Operational Research

Operational research helps low- and middle-income countries identify local solutions to local problems that lead to changes in policy and practice.

 

Centre for Operational Research (COR)

Many low- and middle-income countries, particularly in Africa, are overburdened with serious communicable disease epidemics, and there are growing epidemics of non-communicable diseases, particularly in Asia. Their capacity to prevent, control and treat these diseases is hampered by weak health information systems and lack of experienced personnel to provide the information needed to improve both policy and practice.

The Centre for Operational Research (COR) was established to enhance the operational research (OR) capacity of these countries in the field of HIV/AIDS and tuberculosis, as well as key non-communicable diseases, such as asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus and hypertension. Read more.

The initial funding to establish the Centre for Operational Research (COR) was from Bloomberg Philanthropies from 2009 – 2014. In 2011, the Centre for Operational Research began to receive additional funding from the UK Government through the Department For International Development (DFID). From 2015 onwards, DFID has been the sole funding institution.

SORT IT and The Union/MSF Operational Research Courses

In collaboration with Médecins Sans Frontières (MSF), The Union developed a unique course in operational research that has had outstanding results.

First offered in 2009, this course is held in three modules over a nine-month to 12-month period. Each module requires participants to complete specific tasks in order to go forward to the next and to satisfactorily complete the course. By the end of the course, the participant will have designed a protocol, carried out the research, analysed the results, written up a scientific paper and submitted the paper to a peer-reviewed journal for publication.

Since July 2012, The Union and MSF have been collaborating with the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO-TDR), and all of the OR courses have subsequently been rebranded as SORT IT (Structured Operational Research and Training Initiative) programmes.

The success of this approach is borne out by the results of the 34 courses that have been completed. These were attended by 390 participants, of whom 354 (91 percent) completed all milestones. A total of 402 papers have been submitted to peer-review journals, of which 308 (77 percent) were in press or published by 31 December 2016. An additional four courses are ongoing. In 2016, as in 2015, the programme received an A+ rating in an evaluation by the funder, the UK government’s Department For International Development (DFID).

Other important aspects of the course are that: i) participants are selected and invited to serve as facilitators for subsequent courses, thereby gaining skills as trainers themselves; and ii) all successful participants are contacted 18 months after the course has finished to determine whether their research has had any effect on changing policy and practice and whether they or their institutions have continued to conduct and publish operational research. The preliminary results of these 18-month follow up contacts are very encouraging.

This course is now available on video. Find out more here.

In 2015, COR developed short courses in Efficient, Quality-assured Data Capture using EpiData, Efficient, Quality-assured Data Analysis using EpiData and Literature Search using PubMed and Managing References using Mendeley. Currently , COR runs multiple short courses in India and Myanmar and Zimbabwe.

OR fellows programme

The OR fellowship programme provides training and mentorship to selected public health professionals who want to build a career in operational research. There are a total of 23 OR fellows globally (11 with The Union, 10 with MSF and two fellows based in the Department of Medical Research in Myanmar and mentored by The Union; Within the Union, many of these fellows are embedded within Ministries of Health, either on a full-time or part-time basis). Funding for these OR Fellows come from the UK Department for International Development (DFID) and WHO-TDR.

The fellows have been very productive: by 31 December 2016, they were authors 1,237 times in research projects, 1,012 times in papers submitted to peer-reviewed journals; and 794 times in papers either published or in press. They have served as facilitators at 317 operational research courses, reviewed 232 scientific papers for peer-reviewed journals, given 388 presentations at national/international conferences and received 20 aliquots of funding for research

Observational study of a nine-month MDR-TB treatment regimen in Africa

The Union used an operational research approach to test a shortened 9-month treatment regimen for multidrug-resistant TB, which had demonstrated a greater than 80% success rate in Bangladesh, Cameroon and Niger. 

The objectives were to evaluate the effectiveness and the tolerance of the treatment delivered under programme conditions. After having standard clinical and laboratory examinations, the patients received treatment under strict daily observation. Their clinical and bacteriological responses to the treatment were followed-up monthly until their treatment was completed and thereafter for two years. The study protocol is accessible here (PDF 790KB).

The study was implemented in nine countries in francophone Africa: Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Côte d’Ivoire, Democratic Republic of Congo, Niger and Rwanda. It began in January 2013 after it received approval from the World Health Organization (WHO) and clearance from the ethics committees of The Union and each participating country. The study concluded in 2016 and the results were presented at the 2016 Union World Conference in Liverpool.

The final results of this research showed treatment successful for 821 of the 1,006 patients who took part, with 734 cured. The regimen demonstrated similar success rates in HIV-infected patients

This study was funded by Expertise-France/5% Initiative.

Investigated Transmission of Childhood Tuberculosis (TITI) study

The Union’s observational study in Francophone Africa (TITI for its initials in French) is taking place in Benin, Burkina Faso, Cameroon and the Central African Republic with funding from Initiative 5%/Expertise-France.

It aims to enrol nearly 2000 children under five years of age into research to conduct a systematic investigation in the homes of TB patients, to identify children at risk of contracting the disease and place them on preventive treatment.

The study began in February 2016, in its first six months 730 children were identified, 670 were put on preventive treatment and 24 were diagnosed with active TB and received medication.