STUDENT VOICES FROM THE FIELD: WORLD HEALTH ORGANIZATION GENEVA, SWITZERLAND O c t o b e r 1 0, 2 0 1 6 M o l l y P e z z u l o University at Albany School of Public Health MPH Epidemiology Candidate 17 mpezzulo@albany.edu 1
DUKE UNIVERSITY PROGRAM IN GLOBAL POLICY AND GOVERNANCE Global Health Fellowship Provides an overview of the forces of globalization shaping health in our world, with particular emphasis on issues of innovation and access to health technologies. The implications of trade rules and intellectual property regimes on public health. The architecture of global health governance. Managing global health programs. https://sanford.duke.edu/academics/geneva-program/global-health 2
INTERNSHIP OVERVIEW Undertake a review of TDR-supported research since 2010 with a view to mapping operational and implementation research. Clean the data, and with input from relevant TDR staff ensure the data is accurate. Utilizing TDR databases and interviews with TDR staff as appropriate. Become familiar with the strategies and current activities of TDR, the Global Fund and the Coalition on Operational Research on the Neglected Tropical Diseases through reading of the literature relevant to operational research, websites. 3
CASE STUDY OBJECTIVES Starting with the recent review of Global Fund programmes and working under the guidance of TDR staff, drafting of multiple case studies that describe the role of operational research in the programme and the impact, positive or negative, on the delivery of HIV, TB or Malaria services. https://upload.wikimedia.org/wikipedia/en/2/2b/the_global_fund_to_fight_aids,_tuberculosis_and_malaria_logo.jpg 4
CASE STUDY OUTPUTS After working extensively with TDR Staff, as well as each OR scientist, I was able to identify three strong case studies that exemplify the role The Global Fund plays in supporting successful operational research studies. China, TB Viet Nam, TB India, TB in collaboration with the International Union of Tuberculosis and Lung Disease 5
IMPLEMENTATION OR OPERATIONAL RESEARCH? Implementation (IR) and operational research (OR) is used to identify bottlenecks in service delivery and improve the accessibility and quality of products and services. It has the potential to improve the outputs and outcomes of disease control programmes by assessing the feasibility of new interventions in specific settings and identifying obstacles to disease control in a particular country. Implementation research is currently described in the TDR IR toolkit as well as the Massive Open Online Course (MOOC) as the systematic approach to understanding and addressing barriers to effective and quality implementation of health interventions, strategies and policies and IR is demand-driven and the research questions are framed based on needs identified together with relevant stakeholders/implementers in the health system. Operational research is carried out by using routinely collected data by programmes in order to provide ways of improving programme operations and thereby delivering more effective, efficient and equitable care. 6
HOW WAS IR/OR DEFINED? Given the multiple characteristics of Implementation/ Operational research, this study relied exclusively on TDR staff self interpretation of projects understood to be either IR/OR. 7
DATA COLLECTION, 2010-2016 Data collection included: Structured Operational Research and Training Initiatives (SORT-IT). TDR Small Grant Schemes. Research Capacity Strengthening & Knowledge Management Impact Fellowship Grants. Intervention and Implementation Research Projects. 8
DISEASE DISTRIBUTION BY COUNTRY 2013 25 20 RCS NCD N= 124 PIs Countries=55 SGS: 13 RCS-KM: 26 SORT-IT: 85 NTD 15 Maternal Child Health TB 10 Sexual Violence NA 5 Malaria HIV/AIDS 0 Congenital Rubella Syndrome 9
DISEASE DISTRIBUTION, 2013 Malaria 8% MCH 4% NA 3% NCD 6% NTD 11% N= 124 PIs Countries=55 SGS: 13 RCS-KM: 26 SORT-IT: 85 HIV/AIDS 6% Congenital Rubella Syndrome 1% RCS 18% Sexual Violence 2% TB 41% 10
Afghanistan Angola Argentina Armenia Azerbaijan Bangladesh Belarus Benin Bhutan Bolivia Brazil Burkina Faso Burundi Cameroon China Colombia Congo Denmark DRC Estonia Ethiopia Fiji Gambia Georgia Ghana India Iran Kenya Latvia Liberia Malawi Mali Mongolia Mozambique Myanmar NA Nepal New Guinea Nigeria Pacific Islands Pakistan Paraguay Peru Republic of Moldova Rwanda Solomon Islands Somalia South Africa South Africa/ DRC Sri Lanka Sudan Swaziland Tanzinia Tunisia Uganda Ukraine United Republic of Tanzania Viet Nam Yemen Zimbabwe DISEASE DISTRIBUTION BY COUNTRY, 2014 10% N= 150 PIs Countries=59 Diseases=10 8% HIV/AIDS 6% HIV/TB/NCD Hospital Outcomes Malaria 4% Maternal Child Health NCD 2% NTD RCS 0% STIs TB 11
DISEASE DISTRIBUTION, 2014 Maternal Child Health 5% NCD 7% NTD 15% RCS 17% N= 150 PIs Countries=59 Disease=10 RCS-KM: 57 SGS: 15 SORT-IT: 78 Malaria 11% STI 1% Hospital Outcomes 1% HIV/TB/NCD 1% HIV/AIDS 8% TB 34% 12
Argentina Armenia Australia Bangladesh Benin Benin, Ethiopia, Guinea, Brazil Burkina Faso Cambodia Cameroon Cape Verde China Colombia Democratic Republic of Congo Ethiopia Gabon Gambia Germany Ghana Guinea Guinee-Bissau Iran, Islamic Republic of Ireland Ivory Coast Liberia Luxembourg Malawi Mali Mauritania Mexico Moldova Nepal Netherlands Niger Nigeria Peru Philippines Senegal Sierra Leone Solomon Islands Somalia South Africa Sri lanka Swaziland Tanzania Togo Tunisia Uganda Ukraine United Kingdom Vietnam Zimbabwe NA: Rafascreen, multiple DISEASE DISTRIBUTION BY COUNTRY, 2015-2016 N=142 Countries= 53 Disease =7 IIR: 78 SORT-IT: 32 (71 On-going) RCS-KM: 14 (21 On-going) SGS: 18 (34 On-going) 20 18 16 14 12 10 8 6 4 2 0 TB RCS NTD MCH Malaria HIV/AIDS Ebola 13
DISEASE DISTRIBUTION, 2015-2016 45, 32% 9, 6% 1, 1% 18, 13% N=142 Countries= 53 Disease=7 IIR: 78 SORT-IT: 32 (71 On-going) RCS-KM: 14 (21 On-going) SGS: 18 (34 On-going) 10, 7% 51, 36% 8, 5% Ebola HIV/AIDS Malaria MCH NTD RCS TB 14
DISCUSSION Consolidation among TDR Teams, single characteristic/definition of IR/OR. Need for consistency TDR-wide, to avoid contradiction of IR Toolkit and Massive Open Online Course (MOOC). Need to create a tool or checklist of characteristics to define OR/IR? How to define Topics/Diseases (example: NCDs) Including mental health, Diabetes Mellitus, CVD, Cancer and Nutrition Grant Management System Knowledge Management across grants management is weak need to follow-up on consultancy to improve Grant management system. Define what TDR directly funds and facilitates? 15
FUTURE IMPLICATIONS Strategy 2018-2023 Identifying weak Knowledge Management system, increases difficulty in accessing IR/OR data. How do we assess current IR/OR definitions as TDR approaches new strategy? How will TDR fit into the SDG era, and how will we communicate our role? Photo: WHO/TDR 16
LESSONS LEARNED ABROAD Exposure to global policy, and the powerful impact on international public health. Applying evidence based research in the development and evaluation of public health interventions. Differing political views may hinder research and development towards improving universal health care. Work outside of your comfort zone. Building professional relationships that last! 17
THANK YOU! Special thanks to Dean Nasca, John Justino, Carol Whittaker, Katrina Chamberlin, Mr. Bill Kelly, Dr. Alvaro Carrascal, and the SPH Center for Global Health 18