The Union and Médecins Sans Frontières approach to operational research. [State of the Art Series. Operational Research. Number 2 in the series]

International Union Against Tuberculosis and Lung Disease, Paris, France.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 02/2011; 15(2):144-54, i.
Source: PubMed


Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world.

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Available from: Sven Gudmund Hinderaker, Dec 31, 2013
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    • "Both prison authorities and Ministry of Health officials were engaged from the beginning and implemented the study findings promptly. Two, district-based OR studies of cotrimoxazole prophylaxis therapy in rural Malawi had strong engagement of policy makers right from the beginning, resulting in swift translation into policy and practice at country level, in contrast to the situation in Uganda and Zambia, where excellent research was conducted, but cotrimoxazole uptake in routine services was slower (Hutchinson et al. 2010; Harries et al. 2011a,b). Three, a study of HIV patients in Nairobi, Kenya, reported higher losses to follow-up in a cohort that paid for antiretroviral treatment (ART) than one that received ART free-of-charge: acceptance of the findings by key people from the Ministry of Health led to ART being offered free-of-charge to all (Zachariah et al. 2008). "
    Tropical Medicine & International Health 05/2013; 18(8). DOI:10.1111/tmi.12133 · 2.33 Impact Factor
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    • "In addition to initiatives highlighted by Whitworth et al. (2008), capacity-building efforts in developing countries can also be complemented by programme staff in external operational agencies such as Médecins Sans Frontieres (MSF) and The Union Against Tuberculosis and Lung Disease (The TB Union). Both organisations have highlighted their views on capacity building and leadership development in operational research in two previous publications (Harries et al. 2011; Zachariah et al. 2011). In terms of current "
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    ABSTRACT: Le thème du Rapport de la Santé Mondiale 2012 est «pas de santé sans recherche» et est un appel à l’action pour combler les lacunes mondiales dans la recherche en santé. Combler l’écart entre les «nanti »et les «démunis» est vital si nous voulons être à la hauteur de l’appel de ce thème et utiliser la recherche pour apporter des améliorations sur le terrain. Les nombres absolus de publications scientifiques et des publications par habitant ont été utilisés comme les principaux indicateurs pour évaluer la capacité mondiale de la recherche et identifier les zones à lacunes. A l’échelle des pays, nous estimons que cela reflète un seul côté de la médaille. Bien que l’absence de stratégies nationales de recherche en santé empêche une allocation optimale des ressources, une réalité toute aussi importante sur le terrain est la transcription inadéquate des résultats de la recherche dans la politique et la pratique, l’autre côté de la médaille.
    Tropical Medicine & International Health 08/2012; 17(11). DOI:10.1111/j.1365-3156.2012.03072.x · 2.33 Impact Factor
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    • "We think this is true, but understandable. Proponents of OR for global health – and for TB control in particular – see it as research ''intended to provide managers, administrators, and policy makers with the information that they need to improve service delivery activities and plan future ones'' [4]; or, ''research into strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of the health system or programmes in which the research is being conducted'' [5] [6]. This sort of language is less intimidating than ''an interdisciplinary branch of applied mathematics or formal science that uses advanced analytic methods to make better decisions or research that provides optimal solutions to complex decision-making'' ( "
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    ABSTRACT: Operations research (OR) is well established in India and is also a prominent feature of the global and local agendas for tuberculosis (TB) control. India accounts for a quarter of the global burden of TB and of new cases. Multidrug-resistant TB is a significant problem in Mumbai, India's most populous city, and there have been recent reports of totally resistant TB. Much thought has been given to the role of OR in addressing programmatic challenges, by both international partnerships and India's Revised National TB Control Programme. We attempt to summarize the major challenges to TB control in Mumbai, with an emphasis on drug resistance. Specific challenges include diagnosis of TB and defining cure, detecting drug resistant TB, multiple sources of health care in the private, public and informal sectors, co-infection with human immunodeficiency virus (HIV) and a concurrent epidemic of non-communicable diseases, suboptimal prescribing practices, and infection control. We propose a local agenda for OR: modeling the effects of newer technologies, active case detection, and changes in timing of activities, and mapping hotspots and contact networks; modeling the effects of drug control, changing the balance of ambulatory and inpatient care, and adverse drug reactions; modeling the effects of integration of TB and HIV diagnosis and management, and preventive drug therapy; and modeling the effects of initiatives to improve infection control.
    Operations Research for Health Care 06/2012; 1(2-3). DOI:10.1016/j.orhc.2012.06.001
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