Enhancing implementation research within Canada’s investments in the health of women and children globally

Sharma et al highlight the uneven progress in achieving improvements in maternal, newborn and child survival in low income countries, emphasizing that "gaps in coverage of essential interventions are related to marginalization of some groups, social inequities and geographic issues" (1). They propose that Canada should focus on addressing this gap through implementation research. Sadly, this approach perpetuates donor country practices of setting developing country change agendas; the "come from away, top down, we know what is needed" approach. Many developing countries are not in a position to say no as any new resources are good no matter what strings or directions. Sadly, the proposed top down scale up model is doomed to failure at the community level. Experience has long shown that once donor funds disappear, programs begin to fade away if not locally owned and sustainable with local resources. For long term impact in each and every community, solutions must be locally owned and address local health problems the community sees as important. The solutions need to be evidence based but also fit the local culture, context and resources. Come from away top down interventions rarely do this. The authors are correct, if one starts with the premise that implementation research could help, there will be many willing to agree, but we would challenge that Canada could be more helpful if the focus is on low income countries building their own community, district and regional capacity for finding local sustainable solutions that fit.. This can be supported by Canada through thoughtful local partnerships, but we cannot drive the bus- that must be done by communities. MicroResearch is one example where local communities learn how to find their own evidence based solutions that fit their community (2).

References

1. Sharma R, Scott H, Bhutta ZA. Enhancing implementation research within Canada's investments in the health of women and children globally. CMAJ 2017;189:E332-3.

2. MacDonald NE, Borotolussi R, Pemba S, Kabakyenga J, Tuyisenge L. Supporting research leadership in Africa. Lancet Global Health 2016; 4: e362.

Noni E MacDonald MD MSc1,2, Robert Bortolussi MD 1,3, Jerome Kabakyenga MC PhD1,4, John Frank MD, MSc 1,5 1. Co-Director or Research Advisory Board Member of MicroResearch an initiative to help develop local research capacity in Eastern Africa" (www.microresearch.ca) 2. Professor of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia 3. Emeritus Professor of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia 4. Director, Maternal Newborn Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda 5. Chair, Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, United Kingdom

Conflict of Interest:

None declared