Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review.

Elizabeth Leonard, Imke de Kock, Wouter Bam
Author Information
  1. Elizabeth Leonard: Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa. Electronic address: liz.leonard93@gmail.com.
  2. Imke de Kock: Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
  3. Wouter Bam: Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa.

Abstract

The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.

Keywords

MeSH Term

Developing Countries
Humans
Income
Poverty
Program Evaluation