Building Bridges: A framework for redefining and decolonizing implementation science in low- and middle-income countries

Implementation science (IS) is gaining recognition for its role in enhancing health outcomes by connecting research evidence with practical application. However, most IS frameworks have been developed in high-income countries (HICs), raising concerns about their applicability, fairness, and sustainability in low- and middle-income countries (LMICs). In LMICs, which are home to over 75% of the global population, implementation challenges are influenced by unique social, cultural, geopolitical, and health system factors. This context reflects both opportunities and disparities in current IS models, such as dependence on external funding, lack of understanding and utilization of Indigenous Knowledge and Practice, and the underrepresentation of local knowledge holders/researchers as inventors. This critical review underscores the urgent need to decolonize and redefine IS in LMICs or Global South. We propose the Building Bridges framework encompassing advancing equitable and decolonized IS as foundational principle and four key pillars, including localizing and adapting IS frameworks, shifting power to LMICs leadership, equitable collaboration, capacity building, reforming funding agencies, and diversifying review panels, to foster a more just and locally relevant IS agenda. By prioritizing local leadership and valuing diverse knowledge systems, IS can reshape the local health landscape by embedding community-led decision-making and privileging locally grounded evidence based on lived experience, cultural practices, and relational worldviews, crucial for driving equitable, resilient, and sustainable health solutions in LMICs.