National Human Resources for Health Observatory HRH Research Forum Dr. Ayat Abuagla

Launching Implementation Research Toolkit in Sudan

Implementation research provides  The ability to test diverse implementation pathways  To identify what works in real country and poor community settings, through different types and at different levels of health systems,  This would improve both the quality and the equity impact of health services and disease control strategies, and so contribute to effective strengthening of health systems. 3 Introduction

Implementation research is  trying to make sure that the results of research are applied in the real world of health care or the activity to which the research is relevant.  concerned with closing what is sometimes called “the know do gap.”  There is also knowledge translation, quality improvement, and scaling up. 4 Introduction

There are two main areas in the life-cycle of innovations where implementation research can play a role:  Adoption  scaling-up 5 Introduction

IR is characterized by the fact that it is contextual, multidisciplinary and addresses a health care/service need Expressed by health care providers, program managers, implementers and policy makers 6 Introduction

IR CharacteristicApplication for use Demand driven. Questions framed based on needs identified by implementers in the health system. Systematic The systematic study of how a specific set of activities integrate an evidence-based public health intervention within specific settings and how health outcomes vary across communities Balances relevance with rigor, strictly adhering to norms of scientific inquiry Multidisciplinary Analysis of biological, social, economic, political, system, and environmental factors that impact implementation of health interventions Interdisciplinary collaborations between behavioural and social scientists, clinicians, epidemiologists, statisticians, engineers, business analysts, policy makers, and stakeholders The characteristics of IR are paramount to the definition

IR CharacteristicApplication for use Demand driven. Questions framed based on needs identified by implementers in the health system. Contextual It is relevant to local specifics and need and aims to improve health care delivery of the health system Generates generalizable knowledge that can be applied across contexts Culture, community Complex Dynamic and adaptive Multi-scale: occurs at multiple levels of health care systems and community practices Analyzes multi-component programs and policies Non-linear, iterative, evolving Addresses complex, important problem Includes many variables, introducing unintended consequences The characteristics of IR are paramount to the definition

9 Interacting Domains in Implementation Research The Intervention Outer setting Economic, social and political contexts Inner setting Context within the organization implementing the intervention – Culture, structure, networks etc. Individuals involved Individuals who have a role to play in the implementation process – health care providers, managers, policy makers, beneficiaries, Process for implementation Methods used to facilitate adoption of the intervention at all levels (strategies, activities- planned and emergent)

10 NeedDesignExample AdequacyBefore-After or Time Series Introduction of health insurance in a resource poor setting, and examine the impact of health insurance on access to healthcare. Using before- after or time-series design to collect the data for the evaluation PlausibilityComparison of intervention to Control Group pre- post; Cross Sectional Studies Introduction of a new approach to the improvement of maternal healthcare in selected districts. A number of districts with a similar socio- economic development level were selected as control sites. The impacts or effects of the new approach were assessed by a comparison of “new approach – intervention” to “control” districts, using the method of differences in differences, for example. IR Study Designs

11 NeedDesignExample ProbabilityClusters RCT; Pre- Post interventions and control sites Using mobile phones as a reminder to increase adherence to TB treatment. Each district is used as a cluster. Among ten districts, a cluster randomized controlled trial is employed to test the impact of using mobile phones as a reminder in the five districts randomly selected. The other five districts served as control sites. ExplanatoryRepeated measures on context and mechanisms Using quantitative, qualitative or mixed methods to understand and examine change in use of health services by pensioners after retirement, and analyse main factors resulting in the changes. IR Study Designs

12 Companion text publications/access_report/en/index.html

 The modules target capacity building in the following skill sets: 1.Understanding the contextual issues in implementation research 2.Developing a research proposal 3.Planning to execute the research 4.Analyzing the research data 5.Communicating the results and feeding it back into the health system 6.Monitoring and evaluating the project 13 Introduction

14

15 Audience

REFLECTION

THANK YOU