Countries of the WHO European Region have access to a large body of knowledge about health, from research to databases to mathematical estimates. But sometimes it takes years before evidence-based good practices become available for people. To help countries in defining the major obstacles on this road, WHO is driving the work on implementation research across the Region.
Today, noncommunicable diseases (NCDs), including cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for nearly 80% of premature deaths across the globe. But not even half of the countries worldwide have implemented WHO-recommended policies to fight NCDs.
This does not mean that countries do not want to use them. Local context and conditions can sometimes prevent governments and health authorities from implementing cost-effective and evidence-based practices. Countries may also lack the resources to analyze the effectiveness of their health policies and need assistance to improve them in the wake of old and new challenges.
Implementation research: bringing scientific evidence closer to people
“For example, health professionals and decision-makers know of the great impact that school nutrition has on children’s health,” says Dr Nilufar Akhmedova, Assistant Professor, Tashkent State Medical Pediatrician Institute, Uzbekistan. “Or that primary health care workers can be a valuable source of advice for their patients in local communities to prevent many noncommunicable diseases. Yet sometimes it can be hard for countries to turn these positive changes into reality. There are many potential obstacles – from economic to societal and behavioural reasons. That’s why we need implementation research. It can show us the main challenges, and how we can get through them and begin to use better health practices.”
Dr Akhmedova is a participant of the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) implementation research workshops. They have been created for health professionals, educators, researchers and decision-makers who want to explore how to link quality scientific research with practice based on a country’s experience.
“During the workshop, we were able to try out new approaches and WHO-recommended tools that help to reveal hidden obstacles in our work and find new potential stakeholders for collaboration,” says Dr Lola Isakova, Senior Researcher, Laboratory of Hygiene for Children and Adolescents, Research Institute of Sanitation, Hygiene and Occupational Diseases, Uzbekistan, who is developing healthy nutrition projects in the country.
“The workshop reassured us that if we want to get real results and move forward on strategically important areas of health, we need to create platforms for open discussions that can bring together experts, practitioners and other stakeholders who are ready to face new challenges together and ensure quality nutrition in schools.”
Countries need better informed policies
The overall aim of implementation research is to improve people’s health through better informed policies, better service delivery and the support of communities through the collaboration of all stakeholders. WHO has set up 2 pilot implementation research projects on school nutrition policies and brief interventions for NCD risk factor prevention in primary health care.
“These projects in Azerbaijan, Kyrgyzstan and Uzbekistan have their own specifics,” says Dr Kremlin Wickramasinghe, Acting Head of the NCD Office. “That is exactly what implementation research does: it sets the standards and protocols while allowing stakeholders to adapt the appropriate method and the research question for each context – promoting best health practices in line with Sustainable Development Goals.”
To build further capacity in the Region, the NCD Office is organizing workshops on Implementation research on NCD prevention. The latest round of workshops happened in June in Bishkek, Kyrgyzstan, where representatives from Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan came together to learn about implementation research tools and how can they be tailored to the needs of countries.
Asking the right questions
The key to a successful implementation research project is to ask the right questions that can clarify its scope and importance.
- How relevant is the research? The project needs to be focused on a problem that is important for stakeholders working in this field and where interventions have the potential to bring positive changes for better health.
- Is the research new or innovative? The research should give new results or expand known facts while not duplicating the results of older works.
- Does the addressed topic require urgent response? If the topic is urgent, new evidence can create a significant change to current practices, bringing well-being to a new level.
- Is the research ethical? The project should be beneficial to members of the community being studied.
“United action for better health” is the motto of the WHO European Programme of Work 2020–2025, and implementation research is becoming a valuable asset that brings this vision closer to reality.