Past Initiatives

The Implementation Science Initiative (ISI) to improve the implementation of Iron and Folic Acid Supplementation (IFAS) programs for women in Kenya and Uganda

SISN partnered with the International Initiative for Impact Evaluation (3ie) under a Bill & Melinda Gates Foundation (BMGF) grant to improve the implementation of Iron and Folic Acid Supplementation (IFAS) programs for women in Kenya and Uganda.

The Implementation Science Initiative sought to apply an implementation science (IS) approach and create a galvanized coalition of policymakers, program actors, and researchers in each country in order to strengthen IFAS programs during implementation. The initiative provided an opportunity to learn how to build the capacity for and practice of IS through a facilitated process of learning-by-doing.  The goal was to strengthen program implementation by:

• closing a knowledge utilization gap by integrating existing evidence into policy and programmatic decisions through technical assistance, mentoring and knowledge brokering
• when necessary, conducting practical implementation research (IR) in the form of rapid assessments, operations research, process evaluation or other exercises, as appropriate to address the critical challenges facing implementers and policymakers.

SISN and 3ie partnered with URC in Uganda and FHI Partners in Kenya to provide the implementation arena for the initiative. In each country, a core team was created and included at least a senior nutrition expert from an NGO, a senior Ministry of Health nutrition official, researcher(s) and a project manager/knowledge broker. More specifically, the core team members worked together to:

• identify implementation bottlenecks in IFAS programs
• facilitate access to and utilization of existing knowledge to address them, when possible
• conduct IR and facilitate the use of findings, when necessary
• facilitate capacity building for IS/IR, through learning-by-doing
• cultivate interest in IS/IR within the larger nutrition community in the country.

In 2018, the initiative was launched in June through an inception workshop in Uganda in which the country core teams from Kenya and Uganda worked to develop and strengthen their proposals to undertake the IS approach in their country. The workshop aimed to foster partnership among the national core team members and provide guidance on IS principles and approach. By the end of the year, each core team had carried out a bottleneck assessment workshop of their IFAS programs; it consisted of a comprehensive system and systematic tool used with participants working at various levels in the national system.

In 2019, the work to operationalize the six components of the initiative in country intensified:

1. National core team to apply an IS approach
2. Creation and continuous updating of a bottleneck inventory
3. IR
4. Knowledge brokering strategy
5. IS network to build national interest and capacity for IS/IR
6. Ongoing documentation of the experiences

The documentation of the experiences allowed sharing of lessons learned among countries during the implementation of the initiative.

In 2020, during the final year of the initiative, the analysis to articulate the insights gained throughout the initiative intensified. Due to the COVID-19 pandemic, several adaptations to planned activities were necessary.

In 2021-22, all efforts were geared towards articulating the main insights from the Initiative into various products such as scientific articles, practical guides and the Implementation Science System Toolkit.

Milestones and Achievements

2022

• Publication of “Operationalizing Implementation Science in Nutrition: The Implementation Science Initiative in Kenya and Uganda” as open access in Current Developments in Nutrition. The paper summarizes how ISI operationalized the IS in Nutrition (ISN) framework in Kenya and Uganda by outlining the strategies employed and describing the challenges encountered by the in-country implementation teams.
• Launch of the Implementation Science System Toolkit on the SISN website. The toolkit was designed to assist implementers and decision makers in diverse settings to operationalize the SISN Framework and build the capacity needed for these endeavours.

2021

• Successful completion of the project (May 2021)
• Preparation of journal articles and toolkit drawing on the main insights and findings from ISI.
• Support the Uganda team for a publication entitled “Improving iron-folic acid supplementation (IFAS) among pregnant women: An implementation science approach in East-Central Uganda” and submitted to the Global Health: Science and Practice Journal” (still under review, delays due to COVID pandemic).

2020

• Webinar on the focused ethnographic study (FES) approach (February 2020)
• Joint development of a manual to carry out a FES on antenatal care (ANC) attendance and iron and folic acid supplementation (IFAS) adherence (May-June 2020)
• Undertaking of a process evaluation of the implementation of an intervention (enhanced support for quality improvement) in Uganda
• Intensification of the analysis of the documentation of the experiences to draw diverse types of learnings over the course of the whole initiative

2019

• Development of the IR protocol to carry out three studies in Kenya and Uganda
• Submission to the national ethics committee and preparatory work to carry the studies, which will use an effectiveness-implementation hybrid design in both countries
• Presentation of three webinars 1) ISI in Kenya and Uganda (April 2019) 2) IS in nutrition for the Consortium of Universities for Global Health (June 2019), and 3) Effectiveness-implementation hybrid designs (December 2019)

2018

• National core team created and terms of reference developed
• Bottleneck assessment workshops carried out on IFAS programs in Kenya and Uganda
• Development of guidance notes on the different components of the initiative and of considerations to carry out IR and use existing implementation knowledge

The KI3 initiative aimed to strengthen the availability, access and utilization of implementation knowledge to accelerate progress in scaling up implementation and impact on nutrition.

KI3 was launched at the end of 2016 through a collaboration among the Scaling Up Nutrition (SUN) Movement Secretariat the International Food Policy Research Institute (IFPRI) and the SISN. It received pilot funding from Sight and Life and the Federal Office for Agriculture and Food in Germany. Its overall aim is to strengthen the availability, access and utilization of implementation knowledge to accelerate progress in scaling up implementation and impact on nutrition, with a focus on SUN countries.

In 2017, the initiative undertook a mapping exercise of implementation knowledge initiatives and organizations at the global level and scoped possibilities for strengthening the access to and utilization of implementation knowledge from these global sources in SUN countries.

In 2018, the initiative implemented a series of activities whose overarching vision was to create a network of organizations at global and national levels willing and able to respond to the diverse needs and requests for implementation knowledge assistance from SUN countries and to help countries share knowledge, methods, and experience on implementation amongst one another. At a meeting of stakeholders in Geneva in 2018, five interlinked strategies were articulated and are illustrated in a figure of a 5-piece puzzle below:

1. Strengthening of a Global Implementation Knowledge Network
2. Strengthening or creation of National Implementation Knowledge Networks
3. Creation of a tools matrix to simplify access to implementation tools produced by various organizations
4. Strengthening the capacity, support and funding for practical implementation research at country and programmatic levels
5. Strengthening the capacity and support for knowledge brokering at national and sub-national levels.

Figure: Interlinked Strategies for Accessing and Using Implementation Knowledge

Insights and progress on these activities were shared in November 2018 with the broader SUN movement through at the FAO/IFPRI Global Event.

In 2019, the work continued to develop further the five strategies that emerged from the discussions among key stakeholders over the first two years of KI3, thanks to modest resources. IFPRI and SUN secretariat have led the work on the tool matrix and SISN has led the work on knowledge brokering.

Funding

The KI3 project was funded by Sight and Life and the German Federal Ministry for Economic Cooperation and Development (BMZ).

Milestones and Achievements

2020

• A journal paper is planned on the insights gained on knowledge brokering in the context of multisectoral nutrition

2019

• To further explore knowledge brokering roles at the national level, interviews were carried out with National Information Platforms for Nutrition (NIPN) actors and with SUN focal points. An article was published in UNN/UNSCN Nutrition News on UNN-REACH facilitator as knowledge broker, based on the study carried out by SISN
• A concept note was developed to further develop the architecture of the KI3 Implementation tools matrix
• SISN collaborated with NIPN and the African Nutrition Leadership Programme to develop a 5-day Leadership Capacity Training tailored to the context of multisectoral nutrition for NIPN country staff

2018

• Minor amendments made to the framework and classification scheme in response to peer feedback
• Paper on the new framework and classification published in a peer review journal, Current Developments in Nutrition
• Interviews were carried out with Renewed Effort Against Child Hunger and undernutrition (REACH) facilitators to explore the concept of knowledge brokering

2017

• SISN Framework and Classification Scheme for Implementation Science (IS) in nutrition developed (with input from a broad range of experts including many Founding Members)
• New framework shared via SISN communication channels, seminars and symposia eliciting very positive responses
• A mapping was conducted of implementation knowledge initiatives and organizations at the global level and a matrix mapping information to the SISN Framework was created

Further Reading

• Improving Access To and Use of Implementation Knowledge: The Knowledge for Implementation and Impact Initiative (KI3)
• UNN-REACH Facilitator as Knowledge Broker
• Implementation in Nutrition: A Tools Map