How can a promising innovation become part of everyday healthcare? This question lies at the heart of the IMCI-PLUS project, which explores how point-of-care lung ultrasound – a portable imaging tool that allows health workers to diagnose lung conditions directly at the patient’s bedside – can support the diagnosis and management of childhood pneumonia in primary healthcare.
Many people may not know what “implementation research” means. How would you explain it in simple terms?
Aita: Implementation research is about understanding how proven health interventions can actually work in the real world. We look at what it takes for an innovation that showed good results in clinical trials to be effectively used in everyday care. In other words, we study how to bridge the gap between evidence and practice – how to make sure effective interventions reach people, especially in resource-limited settings and underserved communities.
What do you do in the IMCI-PLUS project?
Grace: We design the study with the country partners, guide its implementation, and oversee data collection, analysis and the publication of the results. The IMCI-PLUS project runs in three countries – Senegal, South Africa and Tanzania. Our goal is to understand how point-of-care lung ultrasound can be used in primary healthcare facilities to diagnose childhood pneumonia, and what it takes to integrate this technology into existing health systems.
Why is it important to study not only if point-of-care lung ultrasound works, but also how it can be integrated into everyday child healthcare?
Aita: Knowing that a tool works is only half the story. If it can’t be used effectively by health workers or is not accepted by families, it won’t make an impact. Implementation research helps us understand the systems, behaviours and contexts that make or break real-world success. It’s about moving from “it works in theory” to “it works in practice.”
What barriers or opportunities do you expect when introducing this technology into routine services?
Grace: Key challenges include gaining acceptance, building skills, and adapting clinical workflows. The lung ultrasound tool is small and portable, but it’s still new to many health workers. They have to learn how to use it, interpret the images and feel confident in the results. It also changes how consultations are structured and adds to their workload. For caregivers, trust is another issue. Imagine a parent coming with a sick child, but the ultrasound shows the child doesn’t need antibiotics. They leave without medicine – which can be hard to accept. Building understanding on both sides is crucial.
Aita: At the same time, the opportunities are immense. Point-of-care lung ultrasound could enable faster, more accurate diagnoses at the primary care level, reduce unnecessary antibiotic prescription and improve child health outcomes.
How are you involving policymakers, health workers and caregivers in shaping the implementation strategy?
Aita: We started by mapping all the stakeholders involved at the primary healthcare level – from nurses and clinicians to caregivers and local health officials. We then conducted interviews and focus group discussions to understand how best to introduce the technology in each context.
Grace: We are still analysing the data, but we can already see that, for example, acceptability of the intervention is high among health workers and caregivers in South Africa, which is very encouraging.
What will you be looking at to understand if the implementation has been successful?
Grace: Success means that the use of point-of-care lung ultrasound becomes part of routine child healthcare – not a one-off project, but an integrated, sustainable practice. In a previous study, the TIMCI project, we saw that half of the children who received antibiotics didn’t actually need them. One key outcome will therefore be fewer unnecessary antibiotic prescriptions, which is crucial given the global rise in antibiotic resistance.”
Aita: We also look at whether children with pneumonia or tuberculosis are diagnosed and treated earlier. If primary healthcare facilities can provide these services, care becomes more accessible, outcomes improve, and severe illness – even deaths – can be prevented.
Finally, what personally drew you to implementation research – was there a moment in your career that convinced you this was essential?
Grace: I come from a health systems background. Over the years, I’ve seen so many good interventions and innovations, but they’re often just one piece of the puzzle – and many fail when rolled out in real-world settings. In Uganda for example, more than 140 digital health interventions were piloted. It’s impressive, but it also shows how fragmented things can become. The real question is: do they work in practice, and are they sustainable?
Aita: It’s about avoiding research waste. We keep developing new tools, but they don’t always translate into impact. For me, the CARAMAL study was an eye-opener. It evaluated rectal artesunate (RAS) as a first treatment for severe malaria in young children, which was very effective in clinical trials, but in real-world conditions it didn’t save lives as expected. That experience taught me that success depends not just on a good tool, we must understand what it needs to work in practice – and that’s what implementation research helps us figure out.