Embedding research to improve program implementation in Latin America and the Caribbean / Integrar a pesquisa para melhorar a implementação de programas na América Latina e no Caribe

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014–2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the “insider” perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

Na última década, a pesquisa em implementação tem tido papel fundamental em melhorar a implementação de intervenções de saúde comprovadas com o incentivo à absorção metódica dos resultados de pesquisas e outras constatações na prática diária. A Aliança para Pesquisa em Políticas e Sistemas de Saúde e a Organização Pan-Americana da Saúde criaram um programa de pesquisa em implementação integrada para dar respaldo aos programas de saúde na América Latina e no Caribe (ALC) em 2014–2015. Foram recebidas ao todo 234 propostas provenientes de 28 países nas Américas. A iniciativa Melhorar a Implementação de Programas com Pesquisa Integrada (iPIER) subsidiou 12 projetos de pesquisa em implementação conduzidos pelos responsáveis pela execução dos programas públicos de saúde de nove países da ALC: Argentina, Bolívia, Brasil, Chile, Colômbia, México, Panamá, Peru e Santa Lúcia. Esta experiência ensinou que a perspectiva dos “insiders” (pessoal interno), que os responsáveis pela execução dos programas imprimem à proposta da pesquisa, é essencial para identificar a problemática a ser pesquisada com foco nas falhas dos sistemas, que em geral se manifestam como obstáculos à implementação. Neste artigo se destacam a experiência e as principais conclusões sobre a realização de pesquisa em implementação integrada. A experiência iPIER demonstrou serem bastante promissores os modelos de pesquisa integrada quando os responsáveis pela execução dos programas assumem as rédeas das iniciativas de pesquisa em implementação.

En los últimos 10 años, las investigaciones sobre la ejecución de programas han desempeñado una función crucial en lo que respecta a la mejora de la ejecución de intervenciones de salud de eficacia comprobada, porque han promovido la incorporación sistemática de los resultados de investigaciones y otras estrategias basadas en datos probatorios en la práctica cotidiana. Entre el 2014 y el 2015, la Alianza para la Investigación en Políticas y Sistemas de Salud, y la Organización Panamericana de la Salud pusieron en marcha un proyecto que propone incorporar las investigaciones sobre la ejecución para apoyar a los programas de salud en América Latina y el Caribe. En total, se recibieron 234 solicitudes de 28 países de las Américas. La iniciativa “Mejora de la Ejecución de los Programas mediante la Incorporación de la Investigación (iPIER)” respaldó la realización de 12 proyectos de investigación dirigidos por ejecutores de programas de salud de nueve países de América Latina y el Caribe: Argentina, Bolivia, Brasil, Chile, Colombia, México, Panamá, Perú y Santa Lucía. Gracias a esta experiencia, somos conscientes de que la perspectiva “desde dentro”, con la que contribuyen los ejecutores a la propuesta de investigación, es particularmente importante para definir las preguntas de investigación que apuntan a las deficiencias de los sistemas a menudo manifestadas a través de obstáculos que dificultan la ejecución. Este artículo documenta la experiencia derivada de las investigaciones incorporadas en la ejecución de los programas y destaca las conclusiones más importantes. La experiencia iPIER resulta muy prometedora para los modelos de ejecución que proponen incorporar las investigaciones y que colocan a los ejecutores al mando de estas iniciativas.

Embedding research in health policy and systems in the Americas

As countries develop and improve universal health coverage schemes globally, there is increasing recognition that health policymaking and health system strengthening need to be informed by robust research evidence (1, 2). In Latin America and the Caribbean, emerging and complex health challenges require actionable and context-sensitive evidence to improve the responsiveness of health systems (3). This movement towards evidence-informed policymaking also calls for research that addresses key priorities identified by policymakers and stakeholders in the Region [...] Since 2014, the Alliance, in collaboration with the Pan American Health Organization (PAHO), has implemented an embedded research initiative to support health policies and programs in Latin America and the Caribbean. The initiative, entitled “Improving Program Implementation through Embedded Research (iPIER),” aims to support the development of and demand for problem-focused and action-oriented research. The Alliance contributes its embedded research experience and PAHO brings its expertise with supporting research in the Region of the Americas to advocate for this innovative way of developing and using science [...] This special series of the Pan American Journal of Public Health presents the rationale that underpins the embedded research initiative, and the findings of 10 of these projects, conducted within various health system settings in Latin America and the Caribbean. The supplement provides critical knowledge emanating from research prioritized by decision-makers, in addition to documenting the embedded research process and outcomes. Findings and reflections put forth in this series also contribute to bridging the knowledge gap on the engagement process between policymakers and researchers, particularly in LMIC settings. In addition, the learnings provide greater evidence on the pathways through which research is linked to priority health systems and services in the Americas.

Implementation research in health: A practical guide

Esta guía es un intento de corregir la deficiencia en la comprensión de la investigación operativa y fomentar el personal del programa y ejecutores a tomar un mayor interés en el tema, reconociendo que la implementacióninvestigación es de hecho una parte integral de la planificación y la ejecución del programa, en lugar de algo que ocurre una vez que los programas están en marcha. Destinado a los recién llegados a el campo, los que ya la realización de investigaciones de aplicación, y los que tienen la responsabilidad para los programas de desarrollo, la guía proporciona una introducción a la aplicación básica conceptos y el lenguaje de investigación, se describen brevemente en qué consiste, y describe los muchos interesantes oportunidades que presenta.

Caregiving and elderly health in Mexico.

Using the National Mexican Health and Aging Study panel dataset, the authors estimate the effect of having informal care on the probability of dying and on the change in elderly health over a two-year period. Three measures of functional health were used: self-reported health, activities of daily living, and instrumental activities of daily living. We develop an empirical strategy that relies on the panel structure of the dataset to sort out the possible correlation between unobservable characteristics that affect both elderly health and an individual's decision to provide informal care. Our findings suggest that informal care provided by daughters reduces the probability of dying. In addition, informal care provided by daughters reduces the probability of having a decline in activities of daily living and instrumental activities of daily living, while it has no effect on the observed changes in self-reported health status. The protective effect of informal care provided by sons is not statistically significant for any health outcomes. A discussion of the policy options to increase elderly health and to improve the role of caregivers is included.