Background Implementation science (IS) has the potential to improve the implementation and impact of policies, programs and interventions. Most of the training, guidance and experience has focused on implementation research, which is only one part of the broader field of IS. In 2018, the Society for Implementation Science in Nutrition borrowed concepts from IS in health to develop a broader and more integrated conceptual framework, adapted to the particular case of nutrition and with language and concepts more familiar to the nutrition community: it is called the IS in Nutrition (ISN) framework (1). Objective The purpose of this research was to generate knowledge concerning challenges and strategies in operationalizing the ISN framework in low and middle income (LMIC) settings. Methods The ISN framework was operationalized in partnership with country teams in Kenya and Uganda over a three-year period as part of the Implementation Science Initiative (ISI). An action research methodology (developmental evaluation) was used to provide timely feedback to the country teams, facilitate adaptations and adjustments and generate the data presented in this paper concerning challenges and strategies. Results Operationalization of the ISN framework proceeded by first articulating a set of guiding principles as touchstones for the country teams and further articulating six components of an IS system to facilitate development of work streams. Challenges and strategies in implementing these six components were then documented. The knowledge gained through this experience led to the development of an IS system operational model to assist the application of IS in other LMIC settings. Conclusions Future investments in IS should prioritize a system- and capacity-building approach in order to realize its full potential and become institutionalized at country level. The operational model can guide others to improve the implementation of IS within a broad range of programs.
The International Initiative for Impact Evaluation (3ie) promotes evidence-informed equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality assure evidence of what works, for whom, how, why and at what cost. 3ie working papersThese papers cover a range of content. They may focus on current issues, debates and enduring challenges facing development policymakers, programme managers, practitioners and the impact evaluation and systematic review communities. Policyrelevant papers in this series synthesise or draw on relevant findings from mixed-method impact evaluations, systematic reviews funded by 3ie, as well as other rigorous evidence to offer new analyses, findings, insights and recommendations. Papers focusing on methods and technical guides also draw on similar sources to help advance understanding, design and use of rigorous and appropriate evaluations and reviews. We also use this series to publish lessons learned from 3ie grant-making and contributions from 3ie's senior research fellows. About this working paperThis paper, Literature review on selected factors influencing Iron Folic Acid Supplementation in Kenya and East Africa, is a review of published literature using a grounded theory approach to better understand what is known about the identified bottlenecks of the delivery system for IFA supplementation during pregnancy and how they affect consumption and adherence to IFA supplements. The desk study sought to generate preliminary theories about factors affecting the consumption of IFA supplements during pregnancy. The goal was to generate a list of factors for each bottleneck that influences consumption of IFA supplements, which could inform future behavioral change interventions. This paper has not been copyedited but has been formatted for publication by 3ie.
The International Initiative for Impact Evaluation (3ie) promotes evidence-informed equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality assure evidence of what works, for whom, how, why and at what cost. 3ie working papersThese papers cover a range of content. They may focus on current issues, debates and enduring challenges facing development policymakers, programme managers, practitioners and the impact evaluation and systematic review communities. Policyrelevant papers in this series synthesise or draw on relevant findings from mixed-method impact evaluations, systematic reviews funded by 3ie, as well as other rigorous evidence to offer new analyses, findings, insights and recommendations. Papers focusing on methods and technical guides also draw on similar sources to help advance understanding, design and use of rigorous and appropriate evaluations and reviews. We also use this series to publish lessons learned from 3ie grant-making and contributions from 3ie's senior research fellows. About this working paperThe bottleneck assessment and inventory are core components of the Implementation Science Initiative. It was conducted with national stakeholders to identify major systems-level challenges affecting access to and utilization of iron-folic acid supplements for pregnant women in East Central Uganda. It was routinely updated to track progress on bottlenecks, actions undertaken, results achieved, and lessons learned during the Implementation Science Initiative in Uganda (2018Uganda ( -2020. A summary of insights from the workshop are presented in this paper, Assessing bottlenecks within Iron and Folic Acid Supplementation Delivery in Uganda: a workshop report. This paper has not been copyedited but has been formatted for publication by 3ie.
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