Date post: | 01-Apr-2015 |
Category: |
Documents |
Upload: | izabella-bramwell |
View: | 215 times |
Download: | 0 times |
OPERATIONAL RESEARCH
What is it ?
Why is it relevant ? Dr. Rony Zachariah MD, PhD
Operational Centre Brussels
MSF- Luxembourg
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
03
04
05
06
07
08
09
01
00C
offin
sal
es/1
000
pop
ulat
ion
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
0
200
400
600
800
1000
1200
1400
1990 1995 2000 2005 2011 2015
Year
Ma
tern
al M
ort
alit
y R
ati
o
(De
ath
s/1
00
,00
0 li
ve
bir
ths
)
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.