Learning Active Implementation Frameworks: the role of implementation teams in a case study from Pakistan.

In Pakistan, although coverage of Maternal, Newborn, and Child Health (MNCH) services has increased, the attributable disease burden remains high, indicating quality of these services remains suboptimal. To address this quality gap, challenges associated with the implementation of MNCH services will need to be addressed and effective use of the various MNCH guidelines will need to be supported, evaluated, and continuously improved. Even though the application of the field of implementation science and practice in the low- and middle-income settings has been limited, it is our belief, based on the experience described in this article that these competencies could enhance health professionals' ability to, not only successfully integrate MNCH guidelines into health systems, but to also support their effective and sustainable use. To address this capacity gap in Pakistan, the Health Services Academy, as a member of the World Health Organization's Human Reproduction Program (HRP) Alliance for Research Capacity Strengthening (RCS), has engaged, over the course of 16 months, in the 'Implementation for the Professional Learner Program' in 2019. This innovative implementation science and practice capacity-building program is developed and conducted by The World Health Organization (WHO) Collaborating Centre for Research Evidence for Sexual and Reproductive Health at the University of North Carolina at Chapel Hill (UNC). The initial cohort of this Program also included Palestine's West Bank, and Egypt. The objectives of this Program were to cultivate implementation science and practice competencies, and to support the development of national, community-based or institution-based implementation teams. The expected outcomes of this program included, further enhancement of the capacity of local health professionals in implementation science, systemic change and the effective use of innovations in practice at sub-national/regional levels.

A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics.

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.'s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled "communication." There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC-however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.