This Board opportunity seeks to fund research to address the implementation of evidence-based health interventions in low and middle income countries (LMICs) in an accessible and equitable way.
While huge gains have been made in developing and testing health interventions, a study has shown that there remains, on average, a lag of 17 years for research evidence to reach clinical practice. The field of implementation science seeks to address this challenge by providing the evidence needed to effectively implement interventions in the real-world. Importantly, implementation science considers wider system level complexities that can otherwise prevent the expected impact from being achieved.
Maximising impact from research has been a priority for MRC and remains a priority in the 2019 Delivery Plan. This Board opportunity provides a sustained funding mechanism to support implementation focussed health research in LMICs to progress interventions into real-world impact. This funding opportunity compliments MRC’s implementation science activities with the Global Alliance for Chronic Diseases (GACD).
The definition of implementation science to be adopted will be aligned with GACD:
‘Implementation science is commonly defined as the study of methods and strategies to promote the uptake of interventions that have proven effective into routine practice, with the aim of improving population health.’
This Board opportunity seeks to fund the most pertinent research questions for implementation and scale-up/out, with a broad health remit.
Proposals must be based upon a conceptual framework, theory or model that informs the design and variables being tested. The methodological approaches should be appropriate for the research question and can be wide-ranging (e.g. experimental/quasi-experimental study designs, mixed methods studies, comparative case studies, economic and mathematical modelling, combined approaches), however, proposals adopting pragmatic and hybrid trial methodology may be directed to the MRC-DFID-Wellcome-NIHR Joint Global Health Trials scheme which funds large-scale, phase III/IV clinical trials in LMICs. Operational research questions are not within remit and proposals in the field of health systems research are directed to the MRC-DfID-Wellcome-ESRC Health Systems Research Initiative which funds research addressing key questions on strengthening and improving health systems in LMICs.
Research proposals can be small scale to:
- conduct exploratory work such as identifying and understanding barriers to implementation, or
- pilot work to test the feasibility of an implementation strategy in a new context.
Or they can be larger research proposals addressing a portfolio of implementation outcomes, processes and influences, such as: political buy-in, economic factors, regulatory hurdles, community awareness, use of resources, equitable allocation of resources, design, uptake of the intervention, supply and demand, etc.
Proposals are expected to clearly describe the implementation gap to be addressed and how the research is grounded in the local context and aligned with local health priorities. Evidence should be provided to support this, for example through in-kind contributions/support/participation from the local Ministry of Health. In addition, the research setting/s should be carefully justified in terms of future impact (e.g. appetite for implementation) and generalisability (e.g. the contextual learning provided by the setting/s such as geography, demographics, the health system and the political environment).
Due to the very applied nature of implementation science, participatory approaches are encouraged as well as bidirectional communication with stakeholder groups. Applicants should describe which stakeholders will be engaged, when, how and for what purpose? For example, health care providers, implementers, programme managers, policy-makers, civil society groups, beneficiaries, nongovernmental organizations, the media, etc.
Equity is particularly important in terms of the safety and reach of the intervention/implementation strategy and should be at the core of any proposal and potential wider impacts such as ripple effects and unintended consequences should also be considered.
Various resources are available online which may be helpful in developing a proposal:
TDR Implementation research toolkit: https://www.who.int/tdr/publications/topics/ir-toolkit/en/
TDR Massive open online course (MOOC) on implementation research: infectious diseases of poverty: https://www.who.int/tdr/capacity/strengthening/mooc/en/
TDR Implementation research for the control of infectious diseases of poverty: https://www.who.int/tdr/publications/tdr-research-publications/access_report/en/
WHO Nine steps for developing a scaling-up strategy: https://www.who.int/reproductivehealth/publications/strategic_approach/9789241500319/en/
WHO A guide to implementation research in the prevention and control of noncommunicable diseases: https://www.who.int/ncds/governance/policies/NCD_MSA_plans/en/
NIH Fogarty International Center Toolkit: Overcoming Barriers to Implementation in Global Health: https://www.fic.nih.gov/About/center-global-health-studies/neuroscience-implementation-toolkit/Pages/default.aspx
The RE-AIM framework: http://www.re-aim.org/about/
Consolidated Framework for Implementation Research: https://cfirguide.org/
 Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics 2000: Patient-Centered Systems. 2000:65-70.
 Medical Research Council (2018) Impact Report 2017. Publisher: Medical Research Council, Swindon, UK. ISBN: 978-0-903730-26-6