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Addressing the tensions and complexities involved in commissioning and undertaking implementation research in low- and middle-income countries
  1. Tanya Doherty1,2,
  2. Simon Lewin1,3,
  3. Mary Kinney2,4,
  4. David Sanders2,5,
  5. Cathy Mathews1,
  6. Emmanuelle Daviaud1,
  7. Ameena Goga1,6,
  8. Arvin Bhana1,7,
  9. Donela Besada1,
  10. Lieve Vanleeuw1,
  11. Marian Loveday1,8,
  12. Willem Odendaal1,9,
  13. Natalie Leon1,10
  1. 1Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
  2. 2School of Public Health, University of the Western Cape, Cape Town, South Africa
  3. 3Norwegian Institute of Public Health, Oslo, Norway
  4. 4GlobalHealth and Nutrition, Save the Children, Washington, USA
  5. 5Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
  6. 6Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
  7. 7Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  8. 8Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu- Natal, Durban, South Africa
  9. 9Departmentof Psychiatry, Stellenbosh University, Cape Town, South Africa
  10. 10School of Public Health, Brown University, Boston, USA
  1. Correspondence to Prof Tanya Doherty; tanya.doherty{at}

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Summary box

  • Rapid scale-up of new policies and guidelines, in the context of weak health systems in low/middle-income countries (LMIC), has led to greater interest and funding for implementation research.

  • Implementation research in LMICs is often commissioned by institutions from high-income countries but increasingly undertaken by LMIC-based research institutions.

  • Commissioned implementation research to evaluate large-scale, donor-funded health interventions in LMICs may hold tensions with respect to the interests of the researchers, the commissioning agency, implementers and the country government.

  • We propose key questions that could help researchers navigate and minimise the potential conflicts of commissioned implementation research in an LMIC setting.

Against a background of rapid scale-up of new policies and guidelines in the context of weak health systems in low/middle-income countries (LMIC), implementation research is especially important for understanding the ‘evidence-implementation’ gap. Implementation research investigates the various factors that affect how a new health policy or intervention may be implemented in usual practice settings and the contextual factors that affect implementation at scale.1–4 A wide range of qualitative and quantitative methods can be used in implementation research including: pragmatic trials, quality improvement studies, participatory action research and mixed methods evaluation studies where both quantitative and qualitative methods of data collection and analysis are used in the same study.1

There has been an increase in funder requests for research proposals that document and evaluate implementation strategies and impacts of large-scale health interventions aimed at supporting the delivery of health services, programmes and policies.5 The concomitant emergence of ‘global health’ as a field within North American and European universities (referred to here as the ‘Global North’) has led to a plethora of institutions who commission, undertake and collaborate on implementation research within LMIC settings (referred to here as the ‘Global South’), sometimes as part of countries’ overseas development assistance (ODA). …

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