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Willemsen A, Wolka E, Assefa Y, Reid S. A 'training of trainers' programme for operational research: increasing capacity remotely. Glob Health Action 2024; 17:2297881. [PMID: 38224021 PMCID: PMC10791116 DOI: 10.1080/16549716.2023.2297881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Operational research (OR) is a process to improve health system capacity by evaluating interventions to improve health delivery and outcomes. The World Health Organization (WHO) Structured Operational Research Training Initiative (SORT-IT) programme promotes how OR contributes to improved health care delivery and health outcomes. A partnership project between the International Institute of Primary Health Care (IPHCE) in Ethiopia and The University of Queensland (UQ) in Australia modified the SORT-IT programme to deliver a hybrid Training of Trainers programme and improve OR capacity. OBJECTIVE This study was performed to develop and evaluate the effectiveness of Train-the Trainers approach in building capability to expand the capacity of the IPHCE to deliver the SORT-IT programme. METHODS Recruitment of participants and training were aligned with the principles of the SORT-IT programme. Training was face-to-face for the first session with subsequent training sessions delivered via Zoom over a 13-week period. Participants were required to complete all activities in line with SORT-IT deliverables. Slide decks supporting the SORT-IT training videos were developed and adapted to the Ethiopian context. RESULTS Participants had diverse experience from programme directors to research officers. All training sessions were recorded and available for participants to watch and review when required. All participants completed OR protocols to the draft stage. Course evaluation revealed participants found the content and format of the training useful, pertinent, and interesting. CONCLUSION A hybrid model (face-to-face and video platform) for OR training was implemented. Managing contextual challenges such as information technology were managed easily by programme staff. Translating course requirements at a management level proved challenging with data collection for the protocols but provided insight into potential future challenges. This OR Training of Trainers course demonstrated that sharing of skills and knowledge can occur through a hybrid delivery model and contribute to developing capacity.
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Affiliation(s)
- Angela Willemsen
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Eskinder Wolka
- National Primary Health Care, International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Simon Reid
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Kumar R, Bwembya J, Makwambeni V, Musonda V, Chimzizi R, Mwinga A. Designing an operational research TB training program in Zambia. Public Health Action 2024; 14:26-29. [PMID: 38798782 PMCID: PMC11122706 DOI: 10.5588/pha.23.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/06/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The USAID-funded Eradicate TB Project (ETB) partnered with the National Tuberculosis and Leprosy Control Program (NTLP) to establish an operational research (OR) training program in order to generate local evidence to enhance TB care in Zambia. METHOD Between 2017 and 2021, healthcare workers (HCWs) from district teams underwent two 10-day intensive training sessions. The program evolved to include a competitive application process and an additional primer workshop on developing feasible research questions. RESULTS Of the 36 enrollees in the OR training program, 26 (72.2%) completed it, leading to nine OR studies that informed interventions for TB care improvement. Notable achievements include reduced TB mortality, increased pediatric notifications, and enhanced sputum courier systems, with all studies disseminated at national and international conferences, four submitted to peer-reviewed journals, of which three were published. Two studies were replicated by the NTLP at provincial and national levels. CONCLUSIONS Integrating OR training into TB initiatives is feasible and beneficial. The program's phased execution and adaptive strategies provide valuable insights for similar settings, although challenges in sustainability of mentorship and funding persist. This success underscores the importance of continuous OR capacity strengthening among HCWs in Zambia.
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Affiliation(s)
- R Kumar
- United States Agency for International Development (USAID) Eradicate TB Project, Lusaka
- ZAMBART, Lusaka
- PATH, Lusaka
| | - J Bwembya
- United States Agency for International Development (USAID) Eradicate TB Project, Lusaka
- ZAMBART, Lusaka
- PATH, Lusaka
| | - V Makwambeni
- United States Agency for International Development (USAID) Eradicate TB Project, Lusaka
- PATH, Lusaka
| | - V Musonda
- United States Agency for International Development (USAID) Eradicate TB Project, Lusaka
- PATH, Lusaka
| | - R Chimzizi
- USAID Sustaining Technical and Analytical Resources (STAR) Project, Ministry of Health, National TB and Leprosy Control Program, Lusaka, Zambia
| | - A Mwinga
- United States Agency for International Development (USAID) Eradicate TB Project, Lusaka
- ZAMBART, Lusaka
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Kpokiri EE, McDonald K, Abraha YG, Osorio L, Nath TC, Talavera-Urdanivia VA, Akinwale OP, Manabe YC, Castelnuovo B, Tang W, Yilma D, Mihut M, Ezechi O, Iwelunmor J, Kaba M, Abdissa A, Tucker JD. Health research mentorship in low-income and middle-income countries: a global qualitative evidence synthesis of data from a crowdsourcing open call and scoping review. BMJ Glob Health 2024; 9:e011166. [PMID: 38184299 PMCID: PMC10773352 DOI: 10.1136/bmjgh-2022-011166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Research mentorship is critical for advancing science, but there are few practical strategies for cultivating mentorship in health research resource-limited settings. WHO/TDR Global commissioned a group to develop a practical guide on research mentorship. This global qualitative evidence synthesis included data from a crowdsourcing open call and scoping review to identify and propose strategies to enhance research mentorship in low/middle-income country (LMIC) institutions. METHODS The crowdsourcing open call used methods recommended by WHO/TDR and solicited descriptions of strategies to enhance research mentorship in LMICs. The scoping review used the Cochrane Handbook and predefined the approach in a protocol. We extracted studies focused on enhancing health research mentorship in LMICs. Textual data describing research mentorship strategies from the open call and studies from the scoping review were coded into themes. The quality of evidence supporting themes was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach. RESULTS The open call solicited 46 practical strategies and the scoping review identified 77 studies. We identified the following strategies to enhance research mentorship: recognising mentorship as an institutional responsibility that should be provided and expected from all team members (8 strategies, 15 studies; moderate confidence); leveraging existing research and training resources to enhance research mentorship (15 strategies, 49 studies; moderate confidence); digital tools to match mentors and mentees and sustain mentorship relations over time (14 strategies, 11 studies; low confidence); nurturing a culture of generosity so that people who receive mentorship then become mentors to others (7 strategies, 7 studies; low confidence); peer mentorship defined as informal and formal support from one researcher to another who is at a similar career stage (16 strategies, 12 studies; low confidence). INTERPRETATION Research mentorship is a collective institutional responsibility, and it can be strengthened in resource-limited institutions by leveraging already existing resources. The evidence from the crowdsourcing open call and scoping review informed a WHO/TDR practical guide. There is a need for more formal research mentorship programmes in LMIC institutions.
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Affiliation(s)
- Eneyi E Kpokiri
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Kamryn McDonald
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Lyda Osorio
- School of Public Health, Universidad del Valle, Cali, Colombia
| | - Tilak Chandra Nath
- Department of Parasitology, Chungbuk National University, Cheongju, Korea (the Republic of)
- Department of Parasitology, Sylhet Agricultural University, Sylhet, Bangladesh
| | | | | | - Yukari Carol Manabe
- Johns Hopkins Medicine, Baltimore, Maryland, USA
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
| | - Weiming Tang
- School of Public Health, Southern Medical University, Guangzhou, China
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Michael Mihut
- TDR, The Special Programme for Research and Training in Tropical Diseases co-sponsored by UNICEF, UNDP, the World Bank and WHO, WHO, Geneva, Switzerland
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Alemseged Abdissa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia, Addis Ababa, Ethiopia
| | - Joseph D Tucker
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Xiang B, Peterson CE, Dykens JA. Assessment of Institutional Implementation Research Capacity of the National Institutes of Health D43 Network. Am J Trop Med Hyg 2023; 109:975-978. [PMID: 37669760 PMCID: PMC10551085 DOI: 10.4269/ajtmh.23-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2023] [Indexed: 09/07/2023] Open
Abstract
Implementation science enhances the efficient practice of solutions from research to real-world application. Low- and lower- to middle-income countries may benefit significantly from implementation research given their limited resources. The National Institutes of Health Fogarty International Center D43 network consists of partnerships between foreign and U.S.-based institutions and aims to strengthen global health research. This paper assesses the D43 network's implementation research focus and training capacity. A survey was distributed to 387 program directors of ongoing and completed D43 projects. Preliminary results show 51.7% of respondents describe "increasing implementation research capacity" as a "high priority." Only 24.8% of faculty in implementation science received formal training, and 60.3% of D43 programs lacked an implementation research training program. Results show there is an increasing need for implementation research but that more can be done to develop implementation research capacity and training. The low response rate of 18% is a limitation of this study.
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Affiliation(s)
- Bingtao Xiang
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Caryn E. Peterson
- Division of Epidemiology and Biostatistics, University of Illinois Cancer Center School of Public Health, University of Illinois at Chicago, Chicago, Illinois
- Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Cancer Center, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - J. Andrew Dykens
- Department of Family and Community Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Cancer Center, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Kaba M, Birhanu Z, Fernandez Villalobos NV, Osorio L, Echavarria MI, Berhe DF, Tucker JD, Abdissa A, Abraha YG. Health research mentorship in low- and middle-income countries: a scoping review. JBI Evid Synth 2023; 21:1912-1970. [PMID: 37461876 DOI: 10.11124/jbies-22-00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The objective of this scoping review was to explore and synthesize the available literature on health research mentorship in low- and middle-income countries (LMICs). INTRODUCTION Research mentorship is broadly considered a useful strategy to improve research capacities and research outputs. Existing literature and guidance on research mentorship have focused on high-income countries and assumed resource-rich environments. Despite the successful endeavors to improve health research capacity in LMICs, the strategies that work best under different circumstances are poorly understood. There is a need to map and understand the evidence on health research mentorship in the context of LMICs. INCLUSION CRITERIA Sources that reported existing practices, barriers, and mitigation strategies related to health research mentorship in LMICs were included. METHODS We searched for published and unpublished studies and reports written in English, Spanish, or Portuguese. The search strategy was not limited by search dates and the last search was conducted on January 28, 2022. The databases searched included MEDLINE (PubMed), Embase, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis . We also searched for gray literature in a selection of websites and digital repositories. The JBI scoping review methodology was used. RESULTS A total of 77 studies and reports were included in the review. The majority of the papers were from Africa (n=28). Others were from the Americas (n=7), South East Asia (n=4), East Mediterranean (n=2), and Western Pacific (n=2). The remaining studies were from LMICs that included at least 2 regional offices. Most of the mentorship projects (n=55) were initiated and funded by institutions from high-income countries. The first authors of 41 papers were primarily affiliated with LMICs. The findings were categorized under a description of research mentorship practices, barriers related to research mentorship, and suggested mitigation strategies. Deliverable-driven training using intensive hands-on mentorship and ongoing peer mentorship programs were some of the non-regular, non-institutionalized approaches used to improve research capacity for junior researchers in LMICs. None of the included papers focused on institutional components of research mentorship in LMICs. The barriers to research mentorship activities in LMICs included lack of clarity on mentorship, cultural variations, unbalanced power dynamics, socio-political influences, language barriers, lack of experienced mentors, and limited local funding. Institutionalizing research mentorship, adapting mentoring methodologies relying on local resources, and addressing and respecting diversity in mentorship programs were among the main strategies identified to effectively implement research mentorship in LMICs. CONCLUSIONS Research mentorship initiatives and practices are limited in LMICs. Few available practices have been introduced by researchers and research institutions from high-income countries and those that have are not yet institutionalized. The identified existing practices, barriers, and facilitators on health research mentorship could help the design, implementation, and evaluation of programs to institutionalize health research mentorship in LMICs. REVIEW REGISTRATION Open Science Framework osf.io/jqa9z/. SUPPLEMENTAL DIGITAL CONTENT A Spanish-language version of the abstract of this review is available as supplemental digital content: http://links.lww.com/SRX/A32.
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Affiliation(s)
- Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Public Health Faculty, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence Based Healthcare and Development Centre: a JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | | | | | - Maria Isabel Echavarria
- Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Derbew Fikadu Berhe
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Joseph D Tucker
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Yoseph Gebreyohannes Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Group for Health: a JBI Affiliated Group, The Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Delamou A, Tripathi V, Camara BS, Sidibe S, Grovogui FM, Kolie D, Bouedouno P, Kourouma K, Banze DF, Mafu MM. Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017-2021. Int J Gynaecol Obstet 2023; 160:459-467. [PMID: 35900176 PMCID: PMC10087752 DOI: 10.1002/ijgo.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To implement a Flexible Operational Research Training (FORT) course within the Fistula Care Plus Project, Democratic Republic of Congo, from 2017 to 2021. METHODS A descriptive study using design and implementation (process and outcome) data. Two to four members of medical teams from three supported sites were selected for the training based on their research interests and level of involvement in the program. RESULTS Two courses (13-14 months each) involving nine facilitators and 17 participants overall were conducted between 2017 and 2021. Most participants in both courses were medical doctors (67% and 71%, respectively) from the supported hospitals (83% and 77%, respectively). About half were women. In addition to classic face-to-face didactic modules, the courses integrated online platforms to cope with the changing contexts (Ebola virus and COVID-19). Most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences. Participants subsequently published five papers from their research after the first course. The total direct costs for both courses were representing a cost of $3669 per participant trained. CONCLUSION The FORT model proved feasible, efficient, and successful. However, scaling up will require more adaptation efforts from programs and participating sites.
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Affiliation(s)
- Alexandre Delamou
- Africa Center of Excellence (CEA-PCMT), Faculty of Health Sciences and Techniques, University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | | | - Bienvenu Salim Camara
- Africa Center of Excellence (CEA-PCMT), Faculty of Health Sciences and Techniques, University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | - Sidikiba Sidibe
- Africa Center of Excellence (CEA-PCMT), Faculty of Health Sciences and Techniques, University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | - Fassou Mathias Grovogui
- Africa Center of Excellence (CEA-PCMT), Faculty of Health Sciences and Techniques, University Gamal Abdel Nasser, Conakry, Guinea
| | - Delphin Kolie
- Africa Center of Excellence (CEA-PCMT), Faculty of Health Sciences and Techniques, University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | - Patrice Bouedouno
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | - Karifa Kourouma
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, Forecariah, Guinea
| | | | - Michel M Mafu
- Engenderhealth, Kinshasa, Democratic Republic of Congo
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Richmond R, LeeVan E, Dodgion C, Chin TL, Mengesha MG, Jember D, Gari T, Gebrehana E, Alseidi A, Bell N, Long K, Gadisa A, Tefera G, Schroeder ME. Coaching for impact: successful implementation of a multi-national, multi-institutional synchronous research course in Ethiopia. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:20. [PMID: 38013716 PMCID: PMC9122240 DOI: 10.1007/s44186-022-00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Purpose Under the American College of Surgeons' Operation Giving Back, several US institutions collaborated with a teaching and regional referral hospital in Ethiopia to develop a surgical research curriculum. Methods A virtual, interactive, introductory research course which utilized a web-based classroom platform and live educational sessions via an online teleconferencing application was implemented. Surgical and public health faculty from the US and Ethiopia taught webinars and led breakout coaching sessions to facilitate participants' project development. Both a pre-course needs assessment survey and a post-course participation survey were used to examine the impact of the course. Results Twenty participants were invited to participate in the course. Despite the majority of participants having connection issues (88%), 11 participants completed the course with an 83% average attendance rate. Ten participants successfully developed structured research proposals based on their local clinical needs. Conclusion This novel multi-institutional and multi-national research course design was successfully implemented and could serve as a template for greater development of research capacity building in the low- and middle-income country (LMIC) setting.
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Affiliation(s)
- Robyn Richmond
- Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, MS #8312, Lubbock, TX 79430 USA
| | - Elyse LeeVan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Chris Dodgion
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - Theresa L. Chin
- Department of Surgery, University of California Irvine, Orange, CA USA
| | - Mengistu G. Mengesha
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Dawit Jember
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Taye Gari
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Ephrem Gebrehana
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Natalie Bell
- American College of Surgeons, Operation Giving Back, Chicago, IL USA
| | - Kristin Long
- School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
| | - Anteneh Gadisa
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Girma Tefera
- School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
| | - Mary E. Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI USA
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Kumar AM, Harries AD, Satyanarayana S, Thekkur P, Shewade HD, Zachariah R. What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB? Indian J Tuberc 2020; 67:S23-S32. [PMID: 33308668 DOI: 10.1016/j.ijtb.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.
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Affiliation(s)
- Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India; Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, India.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, UK
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Geneva, Switzerland
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