The Question is King – Turning Princely Investments into Practical Solutions

“The question is king,” states the Implementation Research in Health: A Practical Guide (PDF), a new World Health Organization resource from The Alliance for Health Policy and Systems Research/Implementation Research Platform. Launched this month, the guide strives to answer a critical question facing public health today: As we invest increasingly princely sums for health interventions throughout the world, why do we continue to stare down statistics such as an estimated 2.5 million people getting infected with HIV and over 7.6 million children succumbing to preventable deaths each year?

For some, terms such as implementation research, implementation and delivery science are the language of the day. Many more, we suspect, use the terms with a degree of hesitation. The basic underlying principle is clear. Promising programs and research – those with exciting results from a proof of principle study or small stage implementation – may not be readily replicated on a larger scale, or demonstrate similar impact in a different location.

Implementation Research in Health provides a rigorous approach to addressing these gaps. The guide offers researchers and program implementers the rationale for implementation science, and an introduction to its practical mixed methodological approach – drawing from epidemiology to market research, health services research and even political science. Some may recognize much of the content – the guide updates the 2003 Implementation Research in TDR: Conceptual and Operational Framework, for example. But, the easy-to-use-format (key points are summarized for each chapter; helpful graphics summarize everything from implementation science strategies, outcome variables and the research continuum) makes the guide a welcome new addition.

At a recent Investigators’ Meeting for USAID partners supporting implementation science studies to improve PEPFAR programs, participants discussed the importance of publishing not only on the results of these studies, but the rigorous approaches used to generate the results. We applaud such efforts. We encourage more researchers to publish on the rigorous implementation science methods they’ve used – it can only help build a common understanding of the underlying rigor that is the hallmark of quality implementation science research (read a description of USAID’s implementation science portfolio to support PEPFAR programs and on USAID’s implementation science related to maternal, newborn, and child health).

Implementation science can look beyond the impact of individual interventions to evaluate interventions aimed at improving broader health systems. As we ask questions in our increasingly complex global health world – from “how to best integrate previously separate programs?” to “how do we measure impact as we increasingly work through and with our partner governments and donors?” – implementation research plays a critical role in helping us address these issues. We encourage future editions of this and other implementation science resources to share how rigorous implementation science has helped address these broader questions.

Implementation Research in Health calls its subject “new” and “neglected.” Yet, people have been doing implementation research (or variants of it) for decades. The guide is a promising resource to bring implementation research into the spotlight where we think it belongs – we encourage you to read the guide and decide for yourself.