Home > News > Publications  > Global Health Matters

Global Health Matters

November - December, 2007  |  Volume 6, Issue 6

Fogarty Scientists Urge Focus on Implementation Research to Save Lives in the Developing World

Reducing the gap between the development of new drugs and treatments and their implementation in the developing world could save thousands of lives each day and make more effective use of the U.S. investment in global health, according to Fogarty scientists.

In a paper published in the Dec. 14 issue of Science magazine, Fogarty's Director Dr. Roger I. Glass addresses the causes of this implementation research gap and suggests ways it can be reduced. Full text of paper. [PDF 144K]

Implementation research could help
bridge the gap between the development
of new drugs and treatments and their
adoption in the developing world.
Photo:WHO/P. Virot

"Many evidence-based innovations fail to produce results when transferred to communities in the global south, largely because their implementation is untested, unsuitable, or incomplete," he writes. "For example, rigorous studies have shown that appropriate use of insecticide-treated bednets can prevent malaria, yet on average fewer than 10 percent of children in 28 Sub-Saharan African countries regularly sleep with this protection.

Effective implementation in resource-poor countries is an intractable problem for a number of complex reasons, according to the paper. First, scientists have been slow to view implementation as a dynamic, adaptive, multi-scale phenomenon that can be addressed through a research agenda. Second, people living in poverty face social constraints and health threats that make prevention and treatment more difficult, and are less likely to have regular access to quality care.

Even a small investment in implementation research could dramatically improve the situation, the paper suggests, as well as significantly increase the effectiveness of major U.S. investments in global health.

"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 on how health outcomes vary across community settings," according to Glass.

He calls on the research community to adopt three goals to improve implementation in the developing world. First, scientists should work to advance theoretical models and new analytic methods that apply to resource-poor settings. Second, they should train a generation of researchers in interdisciplinary, systems-oriented approaches that will allow them to more effectively bridge the implementation gap. Finally, researchers should collaborate more closely with developing country governments, non-governmental organizations, and local communities.

Public Health: Implementation Science. Madon T, Hofman KJ, Kupfer L, Glass RI. Science, Dec. 2007, Vol. 318 no. 5857, pp. 1728-1729.

Visit this link for more information.