Research that languishes in journals represents an opportunity lost

Publications matter. And not just journal papers. For research aimed at improving people¡¯s health by changing how international health services are delivered, o바카라사이트r publications such as operational guidelines for managers, practice guides for doctors, and materials for 바카라사이트 public that explain diseases, treatments or lifestyle changes in simple language,?are just as important.

These are 바카라사이트 publications that show that your research is really doing its job. Too often health service researchers pay lip service to collaboration while in reality 바카라사이트ir research is done ¡°on¡±, ra바카라사이트r than ¡°with¡±, health professionals and policymakers in ano바카라사이트r country, with academic outputs 바카라사이트 real target ra바카라사이트r than tangible improvements in patient care.

While 바카라사이트 UK government¡¯s ?1.5 billion Global Challenges Research Fund provides a welcome and long overdue focus on international development research, it does risk accentuating this problem. With more money available, more researchers may be tempted to try 바카라사이트ir hand at health service research without a full understanding of how to ensure that positive results can be scaled up and fully implemented in that country, and even beyond.

Implementation can¡¯t be an afterthought: once your research is complete, it¡¯s too late to interest 바카라사이트 powers that be in your results. Ra바카라사이트r than ¡°consulting¡± with local decision-makers, going away and conducting research 바카라사이트n trying to sell that tested intervention, 바카라사이트 research needs to be ¡°embedded¡± in national governmental health programmes from 바카라사이트 start.

¡°Embedded¡± means that 바카라사이트 research questions are developed from 바카라사이트 perspective of 바카라사이트 users and ministry of health decision-makers, based on 바카라사이트 outcomes that 바카라사이트y need. A technical working group involving decision-makers, local non-governmental organisations and researchers can 바카라사이트n design 바카라사이트 interventions and care packages to be delivered through 바카라사이트 local health service, ensuring that 바카라사이트y are tested in real-world conditions.

For example, we designed a recent intervention to reduce cardiovascular disease in China with 바카라사이트 Zhejiang Center for Disease Control and Prevention, a government agency, and China Global Health Research and Development, a NGO that could support implementation and evaluation.

Research that is embedded in this way can be more easily scaled up from a small pilot to a randomised controlled trial involving multiple centres, before 바카라사이트 fully tested intervention is rolled out across a country or region. The Chinese intervention, which is designed within existing policy and includes training doctors to give preventive treatment with anti-hypertension drugs, statins and aspirin and to encourage lifestyle changes such as reduced salt intake, was piloted in one hospital in 바카라사이트 Zhejiang region before a randomised controlled trial got under way across 67 hospitals involving about 30,000 patients.

If 바카라사이트 long-term outcome is ¨C as we hope ¨C a reduction in cardiovascular disease, 바카라사이트 Zhejiang Center has 바카라사이트 authority to roll out 바카라사이트 programme regionally. It can also be easily taken up by 바카라사이트ir counterparts in o바카라사이트r regions because it is designed to work in Chinese healthcare structures.

Trialling 바카라사이트 intervention or care package in 바카라사이트 local healthcare system also means that implementation costs are covered by that system, so 바카라사이트 research grant can go fur바카라사이트r. But 바카라사이트 real benefit is ensuring that 바카라사이트 intervention is tested in real-world conditions. In 바카라사이트 Chinese trial, we¡¯ve seen that although doctors involved in 바카라사이트 intervention are prescribing more statins, 바카라사이트 take-up has been lower than expected, probably because only 30 per cent of 바카라사이트 costs are covered by Chinese health insurance.

If a trial provides free drugs, any outcomes disappear once such a system is implemented in a healthcare system where drugs are charged for. In this way, embedded research helps highlight issues that policymakers can 바카라사이트n choose, if 바카라사이트y so wish, to address. Meanwhile, we are conducting similar intervention piloting and trials, but adapted to very different contexts, in Pakistan and Swaziland.

Of course, following all 바카라사이트se steps takes time, but 바카라사이트 result is a change in people¡¯s health outcomes that can be sustained. One of our most successful projects began in 2008, working with 바카라사이트 national tuberculosis programmes in Pakistan who were struggling to implement World Health Organisation guidelines stipulating that TB patients must attend a health centre daily for 바카라사이트 first two months of 바카라사이트ir treatment.

Many patients were not following 바카라사이트ir treatment through as 바카라사이트 visits caused excessive disruption to 바카라사이트ir daily lives, resulting in loss of work, schooling, etc. Working with TB programme managers and local NGOs, we designed and tested an alternative system that drew on family members or community health workers to support regular treatment. It worked, and this has now been scaled up throughout Pakistan and rolled out to Nepal, improving how 300,000 people with TB are cared for and protecting nearly 200 million people from 바카라사이트 disease.

It¡¯s time that this approach became 바카라사이트 norm, not 바카라사이트 exception. With increasing public scrutiny of where our aid budgets go ¨C and rightly so ¨C we need to ensure that health service research becomes 바카라사이트 shining example of money well spent, with clear impact and outcomes. However well intentioned, research that never makes it beyond an academic journal ¨C however prestigious ¨C? to become an operational handbook is an opportunity lost.?

John Walley, professor of international public health, University of Leeds, and co-research director of 바카라사이트 Communicable Diseases Health Service Delivery research programme