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Changing Practice with Operational Research

Changing Practice with Operational Research. Kate Sadler Valid International. Aims. Changing international practice with simple operational research and well chosen publications: Community-based therapeutic care (CTC) Know your audience Demonstrate need for change

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Changing Practice with Operational Research

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  1. Changing Practice with Operational Research Kate Sadler Valid International

  2. Aims • Changing international practice with simple operational research and well chosen publications: • Community-based therapeutic care (CTC) • Know your audience • Demonstrate need for change • Choose the right research tools • Use a range of data collection instruments • Disseminate results widely and effectively

  3. Community based Therapeutic Care (CTC) • Treats acute malnutrition • Marasmus & Kwashiorkor • Provide easy access for populations • Decentralised outpatient therapeutic care (OTP) • Care in homes not feeding centres or hospitals • Using existing health infrastructure • Community mobilisation • Formal and informal networks • Traditional practitioners • Uses Ready to Use Therapeutic Foods

  4. Your Audience • Medical profession, docs • High science • Donors • Cost! • NGOs and implementers • ‘Doable’ • Impact

  5. Demonstrate need for change • Impact of existing centre-based programmes poor in nutritional emergencies: • Not ‘doable’ • High risks

  6. Demonstrate need for change • Impact of existing centre-based programmes poor in nutritional emergencies: • Not ‘doable’ • High risks • Imbalance coverage : intensity

  7. ETHIOPIA 2000 BOLLOSSO SORIE

  8. One of many highland districts • 400,000 people - 40 km radius • 20% < 5 years = 80,000 children < 5 years • 10% severe malnutrition = 8,000 requiring TFC • TFC programme duration 4 months 20 TFCs REQUIRED (8000 / 400 = 20)

  9. Choose the right research tools • RCTs • Emergencies - too many external constraints • Humanitarianism? Timely interventions, ethical • Directed a lot of our high quality research to outside emergencies and the REAL suffering • Our experience disaster! • Observational studies, retrospective and prospective cohorts • Easily integrated into ongoing programmes

  10. Use a range of data collection instruments (1) • Quantitative, qualitative, observation and case studies • Triangulation

  11. Quantitative: programme monitoring

  12. Qualitative: programme monitoring

  13. Anthropological studies looking at the acceptability of non-centre based treatment compared to traditional TFC models: • Less disruption to home life • Carers able to fulfil social responsibilities • Improved access • Carers felt sense of empowerment being trusted to care for their kids • Tap into community ethos of looking after each other

  14. Observation & case studies: programme monitoring

  15. Use a range of data collection instruments (2) • Meta-data with range of partners • one observational and replicated 20 times. All data comparable and all showed the same thing

  16. Results of CTC programmes: Sep 00-Jun 05

  17. Disseminate results widely and effectively (1) • Use a combination of the right channels of dissemination • High-science journals – difficult? • Low-science journals • Practitioner publications • Meetings and teaching

  18. Disseminate results widely and effectively (2) • Design message with audience in mind: • Impact: outcomes, coverage

  19. Comparison of coverage of severely malnourished in Dowa and Mchinji districts - Malawi (March 2003)

  20. Disseminate results widely and effectively (2) • Design message with audience in mind: • Impact: outcomes, coverage • ‘Doability’: simple protocols integrated into national PHC delivery

  21. OTP: Appetite assessment (RUTF) One week ration « Appetite test »

  22. Disseminate results widely and effectively (2) • Design message with audience in mind: • Impact: outcomes, coverage • ‘Doability’: simple protocols integrated into national PHC delivery • For effective communication • Tell a story

  23. Disseminate results widely and effectively (3) • Don’t be afraid to present problems and failings > credibility

  24. >70% coverage Positive feedback Information and mobilisation

  25. Conclusions • Making a good case for change supports a positive research environment • Choosing the right research tools is key to obtaining rigorous data in emergency settings • Use the right channels of dissemination to reach the target audience • Presentation of research outcomes must focus on information needs of audience

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