Is Collaboration the Key to Successful Implementation at Scale? Experiences from the NIH-PEPFAR PMTCT Implementation Science Alliance
Despite growing recognition of the importance of implementation science (IS) in nutrition, differences exist in how it is defined, and how these varying definitions are interpreted and operationalized by key stakeholder groups. If we are to make significant advances in IS in the global nutrition context, it is now evident that we need to work across these traditional silos and foster collaboration between researchers, program managers and practitioners so that we can capitalize on their diverse knowledge and generate meaningful change within real-world settings.
Facilitating such collaborations and nurturing positive relationships between stakeholders with disparate contexts, motivators and views can also be challenging, but initiatives in other sectors can provide a useful guide on how we might approach this.
At our recent symposium at Experimental Biology in Chicago, USA, Dr. Rachel Sturke, Director of the Fogarty Division of International Science Policy, Planning and Evaluation at the National Institutes of Health (NIH), showcased the organizations experiences in creating, structuring and supporting the NIH-President’s Emergency Plan for AIDS Relief (PEPFAR) Prevent Mother-to-Child HIV Transmission (PMTCT) IS Alliance (or ‘The Alliance’). Despite the distinct differences between the focus of this Alliance and SISNs, their conceptual and innovative approach to IS translates across contexts. The recording of Dr. Sturke’s presentation can be viewed here and is summarized below.
In 2012, in response to Fogarty’s strategic priority to “catalyze interaction between researchers, policy-makers and program implementers to promote uptake of evidence into global health policy and practice” a new network was created. The NIH-PEPFAR PMTCT IS Alliance aimed to:
- Convene researchers, in country policy-makers, and program implementers
- Facilitate dialogue and exchange of ideas between stakeholders
- Enhance communication and collaboration between these communities to enable more effective translation of evidence into health policies and programs
- Ensure that future research is responsive to the local context
- Think together about the emergent IS and Implementation Research (IR) agenda
Formed of approximately 60 members, the Alliance was funded by the Office of the US Global AIDS Coordinator (OGAC) with additional support from external funders. It was led by the Fogarty International Center’s Center for Global Health Studies with support and collaboration from other NIH Institutes and guided by a steering committee comprising of experts from multi-sectors and included:
- 12 researchers receiving NIH PEPFAR Request for Applications (RFA) grant awards
- Program implementers and policy makers from PEPFAR-supported countries (identified by NIH grantees)
- Representatives of multilateral institutions (e.g. World Health Organization, United Nations Program on HIV/AIDS, United Nations Children’s Fund)
- IS methodologists
- Key US government representatives and experts working in leading HIV/AIDS/PMTCT organizations. (e.g. CDC, Anova Health Institute (South Africa))
The primary mode of achieving The Alliance’s objectives was face-to-face meetings. Four of which were held over a two-year period (2013-2015). These gatherings of Alliance members provided an opportunity to raise critical questions and discuss common challenges related to IS in PMTCT. Key lessons that emerged included:
- Researchers and users of research have different perspectives on what evidence is most useful.
- Researchers and policy-makers ask different questions and have different stakeholder audiences.
- There is no clear definition as to what constitutes sufficient rigor or adequate evidence to support scaling-up an intervention (e.g. can interim research results be used to as a basis to progress to full scale implementation?)
- There is tension between generalizability and local context in IR (e.g. if an intervention is effective in Ghana can it be implemented in Ethiopia without conducting additional research is Ethiopia first?)
- Researchers and policy-makers often have differing timelines and project horizons (i.e. research studies tend to be long-term, while the policy-making process is often urgent and time-sensitive).
- The policy and evidence landscape is continuously changing which often leads to interruptions in research and program implementation.
The success and impact of The Alliance have been captured by the publication of a 15-paper special supplement in the Journal of AIDS, which includes a report on ‘Concept Mapping of PMTCT Implementation Challenges (and Solutions)’. Although the formal convening of the network has ended, member collaboration has continued, for example with co-applications for grant funding. In addition, a Nigerian IS Alliance has been established which has mirrored the same collaborative approach.
The NIH-PEPFAR PMTCT IS Alliance is an innovative model that can inform how we might engage nutrition stakeholders to advance IS in nutrition. We hope to highlight more examples in the future, please contact us with details of any collaborative initiatives that you may be aware of.
Have an idea or a comment on any of the issues above? We welcome your feedback – you can comment on this post on our LinkedIn feed or write to us using the email address below.
If you are interested in finding out more about implementation science (IS) or becoming a member of SISN to help us advance the use of IS in nutrition, you can contact us via our website (www.implementnutrition.org) or can email us at email@example.com.