Non-Communicable Diseases: Can Implementation Research Change The Game for Policy and Practice?
Authors: Phyllis Dako-Gyeke, Wanrudee Isaranuwatchai, Yodi Mahendradhata, Morven Roberts, Giulia Loffreda, Sarah Rylance, Bente Mikkelsen
Non-Communicable Diseases (NCDs) are responsible for a staggering 74% of global deaths and 86% of premature deaths in low- and middle-income countries (LMICs). Despite significant advances in developing new therapies, there is a troubling disparity in the equitable delivery of both established and novel treatments. The World Health Organization (WHO) has outlined effective strategies for the prevention and management of NCDs, but many countries are falling short in implementing these measures. This gap in service delivery not only undermines efforts towards universal health coverage but also exacerbates health inequities, poverty, and economic losses.
Implementation research emerges as a critical tool to address this disparity by focusing on the practical application of evidence-based interventions in real-world health systems. Such research involves collaborative efforts among researchers, communities, practitioners, and policymakers to enhance service delivery and tackle obstacles. For instance, hypertension affects approximately 1.3 billion adults globally, with most cases occurring in LMICs. Despite being easily diagnosable and treatable with affordable generic medicines, only half of those affected are diagnosed, and a mere 20% receive effective treatment.
However, implementation research is not a new field. Two decades ago, the Mexico Ministerial Statement on Health Research called for an increase in this type of research, leading to early evidence syntheses. Today, various guides, courses, and journals exist, and countries across different income levels have developed varying degrees of expertise. Yet, this field remains underutilized and underfunded, with institutions often fragile and dependent on external funding. There is also a need for better alignment between research and policy, improved communication tailored to the needs of policymakers, and enhanced methodological innovation.
To improve the situation, the research approach must be integrated, with researchers and policymakers working closely together. This collaboration should align research with policy and budget cycles and ensure that research methods are responsive to the specific contexts of LMICs. Additionally, strengthening funding and institutional support for implementation research is crucial, with a focus on domestic investment and creating career incentives for researchers.
The upcoming Fourth High-Level Meeting of the UN General Assembly on NCDs in 2025 presents a pivotal opportunity to cement implementation research as a fundamental tool for translating political commitments into effective global health policies and practices.
