto: MERET Landscapes/flickr, CC bye-SA 2.0)

• www.medicusmundi.ch

MMS Das Netzwerk Medicus Mundi Schweiz hat eben eine neue Strategie verabschiedet, bei der die Förderung von Wissens- und Lernprozessen eine verstärkte Bedeutung erhält. MMS bietet verstärkt Foren der kritischen Reflexion, um die internationale Gesundheitszusammenarbeit vorwärts zu bringen.

• www.medicusmundi.ch

The Lancet Eine Studie zeigt auf, dass von 151 Ländern nicht einmal die Hälfte, die von der WHO empfohlenen Richtlinien zur Prävention und Bekämpfung von nichtübertragbaren Krankheiten (NCDs) umgesetzt haben. Die Corona-Pandemie verschlechtert die Situation zusätzlich gravierend und unterstreicht die Notwendigkeit, vor allem in Ländern mit niedrigem und mittlerem Einkommen, in das NCD-Management als Teil der primären Gesundheitsversorgung zu investieren. Der vorliegende Bericht nennt drei Gründe, warum Implementierungsforschung diesen Prozess entscheidend beschleunigen und durch Anpassung an den jeweiligen lokalen Kontext Barrieren schneller überwinden könnte. So hat die WHO bereits 2016 einen Leitfaden und ein Toolkit zur Implementierungsforschung bei NCDs entwickelt.

• The Lancet

MEASURE Evaluation A guide from USAID, Pepfar and MEASURE Evaluation that shows step by step how to design an implementation research project, including suitable case studies.

• www.measureevaluation.org

Implementation Science This article by Proctor et al. (2012) gives practical advise on how to strengthen research grant proposals for implementation research studies, including examples of preliminary data, background literature, and narrative details.

• www.ncbi.nlm.nih.gov

TDR The TDR toolkit goes step-by-step through the whole process of a successful Implementation Research project. It helps to "identify system bottlenecks and the stakeholders to be involved in the process, formulate appropriate research questions, conduct the research and develop a plan for implementing the study results" (TDR, 2014) (Photo: MERET Landscapes/flickr)

• www.who.int

WHO A Practical Guide published by WHO. "Intended for newcomers to the field, those already conducting implementation research, and those with responsibility for designing and implementing programmes and policies, the guide provides an introduction to basic implementation research concepts and language, briefly outlines what it involves, and describes the many exciting opportunities that it presents." Available in English, French and Spanish (WHO, 2013)

• www.who.int

ISPM/MMS A short factsheet on Implementation Research published by MMS and ISPM, including definition and characteristics of Implementation Research.(Photo: Baaba Maal inspects failed corn crops in Mauritania/Oxfam International/flickr, CC BY-NC-ND 2.0)

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PLOS Med The need for implementation science in health is now broadly recognized, and a working understanding of the qualities that make an implementation study “good” is needed more than ever before. As defined by Mittman and Eccles, implementation research “is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services. It includes the study of influences on healthcare professional and organizational behavior” (PLOS Med, volume 14, issue 4, April 2017).

• journals.plos.org

Research on Social Work Practice What is the rationale for Implementation Research? What is the know-do-gap? How can we close this gap between knowledge and practice? Bhattacharyya et al. (2009) extensively discuss the role of Implementation research in closing and addressing such gaps (Research on Social Work Practice, volume 19, number 5, pp. 491-502, 2009).

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Administration and Policy in Mental Health This research article from Proctor et al. (2011) has its focus on implementation outcomes. Measuring and conceptualizing implementation outcomes help to advance the understanding of implementation processes, and enhance efficiency in implementation research (Administration and Policy in Mental Health, volume 38, pp. 65–76, 2011).

• www.ncbi.nlm.nih.gov

BMJ This research article by Peters et al. (2013) provides a broad definition of implementation research and outlines key principles (research questions and methods) for how to do it (BMJ, Volume 347, p.f6753, 2013).

• www.bmj.com

DFID "The objective of the evaluation is to assess the project’s performance and impacts during the period October 2011 to August 2014, and provide feedback to the wider research and development community on the OR capacity building model. While the direct users of the evaluation are DFID’s Research and Evidence Division (RED) and The Union, the evaluation will serve for accountability and learning purposes for the OR community, research capacity building programmes, research funders and others, feeding into the design of the next phase of the project and investigating the application of the model in other areas of practice." (pdf)

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The Lancet "Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge—the so-called know–do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings. We also propose measures of success for operational research. Adoption and use of these measures could help to ensure that operational research better changes policy and practice and improves health-care delivery and disease programmes." (The Lancet: Volume 12, No. 5, p415–421, May 2012)

• www.thelancet.com

The Lancet Zachharia et al. (2009) define operational research and analyse its relevance from a disease-control and programme perspective. Moreover, the Lancet article discusses enabling factors and challenges for its integration into programme settings (The Lancet, Volume 9, No. 11, p711–717, November 2009).

• www.thelancet.com

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(BMC) This supplement contains a collection of research articles with approaches and best practices from Asia and Africa on how to engage stakeholders in IR. How can IR help to scale up projects? How can theories of change be used to inform implementation of health systems research and innovation? How can participatory action research strenghten health managers’ capacity? How can participatory monitoring and evaluation (M&E) approaches be used to influence decision-making? Those and other questions are addressed in this supplement.

• health-policy-systems.biomedcentral.com

PLOS Neglected Tropical Diseases The study conducted by FAIRMED aims to identify which interventions for detecting yaws had a synergistic effect and proved to be valuable components of a yaws eradication program, as a response to the resurgence of the Yaws disease. This study is not an Implementation Research project per se, but all IR characteristics are met, as well as most of the IR outcome variables (PLOS Neg Trop Dis, volume 11, number 5, pp. 1-14, May 2017).

• journals.plos.org

MSF On this website a large number of field research conducted by MSF on a huge variety of topics can be accessed (Photo: MSF).

• fieldresearch.msf.org

Emerging Infectious Diseases With this research Médecins sans frontières (MSF) showed that implementation/ operational research is an appropriate method for an emergency medical organization. From the beginning on, MSF nested the operational/implementation research within its emergency response. Research questions were mainly determined by volunteers returning from the field, who had first-hand knowledge of the immediate issues facing teams in the field (Emerging Infectious Diseases, volume 23, number 7, pp. 1057-1062, July 2017) (Photo: Global Panorama/flickr, CC BY-SA 2.0).

• wwwnc.cdc.gov

BMC This journal from BMC provides a wide range of case studies using IR, with the aim to promote the uptake of research findings into routine healthcare in clinical, organizational or policy contexts (Photo: BMC Implementation Science).

• implementationscience.biomedcentral.com