West African implementation research approaches profiled

TDR news item
5 July 2017

TDR’s work building capacity for implementation research in West Africa was presented to members of TDR’s Joint Coordinating Board (JCB) at the annual meeting in June. This includes a new West African regional network on tuberculosis, and training in Ghana that is being used to increase adoption of new health technologies.

TDR scientists Corinne Merle and Olumide Ogundahunsi highlighted the need and potential for this type of research that is focused on increasing access to health products and improving the effectiveness of proven interventions. They cited estimates that between 66% and 85% of deaths among Africa's maternal, newborn, and children under the age of 5 could be avoided by effectively implementing current interventions.

The World Health Organization’s tuberculosis department has estimated decreases in new cases of 10% a year by optimizing the use of existing and new tools.

Global TB trends and options
Global TB trends and options
Credit: WHO/GTB

Reducing the burden of tuberculosis in West Africa

The West African Regional Network for TB Control (WARN-TB) was set up by TDR to increase the region’s capacity to better utilize existing tools – diagnostics, drugs and other interventions. Oumou Bah Sow from Guinea Conakry, the co-chair of WARN-TB, explained to JCB members how the 16 countries with 3 different languages – English, French and Portuguese – are working together to reduce the burden of the more than 250 000 new cases each year.

Caption:  From left: Olumide Ogundahunsi, Margaret Gyapong, Oumou Bah Sow, Corinne Merle
Caption: From left: Olumide Ogundahunsi, Margaret Gyapong, Oumou Bah Sow, Corinne Merle
Credit: WHO/TDR/Jamie Guth

Since TDR’s seed funding in 2015 and ongoing technical support, 15 out of the 16 countries have a national TB task force with terms of reference. These committees are embedded in the ministries of health and will next have support from the The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) through their country grants.

Two regional workshops provided country TB programme officers with training on how to use and analyse TB data. In collaboration with WHO Global TB, the countries piloted the development of a TB surveillance system that provides real-time monitoring and surveillance, helping them define TB control gaps and research priorities.

Three TB control issues were found to be common across the region: the need to improve the detection of cases, reduce the lethality of TB, and reduce the numbers of patients stopping treatment before completion.

Out of this analysis came proposals for many implementation research projects to address the issues. The Ghana and Senegal funded pilot studies for intensifying TB case finding in children were so promising they are now being replicated in Guinea and next year in Burkina Faso. See more on this project here.

Liliana Padilla Rodríguez, the JCB member representing the government of Mexico, praised this model. She said it shows how the training led to projects that were funded by both national government sources and international funders like the Global Fund.

Increasing access and delivery of new health technologies in Ghana

The second project profiled was a pilot to increase capacity in Ghana, Indonesia and Tanzania to deliver new health technologies, called the Access and Delivery Partnership (ADP). This is a joint effort with PATH and managed by the United Nations Development Programme (UNDP), one of TDR’s co-sponsors. TDR’s contribution has been in the training on implementation research and pharmacovigilance.

Margaret Gyapong, the Director of the Centre for health policy and implementation Research at the University of Health and Allied Sciences in Ho, Ghana, gave an overview of the work in Ghana.

Using the TDR-developed implementation research toolkit, the Ghana ADP project sensitized policy-makers of the Ghana Health Service and key players of the African Regional Training Centre at the University of Ghana on the value of this research approach.

Ghana improves disease care through implementation research

Four training workshops were held for multidisciplinary teams from Tuberculosis, Yaws, Malaria and Neglected Tropical Diseases (NTD) control programmes. A scientist was embedded in each team, which comprised policy-makers and disease control department officers.

The NTD team looked into why some people did not take ivermectin as part of a mass drug administration (MDA) programme. Using anthropological approaches, the researchers found that the timing of the MDA activities conflicted with several cultural and economic practices: during Ramadan, farming or fishing seasons, periods not conducive to the campaigns.

This type of implementation research can identify simple shifts in processes like the mass drug administration timing, and test alternatives that could make huge health improvements.

From one country to global impact

TDR support for the country-led stakeholder engagement and prioritization process has resulted in a national implementation research agenda that covers 2015-2019. Ghana is also supporting other countries, providing implementation research training in Nigeria, Tanzania, Pakistan, India and Viet Nam, and working with the INDEPTH network of 52 health and demographic surveillance sites in Africa, Asia, and Oceania to build implementation research capacity.

Amy Bloom from the United States Agency for International Development (USAID) called the projects excellent examples of embedding research, so that research becomes a routine practice within control departments.

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