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Implementation Science and Global Health: From theory to practice in West Africa

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Presentation designed by Valéry Ridde for a symposium held on April 14, 2017 at San Diego State University. The symposium was organised by The Global Health Program at the SDSU's Graduate School of Public Health.

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Implementation Science and Global Health: From theory to practice in West Africa

  1. 1. Implementation Science and Global Health From theory to practice in West Africa Ridde, Valéry April 14, 2017 @equitesante @valeryridde
  2. 2. OUTLINE 1. Definitions 2. Methodological approach 3. Implementation outcomes 4. Conclusion
  3. 3. 1- DEFINITIONS
  4. 4. Definitions of implementation science in HIV/AIDS Odeny, Thomas A et al. The Lancet HIV , Volume 2 , Issue 5 , e178 - e180 69 articles 96-2013 73 definitions
  5. 5. IMPLEMENTATION SCIENCE RESEARCH STUDIES
  6. 6. DEFINITIONS • Scientific investigation of factors associated with effective implementation(Franks and Schroder, 2013) • implementation = process of putting an intervention into use - either evidence-based or theory-based – in a setting(Damschroder et al., 2009; Nash et al., 2006; Thompson et al., 2003)
  7. 7. 2- METHODOLOGICAL APPROACH
  8. 8. PUBLIC POLICY EMERGENCE FORMULATION IMPLEMENTATION Lemieux 2002
  9. 9. EMERGENCE FORMULATION IMPLEMENTATION SWIRL PROCESS FORMULATION IMPLEMENTATION Lemieux 2002; Monnier 1992
  10. 10. INTERVENTION Planning, implementation, evaluation, sustainability
  11. 11. BLACK BOX AND TYPE 3 ERROR INTERVENTION R E S S O U R C E S I M P A C T S
  12. 12. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services.
  13. 13. 16
  14. 14. THE TREE THAT HIDES THE DRILL 0 20/m 40/m 60/m 80/m 100/m 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 Koutougou 0 20/m 40/m 60/m 80/m 100/m Nombre mensuel 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 0 20/m 40/m 60/m 80/m 100/m 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 • Informal payment • Past experiences • Perceived quality • Geographical access Belaid et Ridde, 2015
  15. 15. DIFFERENT TYPES OF THEORIES • “Hypotheses on which people, consciously or unconsciously, build their program plans and actions.” (Weiss, 1997) Program theory • “Basic, usable structure of ideas, less abstract than grand theory, and more abstract than empirical generalizations or micro-range theory.” (Stinchcombe, 1968, quoted by Moore et al., 2012) Middle-range theory • “Unified theory that will explain all the observed uniformities of social behavior, social organization, and social change.” (Merton, 1969) Grand theory Ladderofabstraction What about the Theory of Change? Or the Implementation Theory? Or the Logic Model? Robert and Ridde, 2016
  16. 16. StrengtheningofhealthsystemstowardsUniversalHealthCoverage Supporttopolicydialogueprocessesforhealthplanning&financing Approach (SOFT) On-going technical support Training Capacitystrengtheningof MoH Knowledge and resources production Components of support (HARD) FlexibilityResponsiveness Ad hoc technical expertise Policy dialogue for health planning & financing What is expected from such a policy dialogue GoalResults MAKE IT HAPPEN MAKE IT HAPPEN Outcomes Formulation of robust and comprehensive health policies, strategies & plans Alignment and harmonization of stakeholders Strengthened leadership of MoH Fed by knowledge Inclusive and participatory Led by MoH Robert & Ridde, 2017
  17. 17. SOLENZO HSPC + HSPC + HSPC - HSPC - HSPC +/- HSPC +/- RBF1 RBF4 DIEBOUGOU HSPC + HSPC - RBF1 HSPC + HSPC - RBF2 HSPC + HSPC - RBF3 OUAHIGOUYA HSPC + HSPC - RBF1 HSPC + HSPC - RBF2 HSPC + HSPC - RBF3 R H C RBF1 M C S S RBF1 M C S S RBF1
  18. 18. 3- IMPLEMENTATION OUTCOMES
  19. 19. IMPLEMENTATION OUTCOMES • Acceptability • Adoption • Appropriateness • Feasibility • Fidelity • Cost • Penetration • Sustainability Enola Proctor et al, 2010
  20. 20. SOCIETY FOR IMPLEMENTATION RESEARCH COLLABORATION Lewis et al. Implementation Science (2015) 10:155 mental or behavioral health settings
  21. 21. Harald Saetren The Policy Studies Journal, Vol. 33, No. 4, 2005
  22. 22. Saetren, 2005- Articles 1933-2003
  23. 23. Sustainab*/Implementation Equitesante.org
  24. 24. HP AND POLICY SCIENCE : 1986-2006 E. Breton and E. de Leeuw, 2010 ● 7% of HP article are PP studies ● 18% are referring to a theoretical framework 0 0 1 0 0 3 1 1 6 0 1 7 0 12 8 9 10 16 15 26 3 0 5 10 15 20 25
  25. 25. “We are not even close to a well- developed theory of policy implementation’” Saetren’s (2005, p. 573) « The theoretical base for implementation is relatively new and needs to be tested and operationalized in real-world settings. » Franks & Schroeder (2013, p.12)
  26. 26. Pulzi et Treib, 2007
  27. 27. PROBLEM POLITICS POLICY PROBLEM POLITICS POLICY POLITICSPROBLEM POLICY IMPLEMENTATIONFORMULATIONEMERGENCE Voir Ridde (2009), adapté de Kingdon (1995) et Lemieux (2002)
  28. 28. HOW TO BE SUCCESSFUL ? ‘implementation politics’ (Bardach, 1977), ‘crisis of implementation’ (Mazmanian & Sabatier, 1983), ‘implementation gap’ (Pressman & Wildavsky, 1984), ‘implementation deficit’ (Blackmore, 2001)
  29. 29. de Leeuw et al. Health Research Policy and Systems 2014, 12:55
  30. 30. QUALITY IMPLEMENTATION FRAMEWORK • 8 dimensions • 20/23 contextual factors • 14 critical steps Durlak, 2015; Meyer et al, 2012
  31. 31. Meyer et al, 2012 QUALITY IMPLEMENTATION FRAMEWORK
  32. 32. CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH Damschroder LJ, et al, 2009
  33. 33. Kirk et al. (2016) 11:72
  34. 34. Cole, C, et al 2016
  35. 35. IMPLEMENTATION INTERVENTION • resources • activities FIDELITY • Content • Coverage • Time IMPACTS MODERATORS • Context • Actors • Mechanisms Adapté de Carroll et al. (2007) ADAPTATION
  36. 36. 0% 25% 50% 75% 100% Planification Mise en œuvre Outils de mise en œuvre Autres Implanté Non Implanté Adapté Ajouté NR CONTENT FIDELITY Equitesante.org
  37. 37. DS 1 DS 2 DS3 DS1 DS2 DS3 DS1 DS2 DS3 DS1 DS2 0 DS3 0 0 10 20 30 40 50 60 70 80 90 100 Planification Mise en œuvre Outils de mise en œuvre Autres FIDELITY HETEROGENEITY Equitesante.org
  38. 38. Sekhon et al. BMC Health Services Research (2017) 17:88 THEORETICAL FRAMEWORK OF ACCEPTABILITY
  39. 39. Unintended Consequences Turcotte-Tremblay A-M et al, 2017
  40. 40. Bull World Health Organ 2016;94:58–64
  41. 41. 4- CONCLUSION
  42. 42. WHAT EVERYONE SHOULD KNOW 1. Quality Implementation Is the Sine Qua Non of Effective Programs 2. Monitoring Implementation Is an Essential Component 3. It Is Extremely Costly to Ignore Implementation 4. Implementation Is a Multidimensional Concept 5. Implementation Exists along a Continuum 6. Adaptations Are Common and May Improve Program Outcomes 7. Effective Professional Development Services Are Essential 8. Multiple Factors Affect Implementation 9. at Least 14 Related Steps to Achieving Quality Implementation 10. Quality Implementation Requires Collaboration among Multiple Stakeholders 11. The Same Factors That Influence Quality of Implementation Also Influence Sustainability Durlak, 2015; pp. 395–405

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