“Using one sputum sample, instead of two, sounds like a small thing. But when you consider the logistics and cost of collecting, transporting and testing sputum in a country like India, the change is substantial.”
In little more than four years, Dr Ajay Kumar has gone from being a participant in one of The Union’s first operational research courses to Deputy Director of the Department of Research and Center for Operational Research (COR). Although he continues to be based in his hometown of Bangalore, India, he is affiliated with The Union Southeast Asia Office in New Delhi and travels regularly to facilitate courses, mentor researchers and oversee Union research projects in the region.
Much of Kumar’s time is devoted to passing on his skill and experience in solving public health questions through operational research. He not only shares responsibility for the international courses offered by The Union, the World Health Organization and Médecins Sans Frontières through SORT-IT (the Structured Operational Research and Training Initiative), but he also conducts a variety of other short courses on quality-assured data capture and analysis for medical college faculty in India.
Kumar admits that, when he was in medical school himself, he was inclined towards research but lacked capacity. He completed his MBBS in medicine and surgery then went on to obtain an MD in Community Medicine (public health).
After a brief teaching stint, he joined the World Health Organization in India as a consultant and was assigned to the Revised National Tuberculosis Control Programme. He began as a field consultant in his home state of Karnataka, but quickly moved on to the national level in New Delhi, where he was appointed the ‘national TB-HIV consultant’.
“This was an exciting time”, he says, “because India was scaling up its TB-HIV programme to provide nationwide coverage.” Kumar was involved in developing policy and operational guidelines, as well as conducting training, supervision and monitoring of activities across the country. “One of our key goals was to make sure that the programme was implemented with the right spirit.”
This was also the time when he was introduced to The Union, where his interest in operational research was ignited by taking the three-module course developed by The Union and Médecins Sans Frontières. “Up until then, I had had some training, but I had only published one paper,” he says.
His new skill in developing a research protocol and conducting a study – as well as writing up the results for publication – dovetailed perfectly with the needs of his WHO job. “We had questions,” he says, ”but no evidence on which to base our answers.”
One question related to the WHO recommendation that all presumptive TB patients be offered HIV tests. The recommendation was based on evidence from Africa, but in India the epidemic was concentrated in specific high-risk groups – so was such widespread testing justified? Cost effective?
To find the answer, Kumar and his colleagues designed several studies that shaped and reshaped India’s decision first to offer HIV tests in specific areas – and later nationally.
In 2012, Kumar joined The Union as a technical consultant and Operational Research Fellow. In these capacities, he conducted research with important policy outcomes for India – including the national policy mandating all TB patients be offered diabetes mellitus tests and the decision to use one, rather than two, sputum samples for follow-up tests in monitoring patients with tuberculosis, including multidrug-resistant tuberculosis.
“It sounds like a small thing,” he says. “But when you consider the logistics and cost of collecting, transporting and testing sputum, the change is substantial.”
Kumar has now authored or co-authored 75 papers in peer-reviewed publications. While these results are very impressive, he is equally pleased by the achievements of the 100 or so researchers he has mentored through his OR teaching.
An assessment of the first eight OR courses found that 50% of the participants had published at least one study developed on their own after completing the course. Many are also involved as facilitators in Union courses – and for courses they organise. These provide early indications of long-term value of SORT-IT courses.
As the cadre of experienced researchers grows bigger, Kumar says the need for advanced courses has also emerged. Consequently, he and Prof Tony Harries, Director of the Department of Research, are looking at different models for how to build their capacity. “We want to raise the bar with new methods for qualitative research and systematic reviews, but we need to test them before they are implemented.”
Teaming up with WHO has raised the visibility of The Union/MSF courses, which have been offered since 2009. WHO is helping to scale up the programme with courses offered and now being implemented in new locations such as Eastern Europe, Central Asia and Latin America.
“We’re available to help, but the model is now in place and anyone can use it.” However, to be considered a SORT-IT course, it must meet the 80% targets: that is, 80% of the participants meet all milestones, and 80% publish their papers within 18 months of submission.
“Without submission for publication, the participants don’t even get a certificate,” says Kumar with a smile. But his role is to ensure both, and his success is clear. Of the people he’s worked with since he joined The Union, more than 85% have published their research, adding to The Union’s global impact on health solutions for the poor.