University Partners in Global Health Implementation Science: A discussion among stakeholders of the value added and the challenges with university engagement in implementation science partnerships
Setting the 9th Annual Consortium of Universities in Global Health (CUGH) Conference off to a compelling start, the HEARD Project hosted a standing-room only, three-panel satellite sessions on the topic of “Creating Incentives for Greater University Engagement in Global Health Implementation Science.” The first two panels, which are discussed below, brought together senior-level implementation science stakeholders ranging from academic researchers, to advocates and implementers, to multilateral and bilateral health organizations. (See post about the third panel here.) Panelists engaged in a critical discussion on university participation in implementation science, explored best practices in university-implementer partnerships, and shared experiences and reflections on how to overcome barriers.
Many panelists highlighted the value academic partners bring in achieving a fundamental implementation science goal: to assess and improve the uptake and integration of evidence-based interventions, practices, programs, and policies. Compared to a few decades ago, there is an increased recognition in university settings of implementation science’s critical role in solving and catalyzing progress on major global health issues. Indeed, many academic institutions are now leading efforts to ensure that evidence generated through public health research is useful and used. Such institutions are also increasingly finding that the work of implementation science requires a partnership approach with policymakers, funders and implementers, for whom embedded research has become a new normal. However, in spite of these positive trends, session panelists identified several obstacles to university participation in implementation science in global health. Some notable obstacles included:
- Research questions are often driven by the hypotheses of non-local researchers or funders interested in conducting rigorous studies, but not rooted in the needs and questions of Ministries of Health or those implementing a specific policy or program, whose questions are often more focused on informing implementation improvements.
- Researchers are often brought in late, once the implementation (and data collection) has already been designed and/or completed; funders often want quick results, leaving insufficient time for appropriate design and stakeholder engagement.
- Academic structures are still not sufficiently in place for rewarding “real-world” implementation science as its outputs, though they produce the knowledge implementers want, are often not conducive to the type of academic research publishable in peer reviewed journals, which is how academic achievement is largely measured. This means that implementation science products can prove particularly high-risk for junior faculty.
- Participating in implementation science places a high burden on academic institutions, which must carefully manage the risks of operating in many different countries at one time, including registering in countries, employing foreign nationals, banking, and compliance with labor and tax laws.
- Researchers sometimes think they are conducting implementation science work when they are actually missing important elements that distinguish implementation science from other types of research. Such important elements include local stakeholder engagement, a focus on socially and contextually appropriate needs, management systems, communication skills, and tools which enable scale-up and feasibility.
In addition to these obstacles, the need for time, often decades, to build trust and develop the strong partnerships needed to successfully engage in implementation science in global health emerged as a recurring topic of emphasis. Successful implementation science examples, many panelists contended, required full collaboration between high-income and low-income country stakeholders and across disciplines: universities, implementers, funders, local advocates and end-users. Dr. David Peters of Johns Hopkins University noted that while it is challenging to build trust between academics and implementers, it is even harder to build relationships with governments, which change with election cycles. In reflecting on this, multiple panelists noted the importance of working with well-established sub-regional intergovernmental health bodies, which are well recognized for their technical expertise and with which Ministries of Health have preexisting long-term relationships. Engagement with these bodies can help accelerate the building of trust needed to support collaborative agenda development, more effective evidence use, capacity building potential, and resource leveraging opportunities.
Despite persistent challenges, the panelists have seen growth and potential for greater university involvement in global health implementation science. Panelists presented great examples of the challenges being addressed: from a mental health project in Nepal which approached researchers before the project had been designed, to UNICEF’s across-the-board practice of embedded research and engaging in the promotion of equity in north-south partnership, to the ever-growing field of health communications which recognizes the necessary skill of speaking to different types of decision makers. In addition, many were heartened by the increase matriculation of students into public health graduate degree programs, and in particular the students interest in the practical application of the skills and knowledge they gain through their coursework. . As the field of implementation science matures, there will be increased interest in addressing the challenges outlined, which are largely structural, and other challenges will emerge as priority issues such as overcoming challenges to data sharing, addressing ethically difficult questions, and how to improve documentation of both successes and failures.