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How is implementation research applied to advance health in low-income and middle-income countries?
  1. Olakunle Alonge1,
  2. Daniela Cristina Rodriguez1,
  3. Neal Brandes2,
  4. Elvin Geng3,
  5. Ludovic Reveiz4,
  6. David H Peters1
  1. 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, USA
  3. 3 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  4. 4 Knowledge Management, Bioethics, and Research Department, Pan American Health Organization, Washington, District of Columbia, USA
  1. Correspondence to Dr Olakunle Alonge; oalonge1{at}


This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.

  • implementation
  • delivery
  • science
  • research
  • low and middle income countries
  • literature review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Seye Abimbola

  • Contributors OA conceptualised the paper, led the review, was the principal author and managed all revisions of drafts of the paper. DCR contributed to the review and writing drafts of the paper. DHP provided guidance to the review and writing drafts of the paper. NB, EG, LR and DHP revised the paper for intellectual content.

  • Funding The study has been funded by USAID, Alliance for Health Policy and Systems Research, and the World Bank.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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