Implementation science in Africa—whose epistemology counts?

Implementation science, although promising to bridge the know-do gap in global health, has inadvertently created new forms of epistemic exclusion in African health systems. In this Viewpoint, we present an empirical critique of how widely used implementation frameworks, rooted in Eurocentric and North American epistemologies, systematically fail to recognise the mechanisms through which successful implementation occurs in African contexts. Drawing on case studies across diverse African settings, we reveal how this epistemological mismatch undermines both the science and practice of implementation in African health systems. Using epistemic injustice theory, we show how frameworks operationalise constructs in ways that treat traditional governance, community legitimacy, and relational authority as peripheral variables rather than generative mechanisms of change. We propose concrete transformations to implementation science that centre African epistemological traditions and require genuine power-sharing in knowledge production to support health system improvement across all contexts.

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Publication Details

Journal
The Lancet Global Health
Published
2025-11-12
DOI
https://doi.org/10.1016/s2214-109x(25)00414-0
Primary Topic
Global Maternal and Child Health
Type
article
Field-Weighted Citation Impact
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article

Implementation science in Africa—whose epistemology counts?

Ijeoma Uchenna Itanyi, Jabulani Ncayiyana, Désiré Habonimana, Beatrice Wamuti et al.
The Lancet Global Health
Global Maternal and Child Health
article

Implementation science in Africa—whose epistemology counts?

Ijeoma Uchenna Itanyi, Jabulani Ncayiyana, Désiré Habonimana, Beatrice Wamuti, John E. Ataguba, Lucy Kanya, Alfred Kwesi Manyeh, Francis Ohanyido, Omolayo Anjorin, Juliana Kagura, Latifat Ibisomi, Hlengiwe Sacolo-Gwebu, Ejemai Eboreime, Ermel Johnson, Hikabasa Halwindi
article en

Abstract

Implementation science, although promising to bridge the know-do gap in global health, has inadvertently created new forms of epistemic exclusion in African health systems. In this Viewpoint, we present an empirical critique of how widely used implementation frameworks, rooted in Eurocentric and North American epistemologies, systematically fail to recognise the mechanisms through which successful implementation occurs in African contexts. Drawing on case studies across diverse African settings, we reveal how this epistemological mismatch undermines both the science and practice of implementation in African health systems. Using epistemic injustice theory, we show how frameworks operationalise constructs in ways that treat traditional governance, community legitimacy, and relational authority as peripheral variables rather than generative mechanisms of change. We propose concrete transformations to implementation science that centre African epistemological traditions and require genuine power-sharing in knowledge production to support health system improvement across all contexts.

The Lancet Global HealthVol. 14(2)
University of Fort Hare (ZA), Dalhousie University (CA), University of the Witwatersrand (ZA), University of Health and Allied Sciences (GH), Kenyatta National Hospital (KE), University of Zambia (ZM), West African Health Organisation (BF), London School of Economics and Political Science (GB), University of KwaZulu-Natal (ZA)
Openalex Percentile: Top 54%
Global Maternal and Child Health
DOIOpen Access PDFOpenAlex
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