Must-Read: Temina Madon, Karen J. Hofman, Linda Kupfer, and Roger I. Glass: Implementation Science

Must-Read: Temina Madon, Karen J. Hofman, Linda Kupfer, and Roger I. Glass: Implementation Science:

We face a formidable gap between innovations in health… and their delivery….

Nearly 14,000 people in sub-Saharan Africa and South Asia die daily from HIV, malaria, and diarrhea…. Many evidence-based innovations fail to produce results when transferred to communities… because their implementation is untested, unsuitable, or incomplete…. Insecticide-treated bed nets can prevent malaria… yet… fewer than 10% of children in 28 sub-Saharan African countries regularly slept with this protection…. The same is true of strategies to prevent mother-to-child transmission of HIV….

Why is effective implementation, particularly in resource-poor countries, such an intractable problem?… Scientists have been slow to view implementation as a dynamic, adaptive, multiscale phenomenon that can be addressed through a research agenda…. People living in poverty face a bewildering constellation of social constraints and health threats…. Recent billion-dollar increases in budgets for global health have provided only limited support for studies needed to ensure maximum impact. Instead, planners often assume that clinical research findings can be immediately translated into public health impact, simply by issuing “one-size-fits- all” clinical guidelines or best practices without engaging in systematic study of how health outcomes vary across community settings…