Know-do Gap

Closing the Know-Do-Gap in Global Health through Implementation Science

~Written by Sarah Weber (Contact: sarahkweber@gmail.com)

An area that has gained increased recognition in the past few years is the challenge of the ‘know-do-gap” or bridging the gap between what we know through research and what is implemented. The field of implementation science aims to bridge this gap by getting evidence-based findings out into practice in a timely manner. This is especially important for developing countries facing a shortage of resources and challenging health care systems. Donors, such as USAID, PEPFAR, The Bill and Melinda Gates Foundation, and others have started looking at implementation science as an effective tool and begun funding programs to specifically address the know-do-gap. Implementation science is a fairly new field and has gained greater momentum in developed countries among their domestic health fields than in developing country settings. However, it is a strategy that aligns very well with global health goals and will likely gain greater attention and focus within the global health community over the coming years.

 

Understanding Implementation Science 

The gap between learning effective strategies/interventions and implementing them is far too large. On average, it takes 17 years for 14% of research to translate to practice (an astonishingly long process which results in only a small percentage actually being implemented). This shows that there is a significant delay between learning effective solutions, strategies, and products through research and translating/implementing them to meet the local needs and produce positive health impacts for specific populations. 

Implementation science, still being a relatively new area of science, has multiple definitions and terminology including knowledge translation, knowledge to action, implementation and dissemination, and implementation research. These definitions are relatively similar as they demonstrate the intention of studying how to efficiently push research into the field as evidence-based solutions. The definition of implementation science from the National Institute for Health Fogarty International Center fits well within the global health context: “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. It seeks to understand the behavior of healthcare professionals and other stakeholders as a key variable in the sustainable uptake, adoption, and implementation of evidence-based interventions”. In simple terms, implementation science means implementing proven interventions in real world settings by modifying them based on the local context and incorporating scale-up processes to meet the local needs. Implementation science is a multi-faceted, non-linear process which requires communication with multiple stakeholders throughout the process and the need for evaluation throughout to ensure that strategies are producing the intended results.

 

Why should we pay attention to implementation science?

Disparities exist between the developed and developing world

All of us in the field of public health recognize the significant health disparities between high income and mid to low income countries. Although there are effective solutions, there is a gap between knowing effective solutions and successfully implementing them in diverse, low-resources settings. The following statistics from the World Health Organization demonstrate this:

  • Developing countries account for 99% of annual maternal deaths in the world.
  • In Chad, every fifth child dies before they reach the age of 5, while in the WHO European Region, the under-five mortality rate is 13 out of 1000.
  • Women in the richest 20% of the global population are up to 20 times more likely to have a birth attended by a skilled health worker than a poor woman. Closing this coverage gap between rich and poor in 49 low-income countries could have saved the lives of more than 700,000 women between 2011 and 2015

We have the knowledge to solve most health problems in the developing world

Knowledge exists to address and treat preventable illnesses and health problems, yet preventable diseases continue to affect large segments of the global population. Perhaps one of the best examples is the use of childhood vaccinations, one of the most successful public health interventions of all time. The technology exists to prevent over a dozen childhood diseases with routine vaccinations, yet there were still 1.5 million child deaths in 2011 from diseases preventable by routine vaccinations. Programs need to address the bottlenecks and local barriers preventing comprehensive implementation of immunization programs so all children can be reached.

Increasing the number of interventions translated into practice positively impacts health

It is critical that we close the know-do-gap globally and implement proven interventions in developing countries to be efficient with money and resources. Recipients are currently not able to benefit from the latest evidence-based solutions as old ineffective “solutions” are still utilized during this lag time. For the developing world, the know-do gap has widened, as there is the added challenge of how to best implement evidence-based solutions, without utilizing strategies developed from high income countries with sophisticated health systems. This is difficult and requires modifications based on the local context and resources. 

Increasing access to approaches which have demonstrated effectiveness in diverse populations will lead to improved health. We need to go beyond just learning what is needed and actually implement it. This requires engaging stakeholders, evaluating strategies and measuring impact to ensure the strategies and solutions are meeting local needs. We need to reduce the know-do-gap so that more effective strategies can be utilized to create health impacts, and ineffective strategies and solutions can be retired quickly. Implementation science is not a one-size approach and scaling up evidence-based programs and practices to meet the needs of the target population is of utmost importance.

We have the tools through implementation science to close the gap and get more efficient interventions into practice. The global health community must keep moving the bar from evidence to action, and implementation science can help.  

 

Resources

Canadian Institute for Health Research.  Knowledge Translation of Low and Middle Income Countries: A Learning Model http://www.cihr-irsc.gc.ca/e/44240.html

National Institute for Health, Fogarty International Center. http://www.fic.nih.gov/News/Events/implementation-science/Pages/faqs.aspx 

FHI 360. Perspective on how Implementation Science can Improve Global Health http://degrees.fhi360.org/2014/09/perspectives-on-how-implementation-science-can-improve-global-health/

UNICEF. Immunization Facts and Figures 2013 http://www.unicef.org/immunization/files/UNICEF_Key_facts_and_figures_on_Immunization_April_2013%281%29.pdf

World Health Organization. Fact File on Health Inequalities. http://www.who.int/sdhconference/background/news/facts/en/