Capacity Building in Operational Research in low and middle-

income countriesAnthony Harries

International Union against TB and Lung DiseaseParis, France

[London School of Hygiene & Tropical Medicine]

Previous training models

• Class of 15 – 20 people• One week course on methods and data• Participants return to countries• But…very few publish• Why?? – reasons unclear – perhaps no

financial support, no writing skills for publishing articles, no mentorship, no time

Japan RIT Course: 2001 - 2007

• 28 participants developed ORP

• 11 started OR when home

• 7 collected and analysed data

• 1 wrote a paper

• 0 published a paperOhkado et al, IJTLD 2010, 14: 371-3

Union / MSF proposal for a new type of course

Purpose: To teach the practical skills forconducting and publishing operational research

Approach: • Product –oriented [a submitted research paper]• Modular approach [3 modules over 10 months]• Participants go through whole research process• Milestones must be achieved to stay in course• Trained participants should become facilitators

Three modules – over 10 months

• Module 1: research questions, protocol development and ethics (5 days)

• Module 2: Data management and data analysis (5 days)

• Module 3: Paper writing, peer review and policy implications (5 days)

Routine data collected in public health systems or by NGOs

Data used for operational research

Target Audience

• Applicants should be implementers (doctors, nurses, paramedical officers, data analysts, M&E officers)

• No more than 12 participants in total per course. Funded through Union-MSF

To be a successful applicant:• Defined criteria:-

– Engaged in programme work and will return to this work– Supervisors endorsement -time and opportunity for research– Competent in English and computer literate– Have done MPH or equivalent or come strongly recommended– There is a stated and acceptable mentor at country level– Funding for the research can be acquired through other sources

• Application:-– Submit curriculum vitae plus two references– Complete application form with1/2 page written on programme

problem and research question

Applications to recent Courses: 2012-2013

• 2012 Paris course: 109

• 2012 Luxembourg course: 50

• 2013 Asian course: 123

• 2013 African course: 100

Teaching format

• Lectures followed by discussions

• Group work “on the job training” in developing protocols and writing papers with mentors

• Plenary sessions

Milestones for the course

• Milestone 1: Submission of protocol and Union EAG form within two weeks of completing Module 1

• Milestone 2: Submission of EpiData documentation sheet within two weeks of completing Module 2

• Milestone 3: Submission of proof of study completion and data collection about 6 weeks before Module 3

• Milestone 4: Submission of paper to peer-reviewed journal within 4 weeks of end of Module 3

Does the Model work?

First Paris Course: 2009-2010

Aug 2009: 12 participants from Africa and Asia developed research protocol

April 2010: 11 participants submitted 14 papers to international journals

March 2012: 13 papers accepted for publication

Second Course: 2010 - 2011

3 participants from first OR Course facilitated on second OR Course

Research Training Courses and participants: 2009 - 2013

Research Course No. of courses Participants enrolled

Paris Union-MSF 4 47

Luxembourg MSF-Union 2 24

Hyderabad Union-PHFI 1 10

South Pacific-Union 2 24

Nepal-Regional Asian 2 24

Kenya-Regional African 2 24

TOTAL 13 153

Where do the participants come from?

Region Different country representation

Africa 22

Asia 15

Latin America 2

South Pacific 8

Europe 3

TOTAL 50

Research Projects undertaken in 13 courses

Research Project Subject Number

Tuberculosis / HIV / Diabetes / 87

HIV/AIDS 23

Maternal and Child Health 10

Malaria 3

Malnutrition 4

Other [smoking, NCD, Cancer, NTDs] 32

TOTAL 159

Outputs from eight completed OR courses

Participants starting the course 93

Participants finishing the course with all milestones completed

83 (89%)

Scientific papers submitted to peer-reviewed journals

92

Papers published or in press by 2013 69 (75%)

Preferences for publication:

Open Access Journals:

• PLOS One; PLOS Medicine

• BMC Public Health; BMC Medicine; BMC Health Services; BMC Infectious Diseases

• Public Health Action (PHA)

Why an emphasis on papers

• Quality control standard

• International Guidelines evidence based

• Critical way to disseminate knowledge

• Paper writing makes authors “experts”

• Credibility

Ancient Roman Proverb

“Scripta manent, verba volant”“Spoken words fly away Written words remain”

“If you do not write about it, it did not happen”Virginia Woolf

BUT……• Importantly we go beyond Papers to

influence policy and practice

Use of pharmacy records for determining retention on ART in

South Africa and Malawi 100 years of smoking and population-attributable

deaths in India

Using Telemedicine to reduce childhood deaths in

Somalia

Screening Tuberculosis patients for diabetes mellitus

in India

Reducing maternal mortality through emergency obstetric

services in BurundiCaring for victims of

sexual violence in Liberia and Kenya

Operational Research Alumni Network

Web-based organizationAnnual email follow-up

Track how alumni are doingAlumni to assist with facilitation / mentoring

Alumni to assist with OR paper reviewsAlumni to become Professors of OR!

Bissell K et al. Operational research training: the course and beyond. Public Health Action 2012; 2: 92-97

Structured Operational Research and Training IniTiative

Collaboration between WHO/TDR, Union, MSF, others…..

Vision is to build adequate and sustainable national OR capacity to support public health programmes

S RT ITS RT ITImproving health systems through research