Empowering decision-makers to play a central role in the research process is intrinsic to bringing about the embedding of research. One strategy for bringing about the needed power shift is to engage decision-makers as principal investigators of research. A new supplement of Health Research Policy and Systems (HARPS) provides findings from such studies and reflections on the embedded approach.
Beginning in 2015, the Alliance at WHO and the United Nations Children’s Fund (UNICEF) in partnership with Gavi, the Vaccine Alliance, began supporting a programme of decision-maker-led research focused on immunization (DELIR). This was informed by:
- recognition of the importance of immunization as an intervention whose implementation and scale-up is critical to move towards universal health coverage;
- a felt need for new knowledge to better understand and help overcome health systems barriers to effective scale-up and implementation of immunization interventions; and
- recognition of the added value of engaging decision-makers as principal investigators through an embedded approach informing the generation, dissemination and use of this new knowledge.
The overall purpose of the DELIR initiative was to support the generation of new knowledge to inform the implementation of immunization interventions with the aim of improving coverage in LMICs. 14 research projects in 10 LMICs in Africa and Asia were supported under this initiative. The supplement brings together findings from eight of these projects conducted in six countries (Chad, Ethiopia, India, Nigeria, Pakistan and Uganda).
The collection also highlights the use of diverse methods and approaches. While the majority of the studies (seven out of eight) use mixed methods bringing together key informant interviews, focus group discussions and document reviews, the collection includes examples of innovative approaches – such as participatory action research to understand how interventions to increase the utilization of immunization in Nigeria have met their objectives.
The papers included in the supplement also represent the diversity of priority issues supported under the larger research programme, with two papers each speaking to issues around immunization systems (both papers from Ethiopia), assessing the effectiveness of demand creation communication efforts (Chad and India), and programme management, monitoring and evaluation strategies (Uganda).
The issue concludes with a synthesis paper that systematically analyses experiences and perceptions of those involved in the projects and draws lessons for the further development of decision-maker-led strategies in the future. In that paper, seven enablers and five barriers to the process of conducting the studies or bringing about changes were identified. Key enablers were the relevance, acceptability, and integration of the research, while key barriers included unclear results, limited planning and support, and the limited role of a single study in informing changes to strengthen implementation.