Ojo Temitope, Kabasele Laetitia, Boyd Bethanny, Enechukwu Scholastica, Ryan Nessa, Gyamfi Joyce, Peprah Emmanuel
Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
Global Health Program, New York University School of Global Public Health, New York, NY, USA.
Health Serv Insights. 2021 Mar 15;14:1178632921999652. doi: 10.1177/1178632921999652. eCollection 2021.
Low- and middle-income countries (LMICs) bear the brunt of communicable and non-communicable diseases and experience higher mortality and poor health outcomes compared to resource-rich countries. Chronic resource deficits in LMICs impede their ability to successfully address vexing health issues. Implementation science provides researchers with an approach to develop specific interventions that can generate and/or maximize resources to facilitate the implementation of other public health interventions, in resource-constrained LMIC settings. Resources generated from these interventions could be in the form of increased health workers' skills, task shifting to free up higher-skilled health workers, increasing laboratory capacity, and using supply chain innovations to make medications available. Pivotal to the success of such interventions is ensuring feasibility in the LMIC context. We selected and appraised three case studies of evidence-based resource-generating health interventions based in LMICs (Zambia, Zimbabwe, and Madagascar), which generated or maximized resources to facilitate ongoing health services. We used a determinant implementation framework-Consolidated Framework for Implementation Research (CFIR) to identify and map contextual factors that are reported to influence implementation feasibility in an LMIC setting. Contextual factors influencing the feasibility of these interventions included leadership engagement, local capacity building and readiness for research and implementing evidence-based practices (EBPs), infrastructural support for multilevel scale-up, and cultural and contextual adaptations. These factors highlight the importance of utilizing implementation science frameworks to evaluate, guide, and execute feasible public health interventions and projects in resource-limited settings. Within LMICs, we recommend EBPs incorporate feasible resource-generating components in health interventions to ensure improved and sustained optimal health outcomes.
低收入和中等收入国家（LMICs）首当其冲地承受着传染病和非传染病的影响，与资源丰富的国家相比，这些国家的死亡率更高，健康状况更差。低收入和中等收入国家长期的资源短缺阻碍了它们成功解决棘手健康问题的能力。实施科学为研究人员提供了一种方法，以开发特定的干预措施，这些措施可以产生和/或最大化资源，以便在资源有限的低收入和中等收入国家环境中促进其他公共卫生干预措施的实施。这些干预措施产生的资源可以表现为提高卫生工作者的技能、任务转移以腾出高技能卫生工作者、增加实验室能力以及利用供应链创新来提供药品。此类干预措施成功的关键在于确保在低收入和中等收入国家的背景下具有可行性。我们选择并评估了三个基于低收入和中等收入国家（赞比亚、津巴布韦和马达加斯加）的循证资源生成型健康干预案例研究，这些研究产生或最大化了资源以促进持续的卫生服务。我们使用了一个决定性实施框架——实施研究综合框架（CFIR）来识别和梳理据报告会影响低收入和中等收入国家环境中实施可行性的背景因素。影响这些干预措施可行性的背景因素包括领导参与、当地能力建设以及对研究和实施循证实践（EBPs）的准备情况、对多层次扩大规模的基础设施支持以及文化和背景适应性。这些因素凸显了利用实施科学框架来评估、指导和执行资源有限环境中可行的公共卫生干预措施和项目的重要性。在低收入和中等收入国家内部，我们建议循证实践在健康干预措施中纳入可行的资源生成组成部分，以确保改善并持续实现最佳健康结果。
