The Race to 2020: It’s Paved with OR.

I’m a runner, many of you know that about me. You’ve seen me, shoes in hand at a hotel in Bamako, Decatur, or Sydney.  I love running because all you need is your shoes, your running path or map, and you’re on your way! No equipment, no membership.

Our work in neglected tropical diseases (NTDs) often feels like that. We think of NTDs as “tool-ready” and the WHO NTD roadmap, in many ways, seems clear.  At ENVISION, we get the pleasure of running with many national NTD programs, supporting their efforts to conduct disease mapping, plan and scale-up mass drug administration (MDA), assess impact, and prepare for elimination.

As we near elimination, however, we are recognizing more and more that some tools are missing, and that there are critical challenges we must address in order to reach our 2020 global goals.  The questions we have require us to innovate, succeed or fail fast, learn quickly, and try again. Operational research (OR) is helping to fill the gaps, providing the evidence base for interventions that may otherwise be stalled.

Around the world, ENVISION’s support of Ministries of Health and the World Health Organization in developing and implementing control and elimination strategies has become a learning lab of sorts. Our global work gives us insight into where questions, strategies, and techniques can be put to the test, as well as an in-depth understanding of their urgent importance. Thankfully, our partnerships with Ministries of Health as well as our role in the operational research community provide the people and funding to take many of these questions forward.

In Benin, OR conducted with support from the Task Force for Global Health helped determine that MDA for lymphatic filariasis was not needed in two major urban areas.  These results gave Benin’s Ministry of Health the evidence needed to allocate funding and drug elsewhere. Likewise in Democratic Republic of Congo, recent OR found that the CCA diagnostic can also detect other forms of intestinal schistosomiasis. These results reinforce the use of the CCA as a faster and more sensitive diagnostic tool, but have also helped the national NTD program to understand the magnitude of disease more fully and emphasized the need for increased investments in water and sanitation. These projects advance our understanding on the ground, but also provide the crucial evidence for global NTD policy changes to occur.

The implementation of operational research, however, is no easy task. In our role, ENVISION staff often help connect programmatic questions to research opportunities, though this facilitation role is certainly not without its demand on time and resources to make it work. Adding on a few questions to an existing survey for soil-transmitted helminths, for example, seems simple at first, but it requires significant coordination and effort, and if not carefully designed and carried out, risks compromising the fundamental program work at hand, an unacceptable outcome. Therefore, it’s important that we continue to maintain our focus on the questions critical to reach the WHO roadmap goals. In the same way, we must ensure we never compromise the progress of national NTD programs in order to advance research for its own sake.  

It’s for this reason that COR-NTD has quickly become an important meeting of the minds in our community. It’s an opportunity to step back and address critical challenges, but also to spur innovation –asking how we can do things quicker, faster, cheaper, and to make sure NTD program managers are getting the answers to their crucial questions. The like-minded focus and commitment to the road ahead make this a tremendous group to be a part of, and I’m happy to have you all as my running partners in this race to see a world free of NTDs. 

Lisa Rotondo is ENVISION Project Director at RTI International