Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda

• DOI: 10.12688/gatesopenres.13214.1
• Publication Date: 2021-03-29T09:05:05Z
• Authors: Lisa R. Hirschhorn; Miriam Frisch; Jovial Thomas Nta...; Amelia VanderZanden; Kateri Donahoe; Kedest Mathewos; Felix Sayinzoga; Agnes Binagwaho
• Keywords: Scope (computer science); Identification; Conceptual framework; Implementation research

Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand pathways, successes, challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) low- middle-income countries (LMICs). Methods: reviewed existing IR frameworks develop designed better U5M reduction LMICs from identification leading causes U5M, EBI choice, strategies, work achieve sustainability at scale key contextual factors. then conducted mixed-methods case study Rwanda using explore its utility understanding steps country took EBI-related decision-making between 2000-2015, factors which hindered or facilitated success, extract actionable knowledge for other working reduce U5M. Results: While relevant were identified, none individually covered scope needed Rwanda's actions success. Building on these frameworks, we combined adapted capture exploration, planning, implementation, such as Rwanda, outcomes beyond effectiveness coverage. Utilizing our studied multiple EBIs identified common pathway cross-cutting strategies that supported country's success reducing system EBIs. Using findings, transferable lessons accelerate Conclusions: found building adapting was successful guiding data collection interpretation results, emerging new insights into how why achieved equitable introduction contributed decline generated drop