Overcoming Implementation Challenges:
The Role of Implementation Science
The global health community is struggling with the challenge of implementing policies, programs, and practices successfully, sustainably, and at scale. Further, many of our most promising life-saving and life-enhancing innovations are not reaching the people they are intended to serve – especially those living in contexts in which availability and access to quality services is most challenging. Implementation science has much to offer on both fronts.
Implementation science is a new interdisciplinary field, but it has been around long enough to give us a better understanding of implementation challenges and to provide new frameworks, strategies, measurements and tools to help us address them.
In 2005, Dean Fixsen, PhD, former professor of maternal and child health at the Gillings School, led a synthesis of the implementation research evidence to reveal an important “formula for success.” “Success” includes three interrelated factors — with all three required for improved outcomes.
First, one must begin with effective innovations — such as a new technical approach or new policy, program, or practice. Second, effective implementation of these interventions must take place. Even if an intervention is 100 percent effective in a randomized trial, if it cannot be implemented, no one benefits from it. Thus, an innovation is not truly effective until it has been effectively implemented. Studies show that effective implementation requires competence, leadership and organizational support. Third, enabling contexts are needed to support implementation. In considering contexts, we often think about infrastructure. However, systems in global health are, to a large extent, human systems, people working together toward a common goal, and we need for these systems to support effective implementation of effective innovations.
These three components — effective innovations, effective implementation, and enabling contexts — are inextricably linked and all are required for successful and sustainable outcomes at scale. Implementation science is about making these three components interact with each other synergistically so that innovations will be more suitable for the contexts into which they are being implemented and contexts will be more ready and more supportive for successful implementation.