OPERATIONAL RESEARCH

What is it ?

Why is it relevant ? Dr. Rony Zachariah MD, PhD

Operational Centre Brussels

MSF- Luxembourg

rony.zachariah@brussels.msf.org

Operational research: historical roots

Military & industrial modelling

defined as “the application of analytic methods to help make better decisions”

Example: Military sector: anti-aircraft artillary efficiency

Examples: Commercial sector:

• Englands « Penny Post » – 1840

• Efficient scheduling of airline crews

“What” is operational research

Search for knowledge on interventions, strategies or

tools that can enhance the quality, or

coverage of health systems and services.

What is not operational research:

• Basic science research

• Randomised controlled trials [RCT] – where research is conducted in a strictly controlled environment, with inclusion and exclusion criteria – efficacy is the end point

The need for RCT and operational research: a necessary continuum

RCT

Patients and communities

Generates knowledge (Trial conditions)

Operational research ‘How to’ apply that knowledge ? (Real world conditions)

Benefits +

Excellent evidence

but

gaps in implementation!

Malaria

Kills 1 to 2 million people each year,

39% reduction in deaths

1988

Why is operational research relevant ?

Bridging implementation gaps

MALAWI

Early 2000’s

Population : 10 Million

HIV/AIDS : 1 Million

Photo with permission

100,000 deaths/ year - no access to antiretroviral treatment

Malawi 2013

650,000 on ART

Measuring population Impact of ART on deaths

“Coffin sales”

10,000 Deaths Averted !Coffin sales in trouble

01

02

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01

00C

offin

sal

es/1

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pop

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2000 2001 2002 2003 2004 2005 2006 2007Year

Coffin sales 95% CI

BURUNDI – Maternal Deaths

Burundi 800 /100,000

Luxembourg 2 /100,000

MDG 5•Reduce deaths by 75% (2015)

African countries – unlikely to achieve MDG 5

Reduced maternal deaths by 74%

Impact in relation to MDG 5

Maternal Mortality Ratio 1990-2010 and MDG 5 target in Kabezi district, Burundi

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200

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1990 1995 2000 2005 2011 2015

Year

Ma

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Reduction in maternal mortality ratio = 74%

40 low-income countries implementing

five interventions – up to 27 years after ! Malaria Vaccinations

CONCLUSION

• Many years pass between ‘definitive’ trial Many years pass between ‘definitive’ trial results and policy and practice changeresults and policy and practice change

• EU Research investment EU Research investment • 55.8 Billion Euros (2007-2013) 55.8 Billion Euros (2007-2013)

– Technology/ Drugs/ Clinical trialsTechnology/ Drugs/ Clinical trials

• Support operational researchSupport operational research apply apply knowledge for maximum public benefit. knowledge for maximum public benefit.