1. Overview of operational research in MSF Myriam Henkens, MD, MPH International Medical Coordinator MSF London 1st of June, 2006

2. 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 meningitis451,254

3. MSF presence by contexts -2004

4. 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

5. 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

6. 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

7. What does MSF do? Overview of all projects Type of research Topics Countries

8. What does MSF do (overview)? Research projects20042006 N° of diseases/topics1715 N° of external partners1218 N° of intersectional projects326 Total N° of projects listed132289

9. What do we mean by “research project”? Type of research project20042006 Clinical trial1311 Tools development3267 Software development88 Resistance study (+ malaria 2004)1944 Effectiveness1141 Needs assessment/description224 Project evaluation713 Monitoring / evaluation /programme analysis1587 Concept validation514 Total132289

10. What topics?

11. Where does MSF do research?

12. 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 ?

13. External publication analysis Year of publication Research papers Comment/discussion papers OtherEpicentre involved Total 2004 1980827 2005 2541930 2006 (to May 30) 19731129

14. 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

15. 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?

16. 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

17. 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

18. 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

19. Thank you very much