Strengthening operational research in Ethiopia: beyond training for a sustainable and successful country OR programme.

Abstract

The recognition of high-quality operational research (OR) as an integral component of successful public health programmes is no longer a foreign concept.1 Increasingly, Ministries of Health, donors and other stakeholders have placed a high priority on strengthening this once neglected area of work. The International Union Against Tuberculosis and Lung Disease (The Union) — through the United States Agency for International Development (US-AID) supported TREAT TB (Technology, Research, Education and Technical Assistance for Tuberculosis) Initiative — developed a guide for programmatic OR support in 2012.2 A central theme of this guidance was a framework that viewed OR support as a cyclical activity of which OR training of health workers was only one component of a much bigger effort, including leadership within the programme, regular OR priority setting exercises and programme evaluation. In Ethiopia, this vision of a multi-faceted approach to strengthening OR in the country was accepted long before OR climbed onto the global TB agenda. The establishment of the TB Research Advisory Committee (TRAC) in 2001 followed a TB control programme assessment that identified implementation gaps where evidence was unavailable to guide action. As a result, TRAC members (research institutes and universities) committed to strengthening OR to advance TB control efforts. Included in these efforts was a joint annual TB conference with the Ministry of Health (MoH), where research findings were presented and discussed and research priorities regularly updated. For their part, the MoH pledged to translate relevant validated findings into practice. TRAC was eventually integrated into the National Stop TB Partnership as a formal structure within the Ministry. A major challenge in this effort was the limited capacity of TB control programme staff to conduct OR efforts independently. With the support of the US-AID-funded TB CARE Initiative, practical team-based training was developed to strengthen this capacity. TRAC also organised new consultations on research priorities, which culminated in a National TB OR Roadmap issued by the MoH in 2013.3 Importantly, these renewed priorities served as the basis for the research topics selected in subsequent OR training. The research topics presented in this supplement, such as assessing impact of ambulatory care for multidrug-resistant TB in Addis Ababa and evaluating community-based treatment in Oromia, stem from this priority-setting exercise, and as a result are more relevant to current programmatic issues. The subsequent step of assessing the impact of OR on public health programmes and policy change is a challenging but vital task that has more recently been undertaken by others working in the field.4 This important component must also be addressed in the Ethiopian context. It, too, will require ongoing leadership and support that has been instrumental in the country to date. As evident in the successful scope of OR efforts presented in this supplement, the TB CARE OR Training Initiative was able to achieve its immediate targets of capacity building, leading to concrete and relevant output to support national TB control efforts. However, it is the country's recognition and support of the broader components required for a successful OR programme that bode well for the sustainable and productive practice of OR in Ethiopia.