On July 9, 2024, the Health Systems Strengthening Accelerator (the Accelerator), in collaboration with Curatio International Foundation, the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana, and Results for Development in Indonesia, hosted a webinar titled “Implementation Research for Health System Equity, Inclusion, and Impact: Experience from Georgia, Ghana, and Indonesia.”
Implementation research is a collaborative process of continuous and timely research into what policies, programs, and practices are working (or not) and why. These findings can help stakeholders solve program problems and help to improve, scale, or sustain implementation. When embedded in programs, implementation research helps to illuminate facilitators, barriers and other contextual factors that influence program implementation and outcomes. It also provides information important for sustainably taking health system programs to scale.
As described in USAID’s HSS Practice Spotlight brief, Enhancing Equity in Health Systems: The Critical Role of Implementation Research, implementation research can address health systems equity challenges by:
- Bridging the often-substantial gap between design and implementation reality of pro-poor policies and strategies.
- Increasing accountability for equity-enhancing outcomes as programs scale-up by explicitly measuring and accounting for equity-related variables.
- Empowering disadvantaged groups to influence programs and policies intended for their benefit.
Country Case Studies
Ghana
Ghana: The Ghana Health Service and the USAID-funded Accelerator conducted IR on the role Networks of Practice (NOPs) can play in advancing community-level health equity. The study used mixed methods to examine care seeking and perceptions of NOP service quality and found disparities in levels of access and satisfaction in poorer communities. Findings suggest that incorporating additional supports, such as referral transportation, could enhance the NOP model’s contributions to health equity. More details are available in the spotlight brief and in the phase two research report, Leaving No One Behind: the Role of Primary Care Provider Networks in Advancing Equitable Universal Health Coverage in Four Districts in Ghana.
Georgia
CIF investigated the initial implementation of a new initiative to reduce financial access barriers for a limited set of outpatient rehabilitation services under Georgia’s Universal Healthcare Coverage Program (UHCP) and identified ways to strengthen the program prior to wider rollout. Research methods included semi-structured interviews and focus group discussions with patients enrolled in the program, service providers, and MoH representatives. Recommendations from the study were adopted by Georgia’s health ministry, which will allow the program to be more inclusive and responsive to population needs, including for people with disabilities, people who are socially vulnerable, veterans, students, and pensioners. More details on the study can be found here: Georgian State Rehabilitation Program: Implementation Research Study Report.
Indonesia
The Government of Indonesia commissioned the USAID Health Financing Activity to implement a Strategic Health Purchasing Pilot for Maternal and Newborn Health (MNH) to improve service quality in two districts. The pilot used inclusive approaches to strengthen the performance of public and private primary healthcare providers and employed a real-time monitoring system and “troubleshooting” tool to mitigate risks, quickly solve technical issues, and propose refinements to policy. Findings from a real-time monitoring mechanism were fed back up to national decision-makers through a national technical working group. Baseline and endline studies were conducted in pilot and control districts to assess impact in combination with focus group discussions to explore acceptance, feasibility, suitability, adoption, and compliance of the pilot design. This allowed for early detection of gaps in district-level regulations, which enhanced the pilot’s ability to provide equitable, high-quality MNH care. The tariff and payment mechanism used in the pilot has since been reflected in a ministerial decree.
Closing Highlights
Implementation research is multipurpose. Although we often think of it as helping to identify or solve known challenges, it can also help uncover key opportunities for enhancing equity and inclusion and ensure that stakeholders have a shared understanding of the situation and how to respond. In addition, implementation research can enhance equity, quality, and sustainability for a wide range of programming, even if that was not the primary focus of the program, policy, or approach being studied.
Timeliness and stakeholder engagement matter: Maintaining a focus on the timeliness of research and dissemination, coupled with effective stakeholder engagement, supports uptake of findings to influence decisions that make a difference in people’s health by contributing to building stronger and more responsive, equitable health systems.
