Doing implementation research on health governance: a frontline researcher’s reflexive account of field-level challenges and their management
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
BACKGROUND: Implementation Research (IR) in and around health systems comes with unique challenges for
researchers including implementation, multi-layer governance, and ethical issues. Partnerships between
researchers, implementers, policy makers and community members are central to IR and come with
additional challenges. In this paper, we elaborate on the challenges faced by frontline field researchers,
drawing from experience with an IR study on Village Health Sanitation and Nutrition Committees (VHSNCs).
METHODS: The IR on VHSNC took place in one state/province in India over an 18-month research period.
The IR study had twin components; intervention and in-depth research. The intervention sought to
strengthen the VHSNC functioning, and concurrently the research arm sought to understand the contextual
factors, pathways and mechanism affecting VHSNC functions. Frontline researchers were employed for data
collection and a research assistant was living in the study sites. The frontline research assistant experienced
a range of challenges, while collecting data from the study sites, which were documented as field memos
and analysed using inductive content analysis approach.
RESULTS: Due to the relational nature of IR, the challenges coalesced around two sets of relationships (a)
between the community and frontline researchers and (b) between implementers and frontline researchers.
In the community, the frontline researcher was viewed as the supervisor of the intervention and was
perceived by the community to have power to bring about beneficial changes with public services and
facilities. Implementers expected help from the frontline researcher in problem-solving in VHSNCs, and
feedback on community mobilization to improve their approaches. A concerted effort was undertaken by
the whole research team to clarify and dispel concerns among the community and implementers through
careful and constant communication. The strategies employed were both managerial, relational and
reflexive in nature.
CONCLUSION: Frontline researchers through their experiences shape the research process and its outcome
and they play a central role in the research. It demonstrates that frontline researcher resilience is very
crucial when conducting health policy and systems research.
Description
Keywords
Implementation research, Frontline researcher, Reflexivity, Experiences, Challenges, Management, Resilience
Citation
Patel, G. et al. (2017). Doing implementation research on health governance: a frontline researcher’s reflexive account of field-level challenges and their management. International Journal for Equity in Health, 16: 198