Strengthening health systems through research

By Access and Delivery Partnership

Even the most promising health interventions can encounter obstacles and fail to produce the desired results when used in unique local settings. A range of unpredictable variables come into play, such as socio-behavioural factors, logistical challenges, financial limitations and extreme environmental conditions.

Implementation research is becoming an increasingly critical tool for health practitioners to ensure the greatest likelihood of success.

Implementation research identifies bottlenecks and, importantly, the solutions to enhance health care service delivery while strengthening overall health systems. This form of research can help determine whether health interventions such as vaccines, drugs, medicines, policies and practices are effective in real life, beyond the laboratory or clinical trial setting.

The Access and Delivery Partnership (ADP) has advanced the use of implementation research across different levels of the health system, through health workforce training and the development of an innovative learning resource called the Implementation Research Toolkit.

Initially developed by the Special Programme for Research and Training in Tropical Diseases (TDR) in 2014, the Toolkit is a self-learning tool offering health care service providers, researchers and administrators a comprehensive guide on the design and planning of implementation research projects, including formulation of research questions, development of funding proposals, data collection and analysis, and sharing of research findings.

ADP supported enhancements to the Toolkit, which included its conversion into a bilingual (French and English) online version. In 2022, a new module was added to strengthen the capacity of researchers to incorporate an intersectional gender perspective in implementation research projects and related proposals. The Toolkit is also in the process of being fully digitized, with updated functionalities optimized for virtual and hybrid learning, to maximize its reach.

Beneficiaries of the Toolkit and training have included disease control programme implementers, district and central hospital personnel and academics. Participants from Malawi and Ghana share their experiences below. They continue to be part of a broad network of researchers and benefit from technical exchanges with their counterparts across countries and regions—which, in turn, will enhance implementation research approaches and contribute to future enhancements of the Toolkit.

“Participating in the implementation research course, using the Implementation Research Toolkit, equipped me with analytical skills in implementing health interventions. With every health intervention being provided to the community, I am able to think of the end from the beginning.”

Dr. Sheena Kaunda

Senior Medical Officer at Chikwawa District Hospital, Malawi

Strengthening health systems through research

“The Implementation Research Toolkit has helped me fully understand and distinguish implementation science and quality improvement projects. I have been able to review our biochemistry department using the data monitoring tips in the tool. Using this data, we are trying to improve performance and participation in external quality control with NHLS [the National Health Laboratory Service]. Secondly, the Implementation Research Toolkit has helped me with identifying and engaging stakeholders with critical roles and influence to implementation of our QIPs [quality improvement processes]. This has promoted and improved linkages between the laboratory and the clinical section.”

Florence Filisa

Head of the Biochemistry Laboratory, Kamuzu Central Hospital, Lilongwe, Malawi

“We are now able to look at project outcomes not only in terms of the biological impacts, but we are now able to look at the process itself in terms of implementation determinants and implementation outcomes that inform the quality of implementation. Now when we engage with partners, we are paying more attention to the implementation process just to make sure that it is also of good quality.”

Steve Manyozo

Epidemiologist, Kamuzu University of Health Science, Malawi

“The implementation research training helped to apply a structured process to identify bottlenecks and barriers—the problem—in the health system, especially in the area of neglected tropical diseases. We were able to successfully develop and implement an interventional study. The implementation research training also helped in identifying and engaging appropriate stakeholders, and identifying potential funding sources for our interventional studies in the region.

[The training] has enhanced my day-to-day activities of identifying problems in the routine service delivery system and being able to use my acquired skills to solve some of the problems in the service. I am now an expert in IR, gained the knowledge, skills and experience, and am able to use IR to conduct research and win international research grants for projects.”

Adam Abdul Razak

Regional Health Research Coordinator, Bono Regional Health Directorate, Ghana Health Service

“The training in implementation research and mentorship were crucial to designing and conducting my Master’s research work. The long-lasting impact of my training in implementation research is worth mention. I am currently applying my knowledge and skills in conducting implementation research to design a study to understand the gaps and facilitators to the implementation of maternity protection regulations in the informal economy of Ghana.”

Faustina Twumwaa Gyimah

PhD candidate and recipient of a TDR postgraduate scholarship, Ghana

“As a health systems development officer and health research officer based at the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service, the implementation research training has systematically sharpened my understanding to demonstrate evidence and highlight alternative recommendations in the act of engaging larger communities.”

Samuel Mayeden

Health Systems Development Officer and Health Research Officer, Policy Planning Monitoring and Evaluation Division, Ghana Health Service

More information:

TDR, ‘TDR Implementation Research Toolkit’

TDR, ‘Massive open online course (MOOC) on implementation research: infectious diseases of poverty’

Africa Regional Training Centre, ‘Training Programmes: Principles of Implementation Research’

TDR, ‘Training course on ethics in implementation research: Participant’s guides’, 29 June 2019

This is part of a collection of impact stories highlighting the work of the Access and Delivery Partnership in ensuring access to health technologies for those in need. For more information and to read additional impact stories, please visit the ADP website.