Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique.
Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique.
复制标题
DOI：
10.9745/ghsp-d-22-00061
复制
发表时间：
2022-09-15
影响因子：
4
通讯作者：
Alirigia, Robert
中科院分区：
文献类型：
--
作者：
Baynes, Colin;Sheff, Mallory;Hirschhorn, Lisa;Adedokun, Lola;Fernandes, Quinhas;Sherr, Kenneth;Gimbel, Sarah;Ramiro, Isaias;Chicumbe, Sergio;Chaquisse, Eusebio;Manaca, Nelia;Augusto, Orvalho;Belay, Hiwot;Tilahun, Hibret;Gebeyehu, Abebaw;Mohammedsani, Afrah;Awoonor-Williams, J. Koku;Bawah, Ayaga;Phillips, James;Kachur, S. Patrick;Kyei, Pearl E.;Kanlisi, Nicholas;Alirigia, Robert
非洲卫生倡议利用多学科伙伴关系模式优先开展嵌入式实施研究，增强决策者的能力，并在各级卫生系统开展嵌入式研究和能力建设。让决策者和执行小组参与，就执行问题的根本原因提出关键意见，优先考虑哪些因素和如何解决，并确定提出和回答哪些问题，以最好地指导初级保健政策的执行。将决策者纳入项目研究领导角色，使数据收集、分析和传播与规划周期保持一致，在规划周期中，新的发现可以务实地反映出来，并在适当的情况下用于指导项目实施。政策决策者、地区卫生系统的执行领导人和当地研究机构之间的多学科伙伴关系促进了在共同制定执行战略和研究计划方面的合作，并强调知识和经验的分享。嵌入式IR不仅受到个人领导和当地执行环境的影响，而且受到非洲卫生倡议伙伴关系本身在国家一级嵌入的总体组织文化的影响。嵌入式IR导致卫生系统发生有意义和持久变化的程度受到传播和吸收新知识的机会和障碍的影响。实现全民保健需要采取循证的初级保健政策和提供战略。虽然这方面面临着多重挑战，特别是在撒哈拉以南非洲的卫生系统，但有一些很有希望的办法来实现这一目标。其中最突出的是嵌入式实施研究（即，研究方法，以促进系统地吸收基于证据的干预措施（EBI）的日常做法）到政策制定和执行过程。自2007年以来，多丽丝杜克慈善基金会的非洲卫生倡议支持建立伙伴关系，利用嵌入式执行研究作为核心战略，加强撒哈拉以南非洲7个国家的初级卫生系统和政策执行。这一方案审查和分析的目的是确定伙伴关系如何运作嵌入式执行研究方法的核心特征和过程，并了解有助于和限制伙伴关系有效利用这一方法的因素。为此，我们借鉴了案头审查的结果，其中包括2016年至2021年在埃塞俄比亚，加纳和莫桑比克的3个非洲健康倡议伙伴关系进行的30个嵌入式实施研究的例子。此外，我们还对这3个项目的嵌入式实施研究利益相关者进行了13次深度访谈，并进行了分析。嵌入式实施研究的核心特征和过程是：（1）政策决策者和实施领导者的领导作用;（2）将研究与卫生系统多层次的计划实施定位;（3）多学科和多部门的伙伴关系;（4）关注研究能力建设;（5）实时反馈循环和知识转化。影响嵌入式实施研究经验的有效性的因素包括：（1）实施气候和领导;（2）传播和吸收新信息的机会和能力;（3）利益攸关方的基线知识和嵌入式科学家在其组织内的身份。
The African Health Initiative prioritized embedded implementation research using a multidisciplinary partnership model that empowered decision makers and embedded research and capacity building at multiple levels of health systems. Engaging policy decision makers and implementation teams elicited critical input on root causes of implementation problems, prioritized which factors to address and how, and determined what questions to ask and answer to best guide primary health care policy implementation. Integrating decision makers in program research leadership roles allowed data collection, analysis, and dissemination to align with planning cycles during which new findings could be reflected on pragmatically and, if appropriate, used to guide program implementation. Multidisciplinary partnerships between policy decision makers, implementation leaders from district health systems, and local research institutes fostered collaboration in cocreating implementation strategies and research plans and emphasized knowledge and experience sharing. Embedded IR was influenced not just by individual leadership and local implementation climate but the overarching organizational culture in which the African Health Initiative partnerships were themselves embedded nationally. The degree to which embedded IR leads to meaningful and lasting change in health systems is affected by opportunities for, and impediments to, disseminating and absorbing new knowledge. Achieving universal health care coverage requires the adoption of primary health care policies and delivery strategies that are evidence based. Although this has been confronted by manifold challenges, particularly in the health systems of sub-Saharan Africa, there are promising approaches for accomplishing this objective. Salient among these is embedding implementation research (i.e., the study of methods to promote the systematic uptake of evidence-based interventions (EBIs) into routine practice) into policy making and implementation processes. Since 2007, the African Health Initiative of the Doris Duke Charitable Foundation supported partnerships that strengthened primary health systems and policy implementation in 7 countries in sub-Saharan Africa using the embedded implementation research as a core strategy. This programmatic review and analysis aims to identify the core features and processes that characterized how the partnerships operationalized the embedded implementation research approach and understand the factors that helped and constrained partnerships’ effective use of this approach. For this, we drew upon findings from a desk review that consisted of 30 examples of embedded implementation research conducted by 3 African Health Initiative partnerships between 2016 and 2021 in Ethiopia, Ghana, and Mozambique. In addition, we conducted and analyzed 13 in-depth interviews with embedded implementation research stakeholders of the 3 projects. Core features and processes of embedded implementation research were: (1) the leadership role of policy decision makers and implementation leaders; (2) positioning research with program implementation at multiple levels of health systems; (3) multidisciplinary and multisectoral partnerships; (4) focus on research capacity building; and (5) real-time feedback loops and knowledge translation. Factors influencing the effectiveness of the embedded implementation research experiences involved: (1) the implementation climate and leadership; (2) opportunities and capacities to circulate and absorb new information; and (3) stakeholders’ baseline knowledge and embedded scientists’ identification within their organizations.