Funding &Health Systems Bill Brieger | 21 Dec 2007 03:56 pm
Implementation Science – Scaling-up Malaria Interventions
An policy forum article on implementation science in Science Magazine is quite timely considering the recent criticism appearing in the Los Angeles Times about large scale funding for single purpose disease control programs. Some of the discussion focused on the need to strengthen health systems, support human resource development and retention and integrate into broader public health programming. Questions about how this can be done fall in the realm of implementation science as described by Madon et al.
The Global Fund has issued a response to the original article, which was commented on in the LA Times on 20 December. Although the authors criticize the Global Fund for not providing convincing data to challenge their claims of health system damage, both the original article and the rejoinder rely on the claim that 1) more time is needed to see the effects of this relatively young effort (5 years only) and 2) available statistics from international organizations do not yet reflect actual Global Fund achievements, such as massive distribution of ITNs.
Implementation science as described by Madon et al. requires a more rigorous approach. They bemoan the fact that “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 of how health outcomes vary across community settings.”
The article in Science further explains that, “implementation science creates generalizable knowledge that can be applied across settings and contexts to answer central questions. Why do established programs lose effectiveness over days, weeks, or months? Why do tested programs sometimes exhibit unintended effects when transferred to a new setting? How can multiple interventions be effectively packaged to capture cost efficiencies and to reduce the splintering of health systems into disease-specific programs?” It is answers to these questions that international donors including the Global Fund and the Gates Foundation need to address.