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Enhancing Health Outcomes: Collaboration Between Operations and Research in Medical Care

This discussion by Gilles Van Cutsem, MD, DTMH, MPH, from Médecins Sans Frontières, explores the synergy between operational healthcare delivery and research initiatives. Key characteristics include a clear agenda aligned with global priorities, strong district-level coordination, and enhanced monitoring and evaluation. The focus is on integrating research within routine health services without disrupting patient care, ensuring community relevance, and building local capacity. Key projects include studying tuberculosis drug resistance and implementing pragmatic trials, demonstrating the importance of collaboration for health system strengthening.

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Enhancing Health Outcomes: Collaboration Between Operations and Research in Medical Care

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  1. Operations versus research: cohabitation or collaboration? Gilles Van Cutsem MD, DTMH, MPH Medecins Sans Frontieres

  2. Key characteristics • Clear agenda informed by global priorities • Enhanced monitoring and evaluation: • Strong district-level coordination • Ongoing supervision, mentoring and training • Communication between M&E, clinicians, and management • Partnership with government health services • Strong academic collaborations (UCT, US, …) • Balancing exercise between service delivery and research priorities

  3. Guiding principles • Relevance and benefit to the community • Patient care is not disrupted • Involvement of local health care providers: capacity building and local interest • Synergy and coherence between projects • Integration within routine health services • Contribution to service delivery

  4. Virtuous cycle

  5. Study designs • Observational cohorts (prospective) • Retrospective cohort (folder reviews) • Model descriptions • Validation and field-testing of diagnostics • Pragmatic trials • Other nested within cohort: • PK • Cost-efficiency

  6. How is this different from usual? • ‘Real world’ setting – generalizability • Constant interaction between operations and research > one informs the other. • NGO & public health sector: no publication pressure as opposed to academic > less conflict of interest between service delivery and research demands • Research as a second job: capacity problem

  7. First description of ART at PHC in Africa • Use of enhanced routine data • Observational cohort – quantitative • Model of care - descriptive

  8. Advocacy for new models of care

  9. Kaplan-Meier failure estimate 0.20 d4T 0.15 0.10 AZT Proportion changed due to toxicity NVP 0.05 EFV 0.00 0 6 12 18 24 30 36 Months on ART Sentinel surveillance informing policy

  10. Project-driven clinical questions

  11. Field testing of TB diagnostics

  12. Large research projects • Tuberculosis drug resistance survey • Randomized controlled trial of isoniazid vs placebo

  13. Ubuntu Clinic Research Committee • Protect services from research chaos • Composed of MoH, NGO, academia • Evaluate impact on service delivery & overall cohesion (guiding principles) • Empower ‘coal-face’ workers to have their say in what is happening in their clinic

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