Implementation research in LMICs—evolution through innovation

Major global health gains can be achieved by strengthening the delivery of public health policies and programmes in lowand middleincome countries (LMICs). The population impact of evidencebased technologies and interventions such as drugs, vaccines and health know-how can only be maximized where programmes optimally identify and reach target populations and support them to take up and sustain their effective use. Examples include significant gaps in the coverage and quality of maternal health, newborn, immunization, non-communicable disease, primary care and adolescent sexual and reproductive health services—all issues tackled in this supplement. While structural change and increased funding are essential, much can be gained through ongoing improvements in programme delivery (Paina and Peters, 2012). Implementation gaps are also widely implicated in the failure of broader health policies and reforms in LMICs (Haines et al., 2004), such as for decentralization, health care regulation and primary health care. This makes it important also to analyse the implementation of policies at all levels, including studying the negotiations and interactions of actors in social and political contexts, understanding gaps in the effectiveness of public policies and helping to resolve them. Rigorous scientific studies of the implementation and effectiveness of public health programmes and policies delivered in real-life settings have long been acknowledged to be critical to accelerating impact and fostering innovation in this area (Fixsen et al., 2005). This area of enquiry interchangeably referred to as implementation research (IR) and implementation science has captured widespread attention. Taking IR to scale is essential to support the delivery of public health programmes and broader reforms such as Universal Health Coverage. This supplement, ‘Innovations in Implementation Research in Lowand Middle-Income Countries’ showcases innovations in IR that are enhancing its value, shaping its development and fuelling the growth of the field. Specifically, we look to innovations that are occurring in LMIC contexts—where IR has the greatest potential to have impact. It does not seek to define IR, since we recognize that numerous authoritative texts have done so already. The supplement is a joint production of Health Policy and Planning and the Alliance for Health Policy and Systems Research. Widely acknowledged as an eclectic area of enquiry not reliant on any one method or discipline, IR needs to adapt and innovate to meet the diverse demands upon it. Innovations are relevant at each stage—from developing more fit-for-purpose study designs to deploying multiple methods and disciplines to better effect, to innovations in fieldwork and analysis (Peters et al., 2013a). The governance of IR, including the evolution of appropriate ethical standards, also represents a potential area of innovation (Gopichandran et al., 2016). A further aspect of innovation has been in considering who participates in IR. The lack of alignment of existing research with the priorities and needs of their ultimate consumers (i.e. health system decision-makers and practitioners in LMICs)—is increasingly being recognized as widespread and counterproductive. To counter this misalignment, innovations such as ‘embedding’ IR into LMIC health systems, and participatory approaches involving implementers and practitioners, are gaining momentum (Ghaffar et al., 2017). The supplement consists of 12 articles that present innovations in the methods, approaches and governance of research on the implementation of public health policies and programmes in LMICs. Each of the papers illustrates the concept and usefulness of IR in different ways and this mix highlights its transdisciplinary character— defined by the real-world implementation challenges that it seeks to address and deploying a range of methodological inputs to analyse and tackle them. Two commentaries, one by country policymakers who have played roles in institutionalizing IR in their countries, and other by the leadership of WHO on the significance of IR in promoting cultures and practices of learning in health systems, complement the research articles. We hope that this supplement will help shape the trajectory of the development of the field and more importantly, help to chart the way forward for the further application of IR to maximize its impact on policies and programmes in the real world.