Mapping implementation science in Pakistan’s health sector: a scoping review of frameworks, strategies, and implementation outcomes

This scoping review mapped how implementation science and implementation-relevant research have been used in Pakistan's health sector. Searches of PubMed, Google Scholar, PakMediNet, WHO IRIS, and major Pakistani institutional repositories identified English-language studies published between 2010 and 2026 that examined implementation processes, strategies, determinants, or outcomes related to health interventions, programmes, or policies in Pakistan. Data were extracted using a structured template covering study characteristics, implementation frameworks, strategies, outcomes, contextual determinants, and actors. Descriptive and thematic synthesis was undertaken. A total of 111 studies were included. Publication activity increased markedly after 2020, and the evidence base was concentrated in maternal, newborn, and child health and infectious diseases. Facility- and district-level implementation settings predominated. Most studies referenced some type of framework, but relatively few used established implementation science frameworks such as the Consolidated Framework for Implementation Research or RE-AIM. Training, community engagement, and supervision were the most frequently reported implementation strategies. Feasibility, acceptability, appropriateness, and adoption were commonly assessed; sustainability was reported in about half of included sources, whereas fidelity, penetration, and cost were less consistently reported. Overall, the review suggests that implementation-oriented research is increasingly visible in Pakistan but often remains adjacent to formal implementation science theory. Greater use of explicit frameworks, broader attention to emerging health priorities, and stronger assessment of sustainability, scale, and costs could strengthen evidence-informed implementation and health system improvement in Pakistan.