Overview of operational research in MSF

Myriam Henkens, MD, MPH

International Medical Coordinator

MSF

London 1st of June, 2006

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

MSF presence by contexts -2004

Post-conflict16%

Stable41%

Internal instability13%

Armed conflicts30%

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

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

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

What does MSF do?

• Overview of all projects

• Type of research

• Topics

• Countries

What does MSF do (overview)?

Research projects 2004 2006

N° of diseases/topics 17 15

N° of external partners 12 18

N° of intersectional projects 3 26

Total N° of projects listed 132 289

What do we mean by “research project”?Type of research project 2004 2006

Clinical trial 13 11

Tools development 32 67

Software development 8 8

Resistance study (+ malaria 2004) 19 44

Effectiveness 11 41

Needs assessment/description 22 4

Project evaluation 7 13

Monitoring / evaluation /programme analysis 15 87

Concept validation 5 14

Total 132 289

What topics?

Research topics 2006

020406080

100120140

No

of p

roje

cts

Where does MSF do research?Countries with ≥3 projects planned, 2006

0

5

10

15

20

25

30

35

No

of p

roje

cts

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 ?

External publication analysisYear of publication

Research papers

Comment/discussion papers

Other Epicentre involved

Total

2004 19 8 0 8 27

2005 25 4 1 9 30

2006 (to May 30)

19 7 3 11 29

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

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?

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

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

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

Thank you very much