The close connection between health and human development is well recognized. Healthy lives influence and shape the overall course of sustainable development. Diseases, inadequate access to health technologies such as medicines, vaccines, diagnostics and devices, and poor implementation of health policies all hinder holistic progress. The 2030 Agenda for Sustainable Development acknowledges this fundamental relationship. Sustainable Development Goal 3 (SDG3)1 captures the global ambition to end some of the major epidemics of poverty by 2030, including tuberculosis (TB), malaria and neglected tropical diseases (NTDs). In turn, underlying targets stress the need for universal health care coverage for all citizens, and for stronger health systems that enable access to essential health services and technologies. Dig even deeper and SDG3 calls for more research and development (R&D) on new medicines, diagnostics and vaccines: critical innovations that fill current gaps in health care and keep national programmes one step ahead of shifting epidemics.
The optimum introduction of new and/or proven health interventions and technologies – including ensuring access, delivery and usage – is critical to good health outcomes, and ultimately to the well-being of populations. All too often this is unfortunately not the case. For example, a new health technology or intervention that proves efficacious in strictly controlled clinical trial settings may not be as effective when used within ‘real life’ health system contexts, particularly in fragile or resource-limited settings.
During the development of an intervention, there is a strong focus on ‘authentic’ implementation: A strict adherence to a study protocol under carefully controlled and monitored conditions, including follow up of subjects (if applicable), to ascertain the efficacy and fidelity of the intervention. However, when the intervention is subsequently deployed in the health system, effectiveness becomes the overriding goal and this can sometimes be enhanced by adaptation to specific contexts.
The large-scale deployment of an intervention within a health system may therefore encounter previously unforeseen barriers to its uptake and penetration. These barriers are often related to deficiencies in the detailed identification and contextualization of regional, country or community-specific characteristics, as well as failures to prepare for or address them. Such context-specific barriers may be due to the physical environment, socioeconomic and cultural contexts, as well as health systems and user characteristics. Failure to identify and address these barriers before large-scale deployment of a new technology results in considerable losses to the health system, as well as loss of confidence in the technology among the target population and other stakeholders.2