Implementation Research: A Primer
David D. Nicholas
It is well known in the international health community that there are a large number of proven, evidence-based interventions that are not being implemented or scaled up in many developing countries. Often these are low resource countries with the highest maternal, newborn and child mortality rates and as a result millions of lives are being lost and MDG goals are not being achieved.
For example, the Active Management of the Third Stage of Labor (AMTSL) is an accepted intervention that can significantly reduce post-partum hemorrhage, the leading cause of maternal mortality in many developing countries. In 2006, Niger had yet to implement this intervention. However, in that year, it used a form of participatory action research, the improvement collaborative, to introduce and expand the use of AMTSL. Facility teams in 33 sites studied their labor and delivery processes and tested ways to effectively incorporate AMTSL into their practice. Within two years, AMTSL had been spread to cover 32 percent of total facility births in Niger with a reduction in post partum hemorrhage of 75 percent.
