Mainstreaming implementation research: A strategy for advancing policy and practice

Funding

ICMR/DHR is perhaps the largest publicly funded health research funding agency in India. Funding IR is part of its mandate¹⁰. In view of the large number of definitions of IR, agencies undertaking IR funding should indicate their working definition, and also clearly articulate the criteria that will be used to score, evaluate and assess IR project proposals.

A review of the investing approaches/strategies adopted at the global level by various funding agencies can be considered important when supporting IR in LMICs; these can be broadly categorized as follows¹⁴:

One, keeping the end-users including policymakers, programme managers as well as the community engaged right from inception through the various stages of the project (before, during and on conclusion). This includes asking their concerns and the programme’s research needs and letting them know how and at what stage would their contributions be most valuable. These interactions lay the foundations of the success in utilizing the research results including scaling-up of the intervention. The funding agencies can mandate and facilitate such partnerships.

Two, teaming up with other funding agencies, particularly those, which have experience and a committed/specified programme for IR funding, to better understand the nuances of funding IR (learning-by-doing). This helps them to define their own approach in this space.

Three, supporting the growth and development of IR as a speciality. This is done through encouraging the development of new definitions (even for IR), novel and better study designs, innovative frameworks, advanced methods and approaches which entail collaboration with other disciplines and sectors.

Four, partnering with other agencies which fund IR, and have common strategic objective(s). This approach results in a combined and stronger base of skills, expertise, experience and funds. Funders even come together to provide grants to a third party to operate a programme for them.

Five, promoting human resource development activities within and without the IR research projects. IR is a relatively new discipline; there are limited number of researchers, few experts and fewer mentors. To address this gap, the funding agencies support training programmes for academia/researchers as well as for the employees of funding agencies through the award of fellowships, assistance in writing grant applications and offering resources to guide researchers.

Six, drafting and enunciating/circulating the yardstick that the agency would use to mark and review grant applications (key ingredients for a successful application). This can help to improve the quality of grant applications as the researchers make efforts to include all those points in their applications.

Seven, making sure that IR results and competencies are absorbed into the health system, thus building in-country expertise. This can be done by prioritizing those grant applications which aim at absorbing IR skills into the health system; supporting studies, which address how IR can influence policy and funding projects aiming to identify factors that may help to create networks capable of promoting and strengthening the links between researchers, policymakers and programme managers.

Funding agencies may like to indicate what is their strategy for funding IR and earmark adequate funds for it, keeping in mind the country’s need for IR.

Human resource development

Broadly, there are two categories of human resources that need to be developed. One is those who conduct IR and the second is those who manage IR.

Co-production

Co-production in IR means when the funders, researchers and key stakeholders work together and own the results of research. Through co-production stakeholders, the chances are that the stakeholders will be more involved in the entire exercise and also use the results of the research to bring about a change in the policies and health programmes¹⁸. Funders generally play a facilitator’s role, while the ICMR also conducts research. The ICMR and its institutes are uniquely positioned to build long-term partnerships with governments – both at the Centre as well as the State level. Having a core group of personnel trained in IR lead, this activity would be extremely helpful. As the ICMR Institutes are theme-based, they could also play a leadership role in conduct of IR research and supporting the co-production of IR in that area.

An example of co-production of IR is the endemic goitre experiments in Kangra Valley during 1950s-1960s. The research implemented by the Government of India, Punjab Government and ICMR not only generated evidence of the burden and development of effective interventions but also in clearly demonstrating the impact in reducing goitre prevalence in the study population as compared to controls. The study culminated in the formulation and implementation of a successful national goitre control programme¹⁹. A more recent example is the India Hypertension Control Initiative – an initiative involving the MoHFW, ICMR, State Governments and WHO-India. It is demonstrating the feasibility of implementing protocol-based hypertension treatment and control supported by a reliable drug supply and accurate information systems at scale in Indian primary healthcare facilities.

In conclusion, India is emerging as a voice and leader of the Global South. One of the obstacles in improving health indicators in the LMICs and in making adequate progress towards the achievement of SDGs is the failure to implement the policies and products developed based on evidence-informed research. IR, especially when mainstreamed, has the potential to address these problems. Agencies like ICMR/DHR are in a distinctive position to set best practices for mobilizing essential workforce, money and infrastructural and resources for this purpose and in the process generate evidence that can inform policy and drive action towards achieving health-related SDGs by 2030.