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Appraising and addressing design and implementation failure in global health: A pragmatic framework
Ejemai Amaize Eboreime1,2, John Olajide Olawepo3,4, Aduragbemi Banke-Thomas5
1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Abstract:
There have been recent concerns about the failure of several global health interventions. Interventions are considered to have failed when they are unable to achieve the intended results. Failure may be linked to how the intervention was designed (design failure) or how it was implemented (implementation failure). Recently, substantial efforts have been employed to improve the outcomes of health interventions. These efforts have led to the development of several theories, models, and frameworks in implementation science to improve the quality of implementation, bridging the divide between evidence and practice. But significant gaps still exist. Whereas much work has been done to develop frameworks and approaches to improve implementation fidelity, not as much effort has been done to guide the adherence of interventions to program theory during the design of the programs. Further, there have been concerns about the applicability of these frameworks in the real-world. This article uses examples to illustrate these gaps and further proposes a pragmatic framework to address identified gaps, thus aiding evidence-informed program design and implementation. The proposed Theory-Design-Implementation (TyDI) framework will support policymakers, program planners and implementers to address potential design and implementation failure, thus improving the fidelity of interventions.
Insights
Global health interventions often fail due to design or implementation issues. This study introduces the Theory-Design-Implementation (TyDI) framework to improve intervention success by addressing these gaps.
Area of Science:
- Global Health
- Implementation Science
- Program Design
Background:
- Global health interventions face challenges in achieving intended outcomes, often due to design or implementation failures.
- While implementation science offers frameworks to improve fidelity, gaps remain in guiding adherence to program theory during design.
- Existing frameworks face challenges in real-world applicability.
Purpose of the Study:
- To identify and illustrate critical gaps in the design and implementation of global health interventions.
- To propose a pragmatic framework, the Theory-Design-Implementation (TyDI) framework, to address these identified gaps.
- To support evidence-informed program design and enhance intervention fidelity.
Main Methods:
- Review of existing literature on health intervention design and implementation science frameworks.
- Analysis of common failure points in global health interventions through illustrative examples.
- Development and proposal of the Theory-Design-Implementation (TyDI) framework.
Main Results:
- Significant gaps exist in aligning intervention design with program theory and ensuring real-world applicability of implementation frameworks.
- The proposed Theory-Design-Implementation (TyDI) framework offers a structured approach to bridge these gaps.
- The TyDI framework aims to improve the fidelity and effectiveness of global health interventions.
Conclusions:
- Addressing both design and implementation failures is crucial for successful global health interventions.
- The Theory-Design-Implementation (TyDI) framework provides a novel approach to enhance intervention planning and execution.
- Implementing the TyDI framework can lead to more effective and evidence-informed health programs.
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