­­Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India

ABSTRACT

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this ‘how we did it’ paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

KEYWORDS:

• Triaging for severe illness
• ending TB deaths
• differentiated TB care
• operational research
• technical support

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgment

Tamil Nadu State TB Cell and ICMR-National Institute of Epidemiology led TN-KET with support from the WHO Country Office in India and the ICMR-National Institute for Research in Tuberculosis. It is facilitated by the National Health Mission Tamil Nadu; Directorate of Medical and Rural Health Services, Tamil Nadu; Directorate of Medical Education, Tamil Nadu; and Directorate of Public Health and Preventive Medicine, Tamil Nadu. We acknowledge the support from Dr S Gurunathan, MBBS MS, Director of Medical and Rural Health Services and Dr R Narayanababu, MBBS MD DCH, Director of Medical Education, Tamil Nadu. The District TB programme staff (medical officers, district programme coordinators, treatment officers, senior treatment supervisors, senior TB laboratory supervisors, health educators, laboratory technicians and TB-health visitors among others) and nodal TN-KET physicians deserve a special mention for their commitment and support.

Author contributions

Conception and design: HDS, AF, MK, JC, JK, PKB, SA, KVS, DPP, RP, MBN, JGT, PR, TB, SL, TSV, CP, RR, MVM; Preparing first draft of manuscript: HDS, AF, MK; Critical comments and review: all authors; Approval of final draft: all authors; Overall supervision, guidance and administration: HDS, AF, MK, JC, KVS, TSV, CP, RR, MVM.

Disclosure statement

No potential conflict of interest was reported by the authors. The views expressed in this article are of the authors and do not represent the views of the authors' organizations.

Paper context

We implemented a statewide-differentiated TB care strategy and the operational research around it in Tamil Nadu, south India, targeted towards reducing TB deaths. The state TB programme and a national public research organisation jointly led this. In this capacity-building paper, based on our experience, we have shared eleven tips for operational researchers. Following these tips may increase the chances of a fruitful engagement with health systems/programmes. Against each tip, we have shared example(s) from our experience.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2022.2161231

Additional information

Funding

This research did not receive any specific funding. TN-KET (and the OR around it) is being implemented as a Tamil Nadu health system initiative using existing resources and workforce in a routine programme setting. ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India, supported the publication costs.