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

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Summary

Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient. Thus, research capacity needs to be developed, specific resources allocated, and different stakeholders (academic institutions, national programme managers, and non-governmental organisations) brought together in promoting operational research.

Introduction

Tukur, an illiterate patient diagnosed with malaria for the second time in a month, receives a prescription from the doctor for chloroquine pills, but he is unhappy and returns to the doctor to seek an alternative therapy, arguing that he has taken chloroquine several times in the past and it does not work. The doctor tells him that chloroquine is what the national malaria programme recommends and that it is the only medicine available.

Tukur is not a health professional, policy maker, or scientist, but he realised that the medicines he was given were not working, and had questioned his doctor. His experience should have prompted the doctor to ask similar questions about the drugs that he was prescribing. Similarly, those responsible for the malaria programme should have been monitoring the results of treatment as a part of routine care. Several months later, operational research done by an international non-governmental organisation (NGO) proved that Tukur's experience was correct—chloroquine treatment had a 91% failure rate1—and the drug was not effective in most patients with Plasmodium falciparum malaria.

The described example does not lay blame on clinicians in this kind of setting, who often do the best they can with limited resources. However, what was clearly lacking within this malaria control programme was a systematic process of monitoring drug resistance and treatment failure, and the ability to assess the implications on health-care delivery.

The subject of operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but there is limited published information on its role from a disease-control and programme perspective. We have been involved with operational research in the field of infectious diseases over many years in resource-limited settings, and this article is thus based on our experiences. From a programme perspective, we will suggest a definition of operational research, clarify its relevance to infectious-disease-control programmes, and describe some of the enabling factors and challenges for its integration into programme settings and into changing policy and practice.

Section snippets

What is operational research?

Operational research has its roots in military and industrial modelling, in which it is defined as the discipline of applying advanced analytical methods, including mathematical models, to help make better decisions.2, 3 In the commercial sector, operational research has been widely used, for example, to improve the scheduling of airline crews and in the design of queuing systems at Disney theme parks.2, 3 However, its application to health programming is much less developed.

Many definitions of

Why is operational research relevant?

There are at least three reasons why operational research is relevant to health. To improve programme outcomes in relation to medical care or prevention, to assess the feasibility of new strategies or interventions in specific settings or populations, and to advocate for policy change. Table 1 presents some examples of operational research in each category. In all cases, the research questions were generated from the field and answered issues of relevance for particular health programmes. Some

Enabling factors and challenges for operational research

We have suggested several factors that we believe can foster programme-related operational research and the translation of its results into policy and practice (panel). We also discuss our failures over the past 10–15 years and their possible solutions (table 2).

Where do we go from here?

Despite the demonstrated value of operational research, there seems to be a real gap between the call for more research and action. For instance, although the Sydney Declaration that “good research drives good policy and programming” in 2007 suggested allocating 10% of all resources to HIV programming for operational research,39 this has not been taken up and has had a very limited impact. The Global Fund allows 5–10% of each grant to be allocated for monitoring, evaluation, and operations

Conclusion

We have made the case for the importance of operational research as a necessary component of health programming in low-income countries. What is needed now is further development of operational-research capacity, allocation of specific resources, and the need for different participants such as international and national academic institutions, national programme managers, and NGOs to work together in promoting operational research.

There are some encouraging signs. Strengthening research capacity

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