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Embrace the tension: a decolonial reframing of Implementation Science

bmjgh · 2025-11-27 · canonical JSON source

5 visible annotations · policy: published · automated confidence ≥ 75.00%

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The field of Implementation Science finds itself at a pivotal juncture, confronted by persistent calls to ‘decolonise’ and to more authentically engage with justice, equity, power and messy local realities.1 As articulated in recent commentaries and editorials,2–4 there is a growing recognition that the dominant model in Implementation Science—centred on scaling up and sustaining interventions that were typically developed and tested in high resource contexts—has often reinforced colonial hierarchies that sideline community knowledge, knowers and context. Instead of closing the implementation gap, the field has often widened it by treating local knowledge, knowers and contextual factors as a secondary, technical problem to overcome, rather than as an opportunity for genuine co-creation.56 In Global health programmes, particularly those driven by international funders operating under tight timelines and linear expectations of success, these pressures all but guarantee that the tensions between global models and local realities are simplified and smoothed over, rather than explored. We argue that this suppression of conflict and complexity is a missed opportunity for Implementation Science to centre equity and foster the decolonisation of Global Health. It forecloses the possibility of learning from the friction, resistance and creative adaptation that emerges when an external framework encounters grounded, lived expertise.