Implementation research is crucial to countries’ efforts to strengthen learning health systems

• Published in: Health policy and planning 2020-11, Vol.35 (Supplement_2), p.ii4-ii6
• Main Authors: Ghaffar, Abdul, Swaminathan, Soumya, Sheikh, Kabir, Al-Mandhari, Ahmed, Jhalani, Manoj, Sambo, Boureima, Jakab, Zsuszanna
• Format: Article
• Language: English
• Subjects: Barriers; Commentaries; Decision making; Embedding; Health; Health administration; Health care; Health care facilities; Implementation; Learning; Local knowledge; Medical personnel; Ownership; Policies; Policy making
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czaa119

Implementation barriers can be significant impediments to the performance of health systems in low- and middle-income countries (LMICs) and the achievement of broader goals such as Universal Health Coverage (UHC) (Santos et al., 2017). These barriers often reflect local contextual issues and have a direct impact on the performance of programmes and policies. Sometimes they are traceable to underlying systemic issues—for instance, prevailing incentive structures for health workers may be encouraging them to over-report or under-report data, or past adverse experiences may have caused communities to lose trust in government health facilities. Such barriers are common and often possible to resolve—but only once they have been identified. When well-designed policies and programmes fail to achieve intended outcomes, implementation research (IR) shines a light into the implementation ‘black box’ and helps identify and explain the reasons behind implementation failures and find and test strategies to overcome them. In this way, IR converts local, context-specific knowledge that is often hidden and tacit into systematic learning that can help health systems improve the delivery of policies and programmes (Alonge et al., 2019). The task of generating and using relevant local knowledge cannot take place without an integral role for health system decision-makers (policymakers, programme managers and implementers) in the research process (Tricco et al., 2018)—including defining the research agenda, co-producing the research with professional researchers, deliberating on the applicability of research findings and disseminating and utilizing the findings. Integrating health systems decision-makers into the research processes (also known as ‘embedding’) empowers them by equipping them with the skills and understanding of research processes, enhances their ownership of the research and, most importantly, increases the utilization of research findings for policy and programme improvements (Langlois et al., 2019).A process for de