Insights into Operational Research in MSF: Challenges and Future Ideas

1. Overview of operational research in MSF Myriam Henkens, MD, MPH International Medical Coordinator MSF London 1st of June, 2006

2. MSF in 2004 in 78 countries • OPD patients 9,858,426 • IPD patients 327,529 • Malaria patients 1,862,691 • Patients in HIV programmes 113,899 • Deliveries 73,223 • Surgeries 43,911 • TB patients 14,109 • Vaccinated for measles 964,482 • Vaccinated for meningitis 451,254

3. MSF presence by contexts -2004

4. Why does MSF do research? • To understand the local situation, assess the severity of an emergency, and to focus activities • To gather data in a organised way to strengthen advocacy • To monitor programme outcomes and identify constraints • To adapt treatment protocols to operational constraints

5. Why does MSF do research? (2) • To verify the efficacy of new treatment protocols • To describe treatment outcomes of specific patients • To gather evidence systematically in order to contribute to new knowledge in a scientifically credible manner

6. How research priorities are set Focus on topics with impact on: • Improving how we operate • Policy and practice Based on: • Field questions/suggestions • Technical working groups suggestions • Opportunities • Yearly decision by medical directors in each section and jointly

7. What does MSF do? • Overview of all projects • Type of research • Topics • Countries

8. What does MSF do (overview)?

9. What do we mean by “research project”?

10. What topics?

11. Where does MSF do research?

12. How are research outcomes shared? • Internal: report, within a section or between sections, via technical experts, training or guidelines, informally, lost? • Externally: • MSF website or own report publications • Advocacy (to substantiate a message) • Letter or view point sent to peer reviewed journal • Peer reviewed article • Shared with the population?

13. External publication analysis

14. Comments • Wide and unclear definition of operational research that varies across MSF • Creation of research posts has boosted numbers of projects undertaken within sections of MSF • Not clear how many planned projects are completed and what use is made of data • Much research not published externally • No systematic internal library

15. Challenges • Context: duration, security, logistic constraints, etc • Resources: high turnover of staff, priorities for resource allocation (human, financial) • Internal: field initiative versus research requirements, knowledge gap, collaboration between sections • External: Ethical (MSF and in country), standards (for data collection and sharing, for informed consent, for publication, etc) • Evaluation: effectiveness of operational research in programme improvement, policy changes and thus in improving patients’ lives: how to evaluate this?

16. How to improve within our operational constraints? • Done or decided: • Creation of an institutional ERB • Creation of research support position in some sections • Better overview of research agenda on some topics • Prospective research agenda with standard format, including dissemination plan • Improved collaboration with external partners

17. How to improve – future ideas • Make better use of routine monitoring data • Improve quality and research standards: • Training • External and internal research support • Sharing protocols – internally and externally • Supporting alternative approaches eg qualitative • Improve use of data collected: • Monitor outcomes of research in terms of dissemination • Share data with involved populations • Improve internal knowledge database

18. Conclusions • Clarify the definition of operational research • Establish coordination platform between sections • Establish precise research standards (ERB) • Prioritise research by allocating sufficient time within operational constraints, organise training and expert support

19. Thank you very much