The Union and Médecins Sans Frontières approach to operational research.

Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world

The Complexity of Non-profit Administration in Global Development: A Case-Study on Neonatal Mortality

In 2015, 5.9 million children died with 44% of those deaths occurring in the most vulnerable period of life: the neonatal period (first 28 days of life). Because this is such a pervasive problem, in order to meet the United Nation’s third Sustainable Development Goal of reducing the global neonatal mortality rate down from 27 to 12 deaths per 1,000 live births, there needs to be more evidence-based, effective interventions. Thrive Networks addresses newborn mortality by improving facility-based care in low-resource settings via intensive training and lifesaving medical equipment built to operate in these conditions. Despite all of the evidence Thrive has depicting the success of their programs, they have decided to close down the Health Program due to a litany of moving parts ultimately forcing their hand to refocus and re-strategize their resources away from providing newborn interventions. Since this circumstance does not occur in a vacuum, it is important to understand why nonprofits like Thrive struggle to sustain their programs when they have potential to address the world’s direst problems. A systematic review of academic literature attempts to find qualitative and quantitative measurements to understand nonprofit program closure and continuation. Thrive operates as a case-study in how these measurements can make sense of the closure of its Health Program

Scaling Success: Lessons from Adaptation Pilots in the Rainfed Regions of India

"Scaling Success" examines how agricultural communities are adapting to the challenges posed by climate change through the lens of India's rainfed agriculture regions. Rainfed agriculture currently occupies 58 percent of India's cultivated land and accounts for up to 40 percent of its total food production. However, these regions face potential production losses of more than $200 billion USD in rice, wheat, and maize by 2050 due to the effects of climate change. Unless action is taken soon at a large scale, farmers will see sharp decreases in revenue and yields.Rainfed regions across the globe have been an important focus for the first generation of adaptation projects, but to date, few have achieved a scale that can be truly transformational. Drawing on lessons learnt from 21 case studies of rainfed agriculture interventions, the report provides guidance on how to design, fund and support adaptation projects that can achieve scale

A cost and technical efficiency analysis of two alternative models for implementing the basic package of health services in Afghanistan.

Since 2003, the Afghan Ministry of Public Health (MoPH) and international partners have directed a contracting-out model through which non-governmental organisations (NGOs) deliver the Basic Package of Health Services (BPHS) in 31 of the 34 Afghan provinces. The MoPH also managed health service delivery in three provinces under an alternative initiative entitled Strengthening Mechanisms (SM). In 2011, under the authority of the MoPH and Delegation of the European Union to Afghanistan, EPOS Health Management conducted a cost and technical efficiency study of the contracting-out and SM mechanisms in six provinces to examine economic trade-offs in the provision of the BPHS. The study provides analyses of all resource inputs and primary outputs of the BPHS in the six provinces during 2008 and 2009. The authors examined technical efficiency using Data Envelopment Analysis (DEA) at the BPHS facility level. Cost analysis results indicate that the weighted average cost per BPHS outpatient visit totalled $3.41 in the SM provinces and$5.39 in the NGO-led provinces in 2009. Furthermore, the data envelopment analyses (DEAs) indicate that facilities in the three NGO-led provinces scored 0.168 points higher on the DEA scale (0-1) than SM facilities. The authors conclude that an approximate 60% increase in costs yielded a 16.8% increase in technical efficiency in the delivery of the BPHS during 2009 in the six provinces

Lessons Learned in Conducting Mass Drug Administration for Schistosomiasis Control and Measuring Coverage in an Operational Research Setting

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease (NTD) control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other NTDs, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts

Preventing and responding to gender-based violence in middle and low-income countries : a global review and analysis

Worldwide, patterns of violence against women differ markedly from violence against men. For example, women are more likely than men to be sexually assaulted or killed by someone they know. The United Nations has defined violence against women as"gender-based"violence, to acknowledge that such violence is rooted in gender inequality and is often tolerated and condoned by laws, institutions, and community norms. Violence against women is not only a profound violation of human rights, but also a costly impediment to a country's national development. While gender-based violence occurs in many forms throughout the life cycle, this review focuses on two of the most common types-physical intimate partner violence and sexual violence by any perpetrator. Unfortunately, the knowledge base about effective initiatives to prevent and respond to gender-based violence is relatively limited. Few approaches have been rigorously evaluated, even in high-income countries. And such evaluations involve numerous methodological challenges. Nonetheless, the authors review what is known about more and less effective-or at least promising-approaches to prevent and respond to gender-based violence. They present definitions, recent statistics, health consequences, costs, and risk factors of gender-based violence. The authors analyze good practice initiatives in the justice, health, and education sectors, as well as multisectoral approaches. For each of these sectors, they examine initiatives that have addressed laws and policies, institutional reforms, community mobilization, and individual behavior change strategies. Finally, the authors identify priorities for future research and action, including funding research on the health and socioeconomic costs of violence against women, encouraging science-based program evaluations, disseminating evaluation results across countries, promoting investment in effective prevention and treatment initiatives, and encouraging public-private partnerships.

An examination of the ability of community health workers to effectively conduct community-based screening for cardiovascular disease in South Africa, Guatemala, and Mexico

BACKGROUND: This study explored training effectiveness for community health workers (CHWs) in a successful intervention in which they conducted primary screening for cardiovascular disease (CVD) in low resource settings. Implementation challenges related to scaling were explored with key informants. METHODS: A multiple methods assessment was conducted to: (1) quantitatively assess training effectiveness; (2) qualitatively capture the CHWs’ experience of training; (3) gather feedback from key stakeholders about factors anticipated to impact scaling the intervention to the population level. Change in knowledge levels at three different time points was determined through comparison of group means (ANOVA). The Consolidated Framework for Implementation Research (CFIR) guided the qualitative data collection and analyses, using nVIVO® and Atlas.ti® software, combined with manual coding. RESULTS: Training was effective at increasing content knowledge of CVD and the effect persisted for 3-6 months after completion of field work. CHWs felt empowered by the training and the acquisition of new skills but some expressed their reservations about written tests being used to accurately capture their capabilities. Some supervisors (nurses) perceived CHW training as a threat to their own professional standing while also acknowledging the value CHWs added to health services through their expert community knowledge and connections. CHWs remained frustrated by inadequate and irregular compensation, disrespect from formally trained health professionals, lack of career development pathways, and failure to account for the influence environmental factors – safety, extreme weather, and infrastructure – in workload planning. Key informants raised additional concerns about the negative impact of ineffective government communication regarding CHW programs and policies to communities and key actors in the health care system, including failure to consult key stakeholders, lack of clear role definitions, setting standards for training and performance evaluation, and lack of supervisory mechanisms. The issue of financing for CHW programs was not raised by key informants. CONCLUSIONS: Scaling strategies for successful interventions using CHWs need to be guided by well-designed implementation plans that include proactive, multi-level engagement with communities and health systems, and appropriate evaluation measures tied to health outcomes. Training effectiveness should be evaluated and linked to well-defined outcome measures in CHW’s programs that involve task-shifting