Defining Research to Improve Health Systems

Remme, J.; Adam, Taghreed; Becerra-Posada, Francisco; d’Arcangues, Catherine; Devlin, Michael J.; Gardner, C. A.; Ghaffar, Abdul; Hombach, Joachim; Kengeya, Jane F. K.; Mbewu, Anthony; Mbizvo, Michael T.; Mirza, Zafar; Pang, Tikki; Ridley, Robert G.; Zicker, Fábio; Terry, Robert F

doi:10.1371/journal.pmed.1001000

Cited by 136 publications

(143 citation statements)

References 35 publications

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“…As one example, the emergent field of implementation research, also called implementation science – broadly defined as the application of rigorous mixed methods to the adaptation, testing, and scaling of innovative, effective interventions with the goal of closing the ‘know-do gap’ and shaping broader policy environments – brings together the gamut of disciplines concerned with improving health and healthcare systems: from medicine and the allied health sciences, to demography, operations research, political science, and medical anthropology [65–70]. While we focus here on clinician partnerships, we have not yet figured out how to deliver responsibly on other forms of engagement, and this remains a weakness because of the immense importance of other disciplinary approaches towards understanding and addressing plural approaches to health and healing.…”

Section: Limitations Of the Partnership Modelmentioning

confidence: 99%

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

Citrin

Mehanni

Acharya

et al. 2017

Global Health Action

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Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.

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Section: Limitations Of the Partnership Modelmentioning

confidence: 99%

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

Citrin

Mehanni

Acharya

et al. 2017

Global Health Action

View full text Add to dashboard Cite

show abstract

“…Operational research generates evidence that is immediately relevant to local health delivery and has potential for improving practice [27]. We adopted an outputs-oriented model with defined and time-specified milestones, using a learning-by-doing approach to allow trainees to apply concepts to projects in real time while receiving hands-on intensive mentorship [17,20].…”

Section: Implementation Of Intermediate Operational Research Trainingmentioning

confidence: 99%

“…We targeted this category of trainees to improve problem-solving skills within clinical programmes [27], increase the use of routinely collected programme and clinical data [28], and provide a professional development opportunity to retain health workers in rural settings. With few instructors and limited operational research funding, we limited the number of training projects.…”

Section: Implementation Of Intermediate Operational Research Trainingmentioning

confidence: 99%

Adapting operational research training to the Rwandan context: the Intermediate Operational Research Training programme

Odhiambo¹,

Amoroso²,

Barebwanuwe³

et al. 2017

Global Health Action

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Background: Promoting national health research agendas in low- and middle-income countries (LMICs) requires adequate numbers of individuals with skills to initiate and conduct research. Recently, non-governmental organizations (NGOs) have joined research capacity building efforts to increase research leadership by LMIC nationals. Partners In Health, an international NGO operating in Rwanda, implemented its first Intermediate Operational Research Training (IORT) course to cultivate Rwandan research talent and generate evidence to improve health care delivery. Objective: This paper describes the implementation of IORT to share experiences with other organizations interested in developing similar training programmes. Methods: The Intermediate Operational Research Training utilized a deliverable-driven training model, using learning-by-doing pedagogy with intensive hands-on mentorship to build research skills from protocol development to scientific publication. The course had short (two-day) but frequent training sessions (seven sessions over eight months). Trainees were clinical and programme staff working at the district level who were paired to jointly lead a research project. Results: Of 10 trainees admitted to the course from a pool of 24 applicants, nine trainees completed the course with five research projects published in peer-reviewed journals. Strengths of the course included supportive national and institutional research capacity guidelines, building from a successful training model, and trainee commitment. Challenges included delays in ethical review, high mentorship workload of up to 250 hours of practicum mentorship, lack of access to literature in subscription journals and high costs of open access publication. Conclusions: The IORT course was an effective way to support the district-based government and NGO staff in gaining research skills, as well as answering research questions relevant to health service delivery at district hospitals. Other NGOs should build on successful programmes while adapting course elements to address context-specific challenges. Mentorship for LMIC trainees is critical for effectiveness of research capacity building initiatives.

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“…Where appropriate, a planned health systems approach involving managers and policy makers to operationalise fi ndings should be included as part of research planning. 23 …”

Section: What Steps Should We Take To Identify and Manage Emergent Ncds?mentioning

confidence: 99%

The new epidemic of non-communicable disease in people living with the human immunodeficiency virus [Perspective]

Dawson

Rom

Dheda

et al. 2013

public health action

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Defining Research to Improve Health Systems

Abstract: Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems.

Cited by 136 publications

References 35 publications

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

Adapting operational research training to the Rwandan context: the Intermediate Operational Research Training programme

The new epidemic of non-communicable disease in people living with the human immunodeficiency virus [Perspective]

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