Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017–2021

Several operational research models exist, including the Structured Operational Research and Training Initiative (SORT IT), an outcome-oriented initiative that consists of three 1-week workshops over 9-12 months, with clearly defined milestones and expected output. SORT-IT has resulted in numerous scientific publications with first authors from low- and middle-income countries, more qualified human resources for health who significantly contributed to influencing health policy and programs in settings where the research studies were conducted. In 2017, Engenderhealth, a US-based NGO, decided to integrate operational research in its USAID-supported Fistula Care Plus program in the Democratic Republic of Congo (DRC) using a SORT-IT-like approach and building on the experience of previous SORT-IT participants. This effort aimed to build research capacity among local program staff; support partner fistula repair hospitals to document good practices, and durably increase program effectiveness and efficiency through evidence-based decision-making for continuous quality improvement. The classic SORT-IT model was tailored to the needs of local teams, facilitators, and program requirements for feasibility, acceptability, and appropriateness. Between 2017 and 2021, two courses were conducted with adaptations to ensure safety following the emergence of the COVID-19 pandemic. The flexible operational research training (FORT) course was designed to build operational research capacities among the local staff of FC+ supported sites. It builds on the classic SORT-IT model, which was modified to cope with the program and epidemic contexts. The FORT approach included a protocol development workshop, a data management workshop, and a paper writing workshop, with virtual meetings and working sessions to discuss progress and provide support to local research teams. The two FORT courses involved nine facilitators and 17 participants overall, with most participants being medical doctors from the supported hospitals. About half of the participants were women. The courses integrated online platforms to cope with the changing contexts, and most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences, with participants subsequently publishing five papers from their research after the first course. The total direct costs for both courses were $3669 per participant trained. The FORT model proved feasible, efficient, and successful, with lessons learned that may help other organizations interested in integrating operational research into their routine activities for greater effectiveness and increased country-level research capacity. Scaling up will require more adaptation efforts from programs and participating sites.