Implementation Research Compendium: A Systematic Presentation of the Learnings from Nine Countries

"IR [implementation research] helps close the gap between what is known and what is done, ensuring that proven strategies are effectively translated into real-world actions that benefit children."

This report, published by UNICEF Innocenti - Global Office of Research and Foresight, presents a description of nine examples of implementation research (IR) studies with relevance for children and child rights. It outlines the inclusion criteria used to select the studies and summarises key messages and learnings from across the studies. The nine studies were selected based on relevance for UNICEF priorities and diversity in the following characteristics: country income status; geographic region; sectoral focus; stage and scale of implementation; and research methods. 

The United Nations Children's Fund (UNICEF) defines IR as: "The integration of research within existing programme implementation and policymaking to improve outcomes and overcome implementation bottlenecks." It examines the effectiveness of implementation strategies (rather than the effectiveness of programmes themselves) and seeks to identify solutions to delivery challenges in specific contexts and to support more equitable, sustainable, and scalable programming. IR methods vary, but they can produce insights in close to realtime and at a relatively low cost. The approach involves demonstrating value in understanding how to improve results for children through better design and transfer of programmes, increased uptake and coverage, and system strengthening. UNICEF is committed to IR as a key difference-maker in accelerating outcomes for children and meeting the Sustainable Development Goals (SDGs).

The case compendium summarises the selected IR studies in a consistent format so that similarities and differences across studies, sectors, and geographies can support cross-sector lesson learning. In doing so, the case compendium is intended to enrich understanding of global implementation challenges and solutions, consolidate and accelerate learnings, improve implementation practice, and encourage wider use of IR to improve results for children.

The case studies are as follows:

• Bangladesh: Maternal, newborn, and child health programmes in emergency settings
• Ethiopia: Strengthening national health systems with implementation research
• Greece and Lebanon: Embedding IR in digital learning programmes
• Jamaica: A school-based violence prevention programme for the early years
• Lebanon: Parenting programmes in fragile contexts
• Lesotho: Economic empowerment and health equity through cash transfer programming
• Malawi: A prevention of mother-to-child transmission of HIV programme for adolescent mothers
• Serbia: A UNICEF programme for children and families
• South Africa: Piloting parenting programmes in low-resource settings

Each project summary follows the same structure, covering:

• Country and topic
• Intervention implementation phase, type of study, and implementation outcomes
• Background to the research, aims, and objectives
• Equity considerations
• Context of the IR
• Research methods
• Other information about the IR
• Research findings:
  • Implementation outcomes
  • Implementation processes, strategies, and mechanisms
  • Implementation barriers and facilitators
• Recommendations and research impacts (for each programme based on the IR findings)
• Discussion: summary, limitations, and implications
• Case compendium editorial comments
• Reference links to available publications and external dissemination

The key learnings from the implementation research are summarised by programme characteristics, individuals involved, organisational setting, broader context, and implementation processes and strategies. Overall, key learnings included: 

Learnings related to programme characteristics:

• Enablers: Features that were viewed as supporting implementation included: programme content that was aligned with needs, interests, and preferences; flexibility for those involved in delivery; and the inclusion of peer support.
• Barriers: The main way in which programme characteristics presented barriers to implementation was the demand the programme placed on either participants or those involved in delivery, or both. For example, the programme might have been too intensive so that participants were not able to attend all sessions, or too onerous or complex for delivery as anticipated. There were many detailed findings and recommendations for programme development and adaptation, including reducing intensity, complexity, and demand.

Learnings related to individuals involved in implementation:

• Enablers: Several studies highlighted the important support for implementation stemming from programme-delivery staff's motivation, enthusiasm, commitment, and engagement, as well as the positive and supportive relationships they appeared to build with programme participants.
• Barriers: The main barriers to implementation that were of concern to the staff were: programmes not being effectively aligned with skills and training levels; professional norms, expectations, and cultures hindering implementation (at both organisational and individual staff levels); and low retention of staff.

Learnings relating to organisational contexts:
Features of organisational contexts tended to be discussed as barriers rather than enablers across the studies. These were:

• Constraints relating to staff capacity, including the number of available staff, the breadth of demands on their time, and their expertise and training;
• Constraints relating to physical conditions in programme delivery settings, including overcrowding, lack of space, limits on confidentiality and privacy, insufficient equipment storage space, and the distance of the location; and
• Constraints relating to other aspects of organisational infrastructure, including data and information systems, connectivity, hardware, and other resources.

Learnings related to broader contexts:
A key enabler noted by several studies was programme alignment with current policy frameworks, priorities, and goals. However, as with organisational settings, broader context factors were more frequently described as barriers to implementation. These included (but were not limited to):

• The social circumstances of programme participants;
• Social norms, expectations, and stigmas, which created barriers to people engaging with services;
• Professional norms, expectations, and cultures, which obstructed engagement in implementation and the use of programmes, and the absence of professional incentives to engage in IR (Ethiopia); and
• At an institutional level, institutional distrust (by programme participants and between institutional partners) and poor partnership working, coordination, or connectivity between services and institutions.

The case studies also suggest ways future IR can be improved and strengthened, such as through the use of fuller and more explicit use of implementation theory, frameworks, and models. There is also scope to develop the ways in which programmes and IR address the wider (e.g., social and political) contexts in which programmes operate.