Operational research training helps health systems recover post-Ebola

TDR news item
20 September 2017

After one of the largest Ebola virus outbreaks in history took a devastating toll on lives and health systems, results from research studies in Liberia and Sierra Leone are informing health recovery plans and showing ways to improve services.

Ebola in Sierra Leone
Ebola in Sierra Leone
Credit: WHO/Stéphane Saporito

The strain on the health systems was seen firsthand by Andy Ramsay, a former TDR scientist. TDR provided Andy’s time to help in affected areas during the outbreak.

“The health system virtually stopped functioning,” said Ramsay. “Many people became afraid to seek care of any kind as health workers got sick and died from Ebola, and clinics and hospitals were looked on as dangerous places.”

This meant that children went without routine immunizations, TB patients could not get their medications on schedule, and life-saving measures to keep pregnancy and childbirth safer did not reach mothers and babies, he said.

It was clear to Ramsay that operational research – using experience and data from the health setting to find ways to improve service delivery – could provide health leaders with an evidence base to help them set priorities for recovery after the emergency.

SORT IT informs recovery

In January 2016 Ramsay, WHO and partners organized SORT IT (Structured Operational Research Training Initiative) trainings in Liberia and Sierra Leone to teach public health leaders and practitioners how to analyze and use health delivery information from before, during and after the outbreak to inform revived health systems.

Within the year, course participants from both countries conducted studies to assess performance of mother and child health, HIV, TB, malaria, immunization, malnutrition and non-communicable disease programmes. Results are providing policy-makers with evidence-based recommendations for how to rebuild and improve health delivery going forward.

Liberia: evidence to improve health delivery

“This training was different and went beyond the usual approach to research capacity building,” said Chea Sanford Wesseh, a course participant and Assistant Minister for Vital and Health Statistics at the Ministry of Statistics in Liberia.

“We used the evidence generated to make the case for new, significant funding from Gavi, The Vaccine Alliance, to improve how we deliver immunization services.”

Chea Sanford Wesseh, Ministry of Statistics, Liberia

Participants learned how to conceptualize a research question, set a protocol to investigate it, complete the study, and then publish results, he explained.

“We looked at what was working, and what was not working, and then how to build on those findings with actions,” he said.

For example, Wesseh was part of a research team that examined counties that were under-performing for immunization coverage. Researchers confirmed that the Ebola outbreak had weakened the struggling national immunization programme, and formulated recommendations for how to increase coverage rates and stop outbreaks of vaccine-preventable diseases, such as measles.

“We used the evidence generated to make the case for new, significant funding from Gavi, The Vaccine Alliance, to improve how we deliver immunization services and better protect the health of our children,” said Wesseh.

Results of the studies are helping the country recover from Ebola and improve overall performance, he said. Researchers presented findings of the studies to nearly 300 stakeholders, donors and potential partners at the Annual Health Sector Review Conference of 2016. Scientists hope to attract donor support for measures that show potential for impact.

“Even more importantly the experience has expanded our appreciation, at every level, for using evidence to inform our health decisions,” he added.

“In Liberia we hope to do more work with WHO and other global partners to replicate the research in more places, said Wesseh. “We are also growing the pool of researchers who can use this information and build on it for a stronger health system.”

Sierra Leone: the power of data

“The workshop happened when health leaders and district officers were thinking through lessons learned from the outbreak and how to go forward,” said Katrina Hann, Director of Research and Health Information at Partners in Health in Sierra Leone, and a SORT IT facilitator.

Speaking of the workshop’s value to participants, she said: “They learned how routine health data could be leveraged for better practices and policies. Operational research and their own data sources became powerful tools to improve the health system – that was exciting to see.”

The emphasis on participants becoming mentors for their peers has galvanized momentum for more research, she explained. Sierra Leone now has a group of health managers who are demonstrating to colleagues how this research can inform their work, and interest is high wherever the findings are presented.

Building on the results, Hann and Dr Tom Sesay, a District Medical Officer who participated in the training, are now examining routine health data from a national eye health campaign and a comprehensive care clinic for Ebola survivors to analyze the population’s health needs in the immediate recovery phase.

Results will inform a package of assessment and care for preventing and addressing EVD disease complications during this critical period.

Hann said the SORT IT experience has sparked engagement and interest in operational research at a new level: “We hope for additional support from global and local health partners to do another round of the training and build on this impact and momentum.”

More about SORT IT

SORT IT is a global training initiative that brings international research experts together with health leaders and specialists in countries to help identify and solve their priority challenges.

The trainings help health practitioners collate and analyze available data in their health systems to identify roadblocks to progress, and then test out practical ways to improve practices.

“This is about ministries of health and health workers utilizing their own data to find solutions and improve outcomes,” said Ramsay.

Trained participants are expected to become teachers and mentors to their colleagues, and cascade new knowledge and skills to a wider circle of health workers for broader impact.

More on research findings

Details on research projects and their findings are available in the July 2017 Public Health Action supplement, “Post-Ebola recovery in West Africa.”

SORT IT trainings in Liberia and Sierra Leone were funded by the UK Department of International Development and with support from WHO country offices and TDR.


For more information, contact:
Jamie Guth
TDR Communications Manager
Telephone: +41 79 441 2289
E-mail: guthj@who.int.

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