Relevance of IR for improved access and delivery of interventions

Appropriately designed IR can help deliver and apply interventions more effectively and with greater impact. Emphasis on IR is increasingly important as the global health community faces the challenge of optimizing proven interventions in the real world (i.e. outside the controlled experimental environment associated with clinical trials or proof-of-concept studies). In many settings, this requires innovative approaches to reach populations and optimize delivery. Interventions that may be effective in one setting may have a reduced impact in other contexts due to a variety of context-specific factors. In other words, many proven and efficacious health technologies (medicines, vaccines, diagnostics and devices), lose traction within the health system for various reasons (see Box).

An intervention that has proven efficacious in a trial settings, may not perform as well as expected within a given health system due to wide-ranging potential contextual factors, such as issues of accessibility and/or acceptability, health care providers’ adherence to policy recommendations and patient compliance. Managers in the health system have varied and unpredictable control over the behaviours of providers and patients, as well as other aspects such as managers’ understanding of implementation processes. In this way, efficacious interventions typically become less effective when deployed in real-life settings.

IR is the systematic approach to recognizing, understanding and addressing such system and implementation bottlenecks, identifying optimal implementation options for a given setting, and promoting the uptake of research findings into policy and practice. IR is demand-driven and underlying research questions are framed according to needs identified by relevant stakeholders and/or implementers in the health system.

Essential elements of conducting meaningful IR include:

A good understanding of the intended intervention (for example identifying those elements seen as essential and those that could be modified without undermining the intervention objectives or performance).
A robust grasp of how the intervention is to be delivered in a given health system (implementation process), with particular attention to modifications driven by a perceived need for adaptation to a specific local context.
Identification and early and continuous engagement of crucial stakeholders including the community itself.
A monitoring system that tracks any changes in the implementation process, checks for deviations from the original plan and accurately documents all key processes.