Implementation research is important in global health to address the challenges of the know-do gap in real world settings, and the practicalities of achieving national and global health goals.Implementation research is an integrated concept linking research and practice to accelerate the development and delivery of public health approaches. It involves the creation and application of knowledge to improve the implementation of health policies, programmes, and practices. It uses multiple disciplines and methods, and emphasises partnerships between community members, implementers, researchers and policy makers. Implementation research focuses on practical approaches to improve implementation; to enhance equity, efficiency, scale up and sustainability, and ultimately to improve people's health. There is growing interest in the principles of implementation research, and a range of perspectives on its purposes and appropriate methods.However, there have been limited efforts to systematically document and review learning from the practice of implementation research across different countries and technical areas. Drawing on an expert review process, this paper presents purposively selected case studies to illustrate the essential characteristics of implementation research and its application in low and middleincome countries (LMICs). The case studies are organized in four categories related to the purposes for using implementation research: impacting people's health, informing policy design and implementation, improving health service delivery, and empowering communities and beneficiaries. Common characteristics of these case studies are the focus on addressing implementation problems, ensuring a partnership approach to the co-creation of solutions, including using tacit knowledge, and commitment of key stakeholders to a pathway towards impact. The case studies reveal the complex adaptive nature of health systems, emphasize the importance of understanding context, and highlight the role of multidisciplinary, rigorous and adaptive processes which allow for course correction to ensure interventions have an impact. This Implementation Research: New Imperatives and Opportunities in Global HealthPanel 1: Key messages 1. Implementation research offers a way to understand and address implementation challenges and make a positive impact on people's health by contributing to building stronger and more responsive health systems within the realities of specific contexts. 2. Implementation research can lead to positive health outcomes, inform policy design, improve health management and service delivery, and support and empower communities and beneficiaries. 3. Implementation research uses multidisciplinary approaches and a range of empirical and systematic methods to document, analyse and address key health problems and test technical health interventions as well as contextually tailored innovative strategies within the foundations of local context. 4. Implementation research can be used to evaluate the feasibility, adoption, and a...
Background Since early 2020, the Covid-19 pandemic has engulfed the world. Amidst the growing number of infections and deaths, there has been an emphasis of patients with non-communicable diseases as they are particularly susceptible to the virus. The objective of this literature review is to systematize the available evidence on the link between non-communicable diseases and Covid-19. Methods We have conducted a systematic review of the literature on Covid-19 and non-communicable diseases from December, 2019 until 15th of November, 2020. The search was done in PubMed and in doing so we used a variety of searching terms in order to isolate the final set of papers. At the end of the selection process, 45 papers were selected for inclusion in the literature review. Results The results from the review indicate that patients with certain chronic illnesses such as diabetes, hypertension (and other cardiovascular diseases), chronic respiratory illnesses, chronic kidney and liver conditions are more likely to be affected by Covid-19. More importantly, once they do get infected by the virus, patients with chronic illnesses have a much higher likelihood of having worse clinical outcomes (developing a more severe form of the disease or dying) than an average patient. There are two hypothesized channels that explain this strong link between the chronic illnesses enumerated above and Covid 19: (i) increased ACE2 (angiotensin-converting enzyme 2) receptor expressions, which facilitates the entry of the virus into the host body; and (ii) hyperinflammatory response, referred to as “cytokine storm”. Finally, the literature review does not find any evidence that diabetes or hypertension related medications exacerbate the overall Covid-19 condition in chronic illness patients. Conclusions Thus, the evidence points out to ‘business as usual’ disease management model, although with greater supervision. However, given the ongoing Covid-19 vulnerabilities among people with NCDs, prioritizing them for the vaccination process should also figure high on the agenda on health authorities.
In developing countries, the noncommunicable disease (NCD) and risk factor burdens are shifting toward the poor. Treating chronic diseases can be expensive. In developing countries where generally much health care costs are borne by patients themselves, for those who live in poverty or recently escaped severe poverty, when faced with large, lifelong out-of-pocket expenses, impoverishment persists or can reoccur. These patterns have implications for national economic growth and poverty-reduction efforts. NCDs can change spending patterns dramatically and result in significantly reducing non-medical-related spending on food and education. In India, about 40% of household expenditures for treating NCDs are financed by households with distress patterns (borrowing and sales of assets). NCD short- and long-term disability can lead to a decrease in working-age population participation in the labor force and reduce productivity and, in turn, reduce per capita gross domestic product growth. To fully capitalize on the demographic dividend (i.e., aging of the population resulting in less dependent children, not yet more dependent elderly, and greater national productivity), healthy aging is necessary, which, in turn, requires effectively tackling NCDs. Last, from an equity standpoint, the economic effect of NCDs, evident at the household level and at the country level, will disproportionately affect the poor and vulnerable populations in the developing world.
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