Frenk

Graham

Harries

Mckee

Ohkado

Walley

Whitworth

Zachariah

Zumla

English

Zachariah, R.

Reid, T.

Ford, N.

Van den Bergh, R.

Dahmane, A.

Khogali, M.

Delaunois, P.

Harries, A. D.

Tropmed Central Antwerp

The 2012 world health report 'no health without research': the endpoint needs to go beyond publication outputs [editorial]

Zachariah, Rony

Reid, Tony

Ford, Nathan

Van den Bergh, Rafael

Dahmane, Amine

Khogali, Mohammed

Delaunois, Paul

Harries, Anthony D

MSF Field Research

Editorial
The 2012 world health report ‘no health without research’: the
endpoint needs to go beyond publication outputs
Rony Zachariah
1, Tony Reid
1, Nathan Ford
2, Rafael Van den Bergh
1,3,4, Amine Dahmane
1, Mohammed Khogali
5,
Paul Delaunois
6 and Anthony D. Harries
7,8
1 Operational Research Unit, Medical Department, Operational Centre Brussels, Medecins sans Frontieres, MSF- Luxembourg,
Luxembourg, Germany
2 Medecins sans Frontieres, Geneva, Switzerland
3 Department of Molecular and Cellular Interactions, Flemish Institute of Biotechnology, Brussels, Belgium
4 Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
5 Medecins Sans Frontieres, Addis Ababa, Ethiopia
6 Operational Centre Brussels, Medecins sans Frontieres- Luxembourg (Direction General), Luxembourg, Germany
7 International Union against Tuberculosis and Lung Disease, Centre for Operational Research, Paris, France
8 London School of Hygiene and Tropical Medicine, London, UK
keywords operational research, health, capacity, outputs
The theme of the 2012 World Health Report is ‘no health
without research’ and is a call to action for ﬁlling the global
gaps in health research (Mckee et al. 2012). Bridging the
difference between the ‘haves’ and ‘have-nots’ is vital if we
are to live up to the call of this theme and use research to
make improvements on the ground. Absolute numbers of
scientiﬁc papers and papers per capita have been used as
the principal indicators to assess global research capacity
and identify gap areas (Mckee et al. 2012).
At the country level, we feel this only reﬂects one side of
the coin. Although the lack of national health research
strategies precludes optimal allocation of resources, an
equally important reality on the ground is the inadequate
translation of research outputs to policy and practice
(Walley et al. 2007; Frenk & Chen 2011; Mckee et al.
2012) – the other side of the coin. Thus, although it is vital
to try to boost research and publications in countries where
there are shortfalls (Zachariah et al. 2010), there is also
an imperative to move beyond the publishing milestone
to translate the evidence into policy and practice.
Over the decades, billions of dollars have been invested
in research, and much knowledge has been generated, but
the gap between that knowledge and what we do with it -
the so-called ‘know-do’ gap – is huge (WHO 2005;
Graham & Tetroe 2009). Operational research(Zachariah
et al. 2009) has a key role in bridging this implementation
gap and ensuring that scarce resources invested in research
produce results that can go beyond pure academic goals
and can be applied for strengthening health services and
beneﬁting communities. This is the core determinant of
practically building a dynamic and effective relationship
that will marry the two key aspects of the theme of the
2012 World Health Report ‘research’ and ‘health’.
We therefore advocate that brightening the other side of
the coin should include capacity building in operational
research as a means to (a) help bridge existing publication
gaps; (b) strengthen national-level health research and (c)
translate generated evidence into policy and practice.
Whitworth et al. (2008) highlighted the need to encourage
and build research by staff within national health services
and local universities particularly in Africa. They called
for improving the research environment, supporting and
retaining promising individuals and building national
infrastructure and management capacity through indige-
nous funding mechanisms.
New innovative and output-based models that deliver
are urgently needed. In addition to initiatives highlighted
by Whitworth et al. (2008), capacity-building efforts in
developing countries can also be complemented by
programme staff in external operational agencies such as
Me ´decins Sans Frontieres (MSF) and The Union Against
Tuberculosis and Lung Disease (The TB Union). Both
organisations have highlighted their views on capacity
building and leadership development in operational re-
search in two previous publications (Harries et al. 2011;
Zachariah et al. 2011). In terms of current capacity-
Tropical Medicine and International Health doi:10.1111/j.1365-3156.2012.03072.x
volume 17 no 11 pp 1409–1411 november 2012
ª 2012 Blackwell Publishing Ltd 1409building models, we thus ask, ‘What are the problems?
What are the solutions? What needs to happen next?’
What are the problems? The main problems of most
current research-training models include weak selection
criteria for candidates; research questions that are dis-
tanced or irrelevant to ﬁeld realities or priorities; lack of
continuing mentorship; no emphasis on deliverable out-
puts; and few opportunities and/or budgets for conducting
operational research (Ohkado et al. 2010). In the after-
math of many research training courses, these problems
contribute to demotivation for continuing operational
research within programmes and the trainees stop pursuing
research altogether or seek greener pastures. Providing new
opportunities and strategies to enhance retention of trained
individuals thus needs to be inherent to training strategies.
What are the solutions? Ensuring strict selection criteria
and promoting practical and output-based approaches are
essential. Participants need to be taught the principles of
operational research while simultaneously being taken
through a project spanning the entire life cycle from
generating a relevant operational research question to
appropriate design, data collection, analysis, paper writing,
publication in a peer-reviewed journal and moving to
changing policy and practice. To give an example, MSF and
The TB Union began running operational research training
courses in 2009. So far, we have trained 34 participants
(doctors, nurses, paramedical ofﬁcers and monitoring and
evaluation ofﬁcers) from Asia, Africa, Latin America and
Europe and have seen 27 of their papers published in
scientiﬁc journals. We have ﬁve other courses currently
being implemented with 60 participants (Harries 2012),
and there is every indication that they, too, will deliver. The
next step is to assess and measure, in a standardised
manner, how this research inﬂuences policy and practice.
Guidance on how to do this has been recently published
(Zachariah et al. 2012). We have also introduced career
initiatives, such as programme-based operational research
fellowships, as a way of retaining and sustaining capacity
(Zachariah et al. 2011). The core message from our model
is that one needs to build practical skills, be able to sustain
and retain the people with these skills and ensure that there
are deliverable and measurable outputs.
What needs to happen next? International and national
interest needs to be built. This can only be done by
generating awareness of the important role that opera-
tional research can have for health workers, programme
managers and policy makers. There is a need to improve
complementary linkages between academia and imple-
menters, including nongovernmental organisations, and to
foster partnership models that boost national capacity
(Zumla et al. 2010). We also need ways of measuring
whether research is actually delivering the expected goods,
by tracking its journey through various stages from the
start line of the research protocol to the end line – the
impact a given research study has on improving health of
beneﬁciaries (Zachariah et al. 2012). All this is crucial if
we are to build a spirit of co-ownership and responsibility
for all stakeholders to the World Health theme ‘no health
without research’. Most important of all, there is a need for
increased funding for capacity building and for assessing,
on a continuing and vigilant basis, what works and what
does not work, so that we can make the best of the
available resources and time and address our past failures.
References
Frenk J & Chen L (2011) Overcoming gaps to advance global
health equity: a symposium on new directions for research.
Health Research Policy and Systems 9, 11.
Graham ID & Tetroe JM (2009) Getting evidence into policy and
practice: perspective of a health research funder. Journal of
the Canadian Academy of Child and Adolescent Psychiatry 18,
46–50.
Harries AD (2012) Operational research: getting it done and
making a difference. Public Health Action 2, 1–2.
Harries AD, Rusen ID, Reid T et al. (2011) The Union and
Me ´decins Sans Frontie `res approach to operational research. The
International Journal of Tuberculosis and Lung Disease 15,
144–154.
Mckee M, Stuckler D & Basu S (2012) Where there is no health
research: what can be done to ﬁll the global gaps in health
research? PLoS Medicine 9, e1001209.
Ohkado A, Pevzner E, Sugiyama T et al. (2010) Evaluation of an
international training course to build programmatic capacity for
tuberculosis control. The International Journal of Tuberculosis
and Lung Disease 14, 371–373.
Walley J, Khan MA, Shah SK, Witter S & Wei EI (2007) How
to get research into practice: ﬁrst get practice into research.
Bulletin of the World Health Organization 85, 424.
Whitworth JAG, Kokwaro G, Kinyanjui S et al. (2008) Strength-
ening capacity for health research in Africa. Lancet 372, 1590–
1593.
WHO (2005) Bridging the ‘‘Know-Do’’ Gap. Meeting on
Knowledge Translation in Global Health 10–12 October 2005.
WHO, Geneva, Switzerland. Available: http://www.who.int/
kms/WHO_EIP_KMS_2006_2.pdf. Accessed 18th May, 2012.
Zachariah R, Harries AD, Ishikawa N et al. (2009) Operational
research in low-income countries: what, why, and how? The
Lancet Infectious Diseases 9, 711–717.
Zachariah R, Tayler-Smith K, Ngamvithayapong-yana J et al.
(2010) The published research paper: is it an important indi-
cator of successful operational research at programme level?
Tropical Medicine and International Health 15, 1274–1277.
Zachariah R, Reid T, Srinath S et al. (2011) Building leadership
capacity and future leaders in operational research in low-
income countries: why and how? The International Journal of
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Tropical Medicine and International Health volume 17 no 11 pp 1409–1411 november 2012
R. Zachariah Editorial
1410 ª 2012 Blackwell Publishing LtdZachariah R, Ford N, Maher D et al. (2012) Is operational
research delivering the goods? The journey to success in
low-income countries. The Lancet Infectious Diseases 12,
415–421.
Zumla A, Huggett J, Dheda K, Green C, Kapata N & Mwaba P
(2010) Trials and tribulations of an African-led research and
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Corresponding Author Rony Zachariah, Operational Research Unit, Medecins sans Frontieres (Brussels Operational Center), 68 Rue
de Gasperich, 1617 Luxembourg, Germany. Tel.: +352 332515; Fax: +352 335133; E-mail: zachariah@internet.lu
Tropical Medicine and International Health volume 17 no 11 pp 1409–1411 november 2012
R. Zachariah Editorial
ª 2012 Blackwell Publishing Ltd 1411

Bridging the ‘‘Know-Do’’ Gap. Meeting on Knowledge Translation

Building leadership capacity and future leaders in operational research in lowincome countries: why and how?

Corresponding Author Rony Zachariah, Operational Research Unit, Medecins sans Frontieres (Brussels Operational Center), 68 Rue de Gasperich,

Editorial 1410 ª

Evaluation of an international training course to build programmatic capacity for tuberculosis control.

Getting evidence into policy and practice: perspective of a health research funder.

How to get research into practice: first get practice into research.

Operational research in low-income countries: what, why, and how?

Operational research: getting it done and making a difference.

Overcoming gaps to advance global health equity: a symposium on new directions for research.

Strengthening capacity for health research in Africa.

The published research paper: is it an important indicator of successful operational research at programme level?

The Union and Me´decins Sans Frontie`res approach to operational research.

Trials and tribulations of an African-led research and capacity development programme: the case for EDCTP investments.

Where there is no health research: what can be done to fill the global gaps in health research?

The 2012 world health report 'no health without research': the endpoint needs to go beyond publication outputs.

Le thème du Rapport de la Santé Mondiale 2012 est «pas de santé sans recherche» et est un appel à l’action pour combler les lacunes mondiales dans la recherche en santé. Combler l’écart entre les «nanti »et les «démunis» est vital si nous voulons être à la hauteur de l’appel de ce thème et utiliser la recherche pour apporter des améliorations sur le terrain. Les nombres absolus de publications scientifiques et des publications par habitant ont été utilisés comme les principaux indicateurs pour évaluer la capacité mondiale de la recherche et identifier les zones à lacunes. A l’échelle des pays, nous estimons que cela reflète un seul côté de la médaille. Bien que l’absence de stratégies nationales de recherche en santé empêche une allocation optimale des ressources, une réalité toute aussi importante sur le terrain est la transcription inadéquate des résultats de la recherche dans la politique et la pratique, l’autre côté de la médaille

LSHTM Research Online

Rony Zachariah

Tony Reid

Nathan Ford

Rafael Van den Bergh

Amine Dahmane

Mohammed Khogali

Paul Delaunois

Anthony D. Harries

Crossref

Tropical Medicine & International Health

The 2012 world health report ‘no health without research’: the endpoint needs to go beyond publication outputs

The 2012 world health report 'no health without research': the endpoint needs to go beyond publication outputs.

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