Lynn Freedman, Director, Averting Maternal Death and Disability Program and Law and Policy Project, and Professor of Clinical Population and Family Health, Mailman School of Public Health, Columbia University, gave the Keynote Presentation at the Implementation Science and Global Health satellite meeting on March 17, 2010 in Bethesda, Maryland.
Implementation science: The engine of accelerated progress in global health?
Ms. Freedman called for a paradigm shift in international thinking and action in response to global health challenges. The prevailing global health strategy, which typically focuses on single diseases, health issues, and interventions, has resulted in important achievements; however, they are often too limited in scope and unsustainable in the long run. Most major global health challenges are multifactorial and complex; as such, they defy simple or generic solutions. Consequently, the global health community is often frustrated with implementation failures of promising interventions and face difficulties in replicating or sustaining implementation successes. Ms. Freedman argued that we need to directly address the complexity of real-world implementation of evidence-based health interventions by holistically tackling the multitude and intertwined obstacles that undermine the successful translation to better health outcomes. She posed the question “Can implementation science be the engine of accelerated progress in global health?”
A broader health systems approach and the role of implementation science
Currently, most global health strategies do not address the root causes of health burdens. Instead, they tackle the “disarray” in health systems by reorganizing and reordering its existing elements. We fail to also face our own “disorientation,” that is, the lack of a compelling vision of where we want to go or how to get there in global health. Ms. Freedman argued that we need to adopt a systems thinking approach which allows for a broad, holistic, long-term and dynamic approach to solving complex problems. Systems-thinking recognizes that there are free agents whose actions influence each other, that causality is non-linear, and progress can only occur through functioning feedback loops.
Implementation research, guided by a systems-thinking approach, can help address big picture questions that continue to hinder worldwide efforts to achieve global health. Such research can serve to successfully narrow or close the know-do gap – the gap between what is known and what is done in practice. With persistent failures in implementation, significant and sustainable improvements in global health cannot be fully achieved.
Updated April 2010