Doing implementation otherwise: territory, trust, and the work of staying

Abstract

The article proposes a critical reading of implementation in global health, arguing that it is not enough to adapt interventions or include more stakeholders if power hierarchies and extractive forms of knowledge production remain in place. Drawing from the Bolivian experience, the text shows that community-based research processes do not always begin with a closed design, a predefined intervention, or a linear theory of change. In many cases, they emerge from sustained relationships, situated conversations, silences, tensions, and local forms of care. One of its main contributions is showing that rigor in community-based transdisciplinary research is not reduced to compliance with technical procedures; it also implies staying in the territory, sustaining bonds of trust, recognizing local knowledge, and accepting that some processes are not easily scalable or replicable. The essay also links this reflection to climate change and mental health, demonstrating how rural and indigenous communities face psychosocial suffering associated with the loss of territories, wildfires, the disruption of agricultural cycles, migration, and the weakening of community care networks.