How Do We Make Implementation Science Partnerships More Sustainable?

The American Academy for the Advancement of Science (AAAS), together with USAID-funded Health Evaluation and Applied Research Development (HEARD) Project, hosted a high-level roundtable during the AAAS 2019 Annual Meeting on the challenge of sustainable partnership in implementation science (IS). The discussion, “Beyond Research to Partnership for Policy and Program Change” brought almost twenty domestic and global health policy leaders to offer their expertise and experiences on how to overcome the cultural and structural challenges of sustainability of long-term partnerships.

Speakers and participants of the “Beyond Research to Partnership for Policy and Program Change” Roundtable at the 2019 AAAS Annual Meeting

Although the mission of AAAS is to “advance science, engineering, and innovation throughout the world for the benefit of all people”, the Academy does not, as Dr. Julia MacKenzie, Director of International Relations noted, “see itself as focusing on implementation science”.[1] The discussions at this meeting suggested that this may change. Ambassador Jimmy Kolker, Visiting Scholar at the AAAS Center for Science Diplomacy, opened the meeting by reflecting on the importance of partnership in IS to achieve the goals of data translation. “Data rarely speaks for itself whether in public health or other field”, he reflected. He then went on to explain that unlike other fields, IS requires partnership because if we are interested in data and evidence being used to influence policy, program and health outcomes, then it needs to be translated for those in a position of influence. This translation of the evidence into actionable information, is not a simple act — it requires multiple stakeholders involved to work together towards a common goal and at its heart is highly political. Thus, data translation relies on long term sophisticated partnerships built on mutual respect, trust and common vision.

A key challenge to building IS partnerships is not in convincing others of their importance, but in putting in place mechanisms, tools, and governance needed to ensure their sustainability.  Participants reflected how ImS partnerships are relatively easy to launch- as that is at its core, the simple act of organizing a meeting to bring stakeholders together. The challenge is that an IS partnership must be sustainable for years, and possibly decades, since the horizons for health and other public policy goals extend much further out in time than do typical political and funding cycles.

For this reason, long-term partnerships must include sustained funding and mechanisms that support the development of partner capacity. The importance of this is evident in the Academic Model Providing Access to Healthcare (AMPATH) which, through a multi-decade relationship between Moi University in Kenya and University of Indiana, has been able to work together on multiple projects in East Africa. AMPATH, thus, does not have the challenge of a loss of partnership when a funding stream ended because that capacity and relationships are intact.

Robert Clay, Vice President of Global Health for Save the Children, speaking at the roundtable

Another necessary element of sustainability is partnerships with Governments and Ministries of Health. Georgetown University’s Dr. Charles Holmes reflected that every in-country project needs a co-investigator in the ministry of health to help shepherd it through the translation stage. For example, Zambia’s Ministry of Health led quarterly science-to-policy forums which engaged multilateral health organizations as well as other in-country researchers for the purpose of helping to drive evidence into use.

Finally, participants discussed the importance of trust and respect, not only with those stakeholders but also with the individuals and community impacted by the research outcomes. Community members must be engaged to shape the research questions reflecting a respect for their expertise in diagnosing a problem and their personal experience of the existing information gaps. Research which is designed to be relevant to lives will be met with greater interest and opportunity for impact and scale-up.

Attendees enumerated the essential elements in partnership creation and included what is needed to create a sustainable relationship that will thrive in the long term:

  • Ensure a shared vision across all stakeholders
  • Articulate clear roles and responsibilities
  • Put effective communication structures in place
  • Have structures in place to enable sharing technical resources and capacity
  • Build in adequate time (including time to have ideas taken onboard; time to build relationships based on trust, mutual respect and common goals; time to determine what current and future role(s) each partner will undertake)
  • Include the Ministry of Health as a partner to ensure buy-in and sustainability
  • Assure adequate funding to build institutional capacity so that there are counterparts with whom to work
  • Design research which is relevant for the real world (seeking out advice of those potentially impacted)
  • Include demonstrations, a reflection of a commitment to success (not pilots) and focus efforts on moving demonstration to scale

Dr. Honorati Masanja of the Ifakara Health Institute, summarized the discussion through the following bullet points. Implementation science:

  • Is all about trust and mutual respect
  • Is not just about institutions and foreign governments working together, it is about diverse partnership
  • Must appreciate local context and expertise
  • Must recognize that success requires investment in institutional capacity strengthening—key to sustainability and maintenance of partnerships.
  • Must take into account that Health Systems are political

As the group concluded, they reflected on how one of the misunderstood, or often rarely spoken about aspects of public health is how political a field it is. Both political because priorities (and funding), are driven by considerations outside of the health sector, but also political because so much about success in partnership necessary for evidence translation depends of the relationship between diverse individuals. Thus, the statements about the importance of trust and respect is not specific to health, but rather the foundation of all human relationships.