Bridging policy and practice: a scoping review of health system implementation research practice in Ethiopia.

Abstract

Background: Implementation research plays a key role in bridging the gap between evidence and practice, particularly in low-resource settings. In Ethiopia, persistent challenges in healthcare access, quality, and system performance highlight the need for context-specific implementation evidence. Although implementation research has been advancing in the country, its scope, practice, and contribution to health system improvement remain insufficiently characterized and documented. This gap underscores the need to assess the landscape of healthcare and health system implementation research in Ethiopia to inform decisions about health policies, programs, and practices. Therefore, this scoping review aimed to comprehensively investigate the current landscape of healthcare and health system implementation research in Ethiopia.

Methods: We conducted a scoping review in accordance with Joanna Briggs Institute guidance and PRISMA-ScR reporting standards. A systematic search of major electronic databases and relevant sources was performed using the Population, Concept, and Context (PCC) framework, which involved keywords and MeSH terms. Two researchers independently screened the studies and extracted data using a piloted form, resolving and discrepancies through discussion. Extracted data included study characteristics, outcomes, contextual factors, and implementation strategies. We categorized implementation strategies using ERIC frameworks. The findings were analyzed through descriptive and thematic approaches and organized across key health system blocks and contextual dimensions.

Results: The search identified 10,853 studies. One hundred sixty-four articles underwent full-text review, and 96 were included in the analysis. The studies included in the review used 40 mixed methods, 23 quantitative, and 33 qualitative approaches. According to the health system building blocks, 70 studies focused on service delivery, 16 on health information systems, and 5 on leadership or health financing. Among the service delivery studies, neonatal, child, maternal, and reproductive health were most commonly addressed topics. Key implementation outcomes included fidelity, feasibility, acceptability, sustainability, and cost-effectiveness. Forty-three studies used determinant, process, or evaluation frameworks, including Consolidated Framework for Implementation Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; Exploration, Preparation, Implementation, and Sustainment; Theoretical Domains Framework; Medical Research Council Framework; diffusion and social network theories; and Donabedian's quality framework. Fifty studies involved stakeholders in implementation research. Global funders supported 72 studies. A total of 55 studies reported the use of implementation strategies, with 27 out of 39 maternal and child health studies including such strategies.

Conclusions: This review highlights implementation research conducted with a strong focus on service delivery, particularly in maternal, neonatal, and child health. Stakeholder engagement played a crucial role, while global funding supported research efforts. The broad use of implementation strategies demonstrates ongoing efforts to translate research into practice. These findings underscore the need for continued investment in implementation science to enhance healthcare delivery and outcomes.