Despite a large body of evidence describing proven strategies for improving health outcomes, replicating interventions in new settings or scaling them up is a serious challenge. Much of the evidence on health interventions is generated in controlled research settings and requires careful adaptation to reflect the complexity and diversity in different contexts.
By breaking down the walls between the controlled world of traditional research studies and the “messy” realities of programs and policy, Implementation Science (IS) provides an opportunity to close the “know-do” gap. IS strategies can help generate evidence that is relevant and useful to decision-makers, resulting in practical, positive changes on the ground. While the terminology and exact definition of IS remains a topic of debate (there are multiple definitions in use), its potential and demand is becoming increasingly clear.
The Evidence Project, in conjunction with the TRAction Project, FHI360 and colleagues from the East, Central, Southern Africa-Health Community (ECSA-HC) and the Kenya Ministry of Health (MoH), gathered researchers, implementers and policymakers for a webinar titled, “Generating Evidence and Impact Through Implementation Science: Perspectives from FP, RH and MCH Researchers and Policymakers,” held in January 2017. Participants shared specific examples of how IS approaches have informed policies and programs related to reproductive, maternal and neonatal health.
Partnerships between researchers, implementers and policymakers
Strong partnerships between researchers, implementers and policymakers are key to ensure the success of IS projects. Implementation research studies should be informed by policy and practice needs, which requires the participation of decision-makers and policymakers from the start, and should be designed to respond to real world contexts. This means, among other things, taking decision-maker priorities and challenges into account when designing research questions, soliciting input into the selection of study sites or other aspects of study design and identifying and partnering with organizations that understand issues on the ground and that can inform policy change. It also means continuous engagement through regular meetings with policymakers and other key stakeholders throughout the study process. After all, even the strongest evidence will not result in actual policy or program change without partners who are willing and eager to use it.
Implementation science and the case of respectful maternity care
The quick progression of respectful maternity care exemplifies the value of strategic engagement of IS partners. Researchers often embark on their work in isolation and then expect advocates and decision-makers to become interested and involved at the very end of the evidence generation process, rather than investing the time early on to explain their work, solicit feedback and seek engagement from these key partners. This results in long lapses of time between the start of research and the point at which any action could be taken. What distinguished the global respectful maternity care effort and fueled its unusually speedy results was that it intentionally launched both evidence generation in specific countries and awareness-raising activities by the White Ribbon Alliance and others from the beginning.
A further catalyst was the engagement of partners at the national and regional levels. For example, at the national level in Kenya, the right mix of partners and strategic engagement was critical to success. As described by Dr. Muthigani during the webinar, the MoH of Kenya, along with the National Nurses Association of Kenya and National Federation for Women’s Lawyers, was involved at from the beginning and maintained a central role in the IS research undertaken by Population Council Kenya to test solutions that mitigate disrespect and abuse and advance respectful maternity care. As Dr. Muthigani highlighted, this continuous engagement ensured that by the end of the IS study, the MoH of Kenya was informed and prepared to make policy and programmatic changes. At the regional level, partners like the ECSA-HC provided a platform for sharing respectful care evidence and continuing to raise awareness among ministerial level decision-makers in the region.
The respectful maternity care movement illustrates a hallmark of successful IS initiatives: committed partnerships among researchers, implementers and policymakers at all levels to address appropriate implementation questions, generate demand for evidence and translate that evidence into practice. The pairing of the IS research results from Kenya, underpinned by engagement with local partners and the ongoing global advocacy led to local change and to global action. That is the power of IS.
Are you using IS in your work to improve maternal newborn health? We want to hear from you!
Download presentations from the webinar.
Read another post about improvement science for maternal health on the MHTF blog.
Learn more about respectful maternity care.