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Empowering Decision Makers: The Decision-Maker-Led Approach to Implementation Research to Strengthen Immunization Programs and Services in LMICs

A new supplement published by Health research policies and systems highlights studies undertaken in LMICs in Africa and Asia as part of an initiative by the Alliance for Health Policy and Systems Research, WHO and UNICEF, with funding from Gavi . In this initiative, policy makers were engaged to conduct research studies aimed at strengthening the implementation of immunization programs and services in their countries, showing great potential for engaging policy makers in implementation research.

A recent supplement published by Health research policies and systems called “Decision-maker-led implementation research for immunizationHighlights studies carried out in low and middle income countries (LMICs) in Africa and Asia as part of an initiative of the Alliance for Health Policy and Systems Research (Alliance) the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), with funding from Gavi, the Vaccine Alliance. In this initiative, policymakers were engaged to conduct research studies aimed at strengthening the implementation of immunization programs and services in their countries. Based on our experience, we believe that there is great potential for engaging decision makers in implementation research. This commitment is important so that research can be used to inform the implementation of programs and services to achieve better health outcomes, such as increases in immunization coverage, and become a routine part of processes. decision-making (a concept we call the “” integration “of research).

Improving immunization coverage: the role of research in implementation

We know vaccination works. Every year, it saves more than three million lives and was responsible for over 70% reduction in new measles cases over the past two decades. Despite this, WHO and UNICEF report that nearly 20 million infants worldwide have not received their third dose of diphtheria, pertussis and tetanus vaccine. So why – even though there is a safe and cost-effective vaccine to protect against these diseases and programs and services in place to deliver them – there are still so many unprotected children? How can we strengthen the programs and services in place to reach these children with life-saving vaccines?

The answers to these questions are complex. Some of the factors that influence immunization coverage include the level of reluctance to immunize, access to immunization services and skilled health workers, the presence of a functioning supply chain, and the availability of quality data for know who has already been reached and where gaps remain. However, the factors at play depend on the country and the context, and it is not always clear what they are or what can be done about them. This is where implementation research comes in. Implementation research (IR) can be used to discover which factors are most likely to prevent interventions (including policies, programs, and services) from achieving their goals and point to potential solutions that can be used to put them back on track. way. As such, RI has a major role in guiding strategies to improve immunization coverage.

Who should be involved in implementation research?

However, just having more implementation research does not necessarily mean that it will be used to improve immunization programs and services in the field. How we do implementation research, including the people we involve, is important. While researchers alone often produce important evidence about implementation, their lack of involvement in day-to-day implementation and decision-making processes means that the issues they focus on and the solutions they explore are not always the most urgent or feasible in a given context.

On the other hand, those directly involved in the implementation – the decision makers – understand how things work on the ground and often need specific evidence of what is going on and the best course of action to follow. This is why decision makers are essential to implementation research. Not only do they understand the context in which they work and the research needs, but they are also the people who make the decisions about implementation and could use the research to inform what they do.

The program

Recognizing the importance of involving decision-makers in implementation research to improve immunization programs and services, the Alliance, UNICEF and Gavi have embarked on an ambitious Directed Implementation Research Initiative. by decision-makers (DELIR). Two calls for research were launched, each with two innovative conditions:

  1. The principal investigator of the research had to be a decision maker or person directly involved in the implementation of an immunization program or service; and
  2. The research team must include at least one researcher affiliated with an academic or research institution based in the country of study.

The response has been overwhelming: a total of 125 teams of policymakers and researchers have expressed an interest in doing this type of policymaker-led research. The DELIR initiative was able to support 14 projects from 10 countries in Asia and Africa. The selected implementation research studies covered a variety of issues, from vaccine reluctance to vaccine delivery in urban slums. Several of the studies supported by this initiative are highlighted in the supplement.

Promises and implications

Reflecting on our experience with the DELIR initiative, we note the immense interest and positive experience of decision-makers and researchers for this collaborative approach to research. The considerable number of applications received in response to the calls and the reflections of the research teams involved in the projects indicate this. Through this initiative, we have demonstrated that decision makers can lead successfully and be meaningfully involved in the research process.

Our work also shows that this commitment by decision-makers has many potential benefits. Both researchers and policy makers have reported that such engagement has resulted in research addressing a current issue facing a policy maker. Having a decision maker on the research team also harnessed their insider knowledge – knowledge only known to those working within a health system – and brought a practical perspective to the projects, helping to integrate research into implementation processes and leverage local networks and resources. The result: research findings that have been described as relevant, useful, applicable and acceptable to inform the implementation of the immunization program and service.

The use of the research results of the projects was also evident. Research teams from many countries – including Chad, Ethiopia and Nigeria – described how their findings had been used to inform the implementation of programs and services. Several teams also noted perceived changes or ongoing activities resulting from the project, suggesting that policy-driven research can be used to strengthen implementation and produce sustainable progress towards greater integration of research into processes. decision-making.

The studies highlighted in this supplement are examples to show that engaging decision makers and integrating implementation research can add significant value to programs and services, especially those for immunization. Our hope is that donors and national governments recognize the importance of investing in decision-maker-led implementation research as part of routine programs and services. We invite them to engage with us in efforts to support this type of work and strengthen the capacity of policy makers and institutions towards greater integration of research.


The authors acknowledge the contribution of Jeff Knezovich and Geetanjali Lamba of the Alliance for Health Policy and Systems Research in the development of this blog post. Zubin Shroff is a member of the staff of the World Health Organization, he himself is responsible for the opinions expressed here which do not necessarily represent the opinions, policies or decisions of the World Health Organization.