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. [Abstract copyright: Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.]