Embedded research is when HPSR organizations are part of the decision-making and implementation process. This enables them to take their lead from health systems stakeholders such as policy-makers and health system staff. It ensures that research is designed to meet demand and that it addresses the most pressing challenges to health system development.

Why is this an important issue?

It is important to produce research which responds to priority research questions and delivers actionable results. Embedded HPSR is much more likely to be used in practice because it is generated with decision-makers and implementers, takes context into account and is likelier to pinpoint bottlenecks and systems failures than other approaches. Embedded research structures may take different forms for example implementer led projects or platforms in Ministries of Health to support rapid evidence synthesis. These ongoing, iterative embedded relationships also speed up the process of knowledge generation. The co-creation of evidence creates more of a sense of ownership on the part of stakeholders. This creates a virtuous cycle where research is more likely to be used in addressing technical questions about interventions, strengthening policy. 

Alliance track record

The Alliance has a history of uniting policy-makers, researchers, implementers, managers, community workers and practitioners in partnerships to improve health systems. Initial work on Implementation Research demonstrated the gains that could be made when researchers worked to improve the scale-up, effectiveness or efficiency of ongoing interventions. WHO’s first strategy on HPSR in 2012, Changing Mindsets, emphasised that implementation research is even more effective when implementers and decision-makers play a central role and where researchers are embedded in the design and reform of programmes.

The Alliance supports several projects that aim to strengthen and study the embedded research process. Since 2013, AHPSR, UNICEF and Gavi, the Vaccine Alliance, have supported 26 embedded maternal, newborn and child health research projects in 15 low- and middle-income countries (LMICs) through the Decision-Maker Led Implementation Research initiative.

In 2014, in collaboration WHO Regional Offices the Alliance launched Improving Programme Implementation through Embedded Research (iPIER). This programme has supported 12 projects from nine countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Implementers were made Principal Investigators in these projects to harness their knowledge and ensure that research was used to create change. Learning from this programme was captured in a special issue  of the Pan American Journal of Public Health.

Issue in practice

The Alliance has supported work on immunization through partnership with UNICEF and Gavi (Global Alliance for Vaccines and Immunisation). Research in Local Government Authorities within Ogun State in Nigeria has used participatory action research with communities, health care workers and decision-makers to uncover the barriers to immunization services and to develop action plans to overcome them. These barriers included the identification of vulnerable groups who needed greater health care worker attention and that male household decision-makers had unresolved concerns around potential adverse effects of immunization.

The study sites showed success. Immunization coverage for children above nine months, as assessed by a household survey of caregivers, went from 61% to 91%, and caregiver visits to health facilities for routine immunization services rose from 54% to 83%. The networks of policy-makers involved in this study have expanded and the approach has been shared nationally and internationally.

In 2019 the Alliance, funded by the Doris Duke Foundation, used digital longform outputs to tell the story of embedded research projects in Ghana and Mozambique that are part of the African Health Initiative. These projects have been running for a number of years and involve policy- and decision-makers in health systems research from the conceptualization and design stage building institutional and individual capacities for embedded health systems research. 

Digital longforms are a cutting edge, innovative form of research communication which use written narrative, video, photography, infographics and design to take the user through an online journey. They open up the topic of embedded research to a new range of audiences and bring to life the characters and stories behind the data.

Future commitment/call to action

Over the coming years the Alliance will support decision-makers in LMICs to utilize an embedded approach and create an enabling environment for the absorption of HPSR into the decisions of policy-makers and practitioners. 

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