Guest post by Ruby Siddiqui and Jane Greig, Epidemiologists, Manson Unit, Médecins Sans Frontières, London, UK
Today sees the publication in PLoS Medicine of an article by Médecins sans Frontières (MSF) on quality control in laboratory work in the resource-poor settings where the agency works. Last week MSF published an article on rapid diagnostic tests in malaria. MSF is a medical humanitarian organisation, best known for responding to tragedies such as the earthquake that devastated Haiti 2 weeks ago.
Although MSF is not a research organisation it does carry out a considerable amount of medical and scientific research, publishing on average 60 peer-reviewed publications per year on topics including malnutrition, mental health, and the effect of user fees in developing countries. But the majority of MSF research is on infectious diseases such as HIV/AIDS, malaria, tuberculosis (TB), visceral leishmaniasis, and African and American sleeping sicknesses.
So why does MSF engage in research?
MSF specializes in medical care in acute emergencies. In natural disasters, such as the South-Asian tsunami, operational research helped guide our emergency response, and this approach will be used again in the Haiti earthquake response.
The key feature of research carried out by MSF is that it is always ‘operational.’ Operational research is defined as ‘the search for knowledge on interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programmes in which the research is being done. MSF research always aims to be relevant and applicable to field operations and settings. Consequently, research is never done for research’s sake.
Most of MSF’s research such as KAP (knowledge, attitude, and practices), mortality, and nutrition surveys, adherence studies, and routine data analysis is undertaken to gauge the type and size of response required and improve and target interventions appropriately. Little of this work is published externally. But some of these studies contain useful generalisable knowledge that should be shared. Recent examples include strategies for sustaining antiretroviral (ARV) therapy and TB drug supplies during slum violence in Nairobi; and a follow-up survey that discovered high levels of bednet usage and ownership, 2 years after a distribution programme in Sierra Leone (Gerstl S, et al. Long-lasting insecticide-treated net usage in eastern Sierra Leone – the success of free distribution. Trop Med Int Health (in press).
Part of the remit of MSF is to bear witness (known as ‘temoignange’ within the organisation) to the suffering of the populations in which we work and advocate change at local and international levels. The people of Port-au-Prince, Haiti, had already endured years of violent conflict before the recent earthquake devastated their city. Epidemiological surveys in the areas where MSF was working were used to document the extent of the violence and its effects on access to health care.
But MSF has also witnessed suffering from lack of access to essential drugs and medical services. One noteworthy example of the use of MSF operational research in advocacy involved studies in 18 countries in Asia and Africa between 1996 and 2004 that showed that existing anti-malaria drugs had become ineffective. As a result, MSF introduced artemisinin-based combination therapy (ACT) for first-line treatment of malaria and launched the ACT NOW campaign to advocate global change in malaria treatment policy. In addition MSF was instrumental in advocating for universal access to ARVs and demonstrated that the provision of comprehensive HIV care, including ARVs, in chronic conflict settings can be feasible and effective by contingency planning for care delivery.
The breadth and calibre of operational research has endowed MSF with international credibility but more importantly, influence. Our unique perspective and strong evidence base has given us access to key decision-makers and bodies, allowing us to influence policy change and improve health outcomes in our programme locations.
Failure to cast a critical eye internally risks reducing the quality and impact of our services. Failure to generate and disseminate data from our often remote and resource-limited settings and use that data to lobby for global improvement in health puts us in danger of neglecting the wider picture. To this end we also feature all our published research free-to-access here.