1. February 03, 2011 Daniel G. Datiko
How to integrate operational and implementation research into a National Tuberculosis Programme?
February 03, 2011
Daniel G. Datiko 1

2. Outline of presentation
Background and definition
What is expected of operational research
What is the current status
Why is such research possible to do in
some settings?
How can we do it?
Conclusions

3. Background Variation in the use of terminologies Mismatch:
Size of health problem and resource constraints
Recognition of the problem
Increased interest to fill these gaps
Increased awareness of research needs
Variation in the use of terminologies

4. Defining research to improve health systems, PLoSMed 7(11):e1001000

5. Definition: Operational research
Pragmatic:
search for knowledge on interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programmes in research area.
Aim:
find solutions for problems
Origin:
demand driven
identified during routine monitoring and evaluation
Operational research in low-income countries: what, why, and how? Lancet Infect Dis 2009; 9: 711–17

6. Definition: Implementation research
A research that focuses on how to promote the uptake and successful implementation of evidence-based interventions and policies
Aim
Identify implementation problems and find solution
Identify ways of introducing into the health system
Characteristics
Involves the systematic and critical investigation and analysis of the dynamic, contextual processes that influence how individuals, populations and health systems change to adopt new interventions.
Operational research in low-income countries: what, why, and how? Lancet Infect Dis 2009; 9: 711–17

7. The Global Fund definition
Operational research
Any research producing practically-usable
knowledge which can improve program
implementation regardless of the type
of research falls within the boundaries
of operations research.
Framework for Operations and Implementation Research in Health and Disease Control Programs

8. The scope of operational research
Defining research to improve health systems, PLoSMed 7(11):e

9. What is expected of operational research?
Using TB as an example
For example, it is important to
Improve access to TB Diagnosis and treatment
Adapt DOTS strategy to
Improve programme performance
Evaluate: feasibility, effectiveness or impact of new strategies or interventions
Provide evidence and change policy

10. What is the current status?
In the past, it shaped modern TB control
It is not much used in developing countries
From Africa contributed only 7% of research on tuberculosis
However, the number of reports increased from 49 in 2006 to 89 in 2008
The impact on TB may be questioned
Generally, it remains underutilized!
Operational research for improved TB control: the scope, the needs and the way forward, INT J TUBERC LUNG DIS 15(1):6-13
A bibliometric analysis of tuberculosis research indexed in PubMed, 1997–2006, INT J TUBERC LUNG DIS 12(12):1461–1468

11. Why was it not done? Failure to recognize its significance
Inadequate and high turnover of staffs
Lack of research capacity
Inadequate funding or use of funds
Little support from decision makers
Lacks coordinating mechanisms
NTPs not included = not implemented
It is not part of NTPs

12. How can it be done? Increasing opportunities
More staffs
Increasing funding
Understanding the significance of research
Increasing operational challenges
Experiences from different settings

13. Why was it possible in Malawi?
They did operational research for many years
Identify research priorities and objectives
A Central Unit for coordinated research activities
They had budget for research
Developed capacity building programs
Scientific reviews and dissemination + booklets
Example of operational research

14. Assessing the diagnostic process of patients labeled as TB suspects who had been admitted to general hospital wards
25 TB officers trained
19 TB officers collected satisfactory data
11 TB officers submitted research paper
5 TB officers presented reseach paper and data used for collating the results
Developing operational research capacity in hospital tuberculosis control officers in Malawi,
INT J TUBERC LUNG DIS 2003,7(3):

15. Recognition by the NTPs

16. How was it done in China? High burden of tuberculosis
They identified operational problems
They set research priorities
Epidemical survey
Socio-economic study on TB patients
Conducted researches and audited reports
They translated research findings into actions

17. Epidemiological survey
Application of the results
Main results
Prevalence of TB = 367 per 105
Estimated no of TB = 4.51 million
The annual prevalence reduction
3.8% from
3.2% from
Informed the central government
Budget by central government
$5 million in 2001
$76 million in 2009
Harmonization of resources

18. Socio-economic study on TB patients
Results
Application…
Among 1278 TB patients
80% earn below the average income
92% did not have medical insurance
Financial problem result in
Escape consultation
Poor treatment adherence
Government fund
Increased to support
Diagnosis
x-ray films
AFB
Treatment

19. Taken from Cancun presentation by Jing Shiwen

20. Experiences from Ethiopia
There is limitted interest in research
Among managers of TB programme
some research done by academicians
Currently increasing interest because of
Increasing health interventions
Community based initiatives

21. Experiences from Ethiopia...
We reviewed programme performance
Involved HEWs in case finding and treatment
Demonstrated its cost-effectiveness
Important questions
How was the message carried across?
Who should be involved?

22. Experiences from Ethiopia...
How should it be communicated?
Involved the Ministry of Health
Reported our finding at review meetings
Build common understanding
Supervised by Ministry of Health and WHO
Endorsed suspect form, specimen referral and treatment

23. Research: Suspect referral sheet
Ministry of Health:
Suspect referral format
Research: Suspect referral sheet

24. Experiences from Ethiopia...
Who should we involve?
Understand the context
National
Part of NTP
Understands operational challenges
Good connection with the health system

25. The continuum…. Now with full support from NTPs
Started implementation at larger scale
Completed baseline activities
Decentralized smear preparation

26. Filling referral form
Labelling …
Smearing …
Fixing smears….

27. Slide referral….
Examination ….

28. How can we do it? Planning for operational research
NTP outline their challenges
Resources: time, offices, training,…
Improve fund allocation and utilization
Research capacity building
Provide sustained mentorship
Develop trained researcher
Build institutional capacity
Establish functional partnership
Managers, decision makers, partners
Coordinating mechanism and shared responsibility
Ways of communicating the research findings

29. The Union’s operational research support package.

30. Conclusion Evidence based decision making
Low research productivity: < 7%
Contrasts with the morbidity and mortality
Still it is possible….irrespective of limits
OR and implementation might not happen
at once, it is a continuous process!!!

31. NO RESEARCH NO HEALTH
‘ It seems astonishing that in the 21st century decisions on health care can still be made without a solid grounding in research evidence’ 2012 WHR REPORT THEME
January 25, 2011 , A Call for Papers. PLoS Med 8(1): e doi: /journal.pmed

32. Thank you!