Perspectives on Implementation Science from Academic Leadership: Six Deans of schools of public health consider the role of universities in fostering and shaping implementation science in global health
At the 9th annual conference of the Consortium of Universities for Global Health (CUGH), USAID’s Health Evaluation and Applied Research Development (HEARD) Project led a satellite session on Creating Incentives for Greater University Engagement in Global Health Implementation Science. The half-day session consisted of three high-level panels of global health university and non-university stakeholders on the challenges with, and models and potential strategies for enhancing the participation of academic institutions in implementation science. For the major highlights from the first two panel discussions, click here. The concluding panel of six public health deans from around the world engaged in a candid discussion on:
- the different ways implementation science exists within the education, research, and service pillars of their institutions
- how best to ensure both students and faculty develop the skills needed to conduct rigorous research that has real-world impact in real time
- how to overcome the barriers for academic researchers engaging in this work.
They represented BRAC University’s James P. Grant School of Public Health (Bangladesh), American University of Beirut (AUB)’s School of Health Sciences (Lebanon), Stellenbosch University’s School of Medicine and Health Sciences (South Africa), Universitas Indonesia’s School of Public Health, and Schools of Public Health in the two largest public university systems in the United States, the City University of New York’s School of Public Health, and University of California, Berkeley.
The Deans reflected on the growing trend towards implementation science in their schools, particularly as Dean Volmink of Stellenbosch University noted, among individual MPH and PhD students who enter degree programs with a deep interest in gaining skills needed directly improving health outcomes. As Dean Nuwayhid of AUB reflected that while institutionally it has become easier for faculty to be engaged in research focused on improving policy and programs, there is a need to reexamine the structure of current PhD programs, as they do not necessarily prepare students for this work. The general model is for a student to spend four to five years focusing on single question, in part, to prove her skills as an independent researcher. Dean Bertozzi of UC Berkeley echoed this, noting “we reward people for answering questions in isolation”. However, outside the Academic setting it is one’s ability to work collaboratively that is often the rubric for success. When implementation research is not merely hypothesis driven, but prioritizes answering questions harvested from the knowledge and experiences of those impacted, the final product tends to create more real-world impact. However, merit and promotion systems still reward the former not the latter.
Another topic featured in the afternoon discussion was the current failure of academic research structures to respond to what is needed to advance public health. There is no lack of important research being conducted. The problem is there is not necessarily a correlation between strong research and positive health outcomes. Dr. Rashid, Dean of BRAC University’s James P. Grant School of Public Health noted that despite robust investment by the Global Fund and others, TB rates have remained largely unchanged in Indonesia in the last four years. “We know we need to do something different so that our research is having a positive impact on the health of our community. Part of the problem, however is that while we have a clear understanding of what good research is in the biomedical field, we do not have the same clear standards for evaluating “good” research in the implementation science field.
The panel kept returning to the question of whether these barriers could be overcome by teaching students implementation science skills. What are the diversity of skills one needs and how do you articulate and evaluate these core competencies? There was agreement that implementation science in public health is a multidisciplinary field which takes into account political and social structures as well as the culture and values of the community being served. “Implementation science and politics are Siamese twins” explained Dr. El-Mohandes, Dean of CUNY’s School of Public health. Someone adept in this field would therefore be able to evaluate the public health impact of a program in a way which educates policy makers on changes needed to continue valuable programs, while remaining faithful to scientific principles. While it was agreed this is a skill, it was not clear how to articulate it as a core competency.
Likewise, Dr. Rashid noted the critical importance of being able to establish strong, trusting and respectful relationships between researchers and implementers and working in partnership, with Dr. Kusumayati emphasizing the importance of these partnership extending to the government. But how does one evaluate a student’s ability to collaborate and build effective partnerships? The panelist posed that perhaps we should not think of implementation science as a field of study, but rather, the process needed to move research to use. But if that is the case, it left outstanding the fact that there are people who do understand how to navigate the challenges and bring stakeholders together in order to achieve positive health outcomes. Dean Bertozzi ended by posing to the audience, “There must be a way to know who the real experts are.” The CUGH Conference in 2019 will focus on implementation science. Between now and then there will likely be far much more exploration on how to teach this expertise.