The Alliance Lift is a series that spotlights the journeys of Alliance alumni shaping health systems around the globe. In this Q&A, we meet Dr Archana Shrestha, a Nepali epidemiologist, researcher and educator whose work is reshaping how we think about prevention and implementation science in low- and middle-income countries.
Archana has spent over a decade designing and leading community-based health programmes in Nepal, with a focus on noncommunicable diseases (NCDs). She directs public health programmes at Kathmandu University, leads the Institute for Implementation Science and Health, and co-leads national efforts to strengthen cardiovascular disease research and training. Through the Alliance, she leads an implementation research project working with female community health volunteers to improve hypertension and diabetes care.
We asked Archana about the experiences that shaped her journey, the lessons she has learned from working closely with communities, and her vision for the future.
Learning from the past
Q: You began as a researcher in a complex and often under-resourced health system. What motivated you to move beyond purely clinical research towards implementation science?
During my PhD in epidemiology, I studied the Nepali diet and its links to hypertension, diabetes and overweight. We assumed traditional diets were healthy, but I found strong associations between large portions of rice, animal fat and these conditions. Or perhaps validate is a better word, because we already understand that link. But it made me wonder, why am I spending my time validating something we already know? It pushed me to move from identifying problems to solving them. My post-doctoral work focused on creating healthier food environments in workplaces and communities, and the positive impact we saw convinced me to focus on research implemented in real-world settings.
Q: You’re now leading an Alliance-supported project to improve hypertension and diabetes care in Nepal. What has that journey been like?
Our early research found a missing link between communities and primary health care facilities for NCDs. We decided to work with female community health volunteers (FCHVs) to deliver group care for hypertension patients closer to home. While some question whether FCHVs can provide NCD care due to age or literacy, our pilot showed about 70% could do so effectively after training.
Q: What have you learned from working with FCHVs, and how is their role evolving?
FCHVs have been essential in reducing maternal and infant mortality. For NCDs, they bring trust and community reach. We’ve supported them with training, ongoing mentorship, and – where needed – peer supporters to help with record keeping. They have been effective with both male and female patients.
Q: Earlier this year, you attended the Alliance inception meeting in Cambodia. Did that change your perspective on your work?
Yes. We often collaborate internationally but rarely within our own region. In Cambodia, we connected immediately over shared challenges and could compare different solutions. I’m looking forward to continuing those discussions.
Living in the present
Q: How have you engaged policy-makers and other stakeholders in your current work?
We work closely with municipalities, training their staff – not our own researchers – to deliver care, and with FCHVs embedded in the health system. We regularly engage local, provincial and federal officials to review progress, discuss barriers and explore scale-up. It’s a co-design process where we solve problems together.
Q: What challenges come with working so closely with communities and different levels of government?
Building relationships takes time, but it’s a core part of implementation research – just like collecting data, doing it is the nature of research and it should be considered an extra challenge, necessarily. Implementation research means working in real-world conditions, adapting when priorities shift – like when a human papillomavirus (HPV) vaccination campaign paused our activities. We document, learn from and share these experiences so others can also learn from them.
Q: The Fourth UN High-Level Meeting on NCDs is coming up in September. What message would you like to convey to world leaders?
Invest in chronic care. Primary health care systems in countries like Nepal were designed for infectious diseases, not lifelong conditions. If we expect them to handle hypertension and diabetes, we need sustained investment in human resources, information systems, community engagement, and long-term access to essential medicines.
Levelling up for the future
Q: What does a health system that truly supports implementation science and community-based solutions look like?
It partners with communities and academic institutions to solve real problems, creates platforms for regular dialogue, and engages patients and planners in decision-making. It’s open to creativity, tests new ideas, embeds research in service delivery, and adapts based on evidence – keeping what works and letting go of what doesn’t.
Q: What gives you hope right now?
When I started working on NCDs in 2010, few people in Nepal even talked about them. Now they’re part of the national conversation. Acknowledging the problem is an important step forward.
Q: What advice would you give to young researchers who want to work at the intersection of research, equity and implementation?
Implementation science offers the chance to make a real impact. Papers are very beneficial for career growth and visibility, but it's not the only thing. It should be the byproduct of the larger impact that you are planning to make in a community. Focus on the change your research can bring – the publications will follow.
Q: Any closing reflections?
Too often we work in silos. Breaking those down and building trust with the people we serve takes time – but it’s part of the work, not a barrier to it.
