This case study is part of our series on academic-practitioner collaborations in humanitarian settings. In this post, we feature the Structured Operational Research and Training Initiative (SORT IT), a training programme for healthcare practitioners in low- and middle-income countries (LMICs) led by TDR, the Special Programme for Research and Training in Tropical Diseases.
The SORT IT programme trains healthcare practitioners including doctors, nurses, paramedical officers, and programme managers in conducting operational research. This aims to generate insights into the interventions, strategies, and tools that improve the quality and reach of health systems. SORT IT was launched in 2012 by TDR, adapting a training model conceived by the International Union Against Tuberculosis and Lung Disease in collaboration with Médecins Sans Frontières (MSF). Today, SORT IT is led by TDR, a cross-UN research and training programme based at the World Health Organization (WHO), and supported by 87 implementing partners across 97 countries, including NGOs, disease control programmes, and academic institutions.
Although SORT IT focuses on healthcare-related research in LMICs more broadly, the model has a track record of successful implementation in humanitarian contexts. This post outlines key features and transferable insights from the SORT IT programme, focusing on its approach to better aligning academic tools and practices with the needs and objectives of practitioners.
An apprenticeship model for integrating operational research and training within health systems
Prior to SORT IT, healthcare practitioners were typically taught research methods through week-long educational courses. But these courses were often disconnected from frontline health systems, making it difficult for participants to apply their skills on returning to the workplace. Using an apprenticeship model, SORT IT was designed to address this problem by integrating research training directly within the health system, offering practical training and mentorship throughout the research process. This way, healthcare practitioners are able to better ground their training in the practicalities and challenges within their local health systems. Building capacity for operational research is especially valuable for actors in LMICs, where large volumes of data in public health systems and NGOs often remain underused or unavailable for generating actionable insights. Topics that have been previously researched by practitioners include diseases like tuberculosis, malaria, HIV/AIDS, antimicrobial resistance, as well as outbreaks and emergencies.
SORT IT’s implementing partners run SORT IT training cycles, which last 9 to 12 months and are open to healthcare practitioners who are engaged in disease programmes. Participants are usually required to hold a Master’s in Public Health and/or be nominated by a given institution or the country’s Ministry of Health.
The programme involves lectures, small-group mentoring, and plenary sessions where participants share their draft papers and receive feedback from their peers. To remain in the programme, participants must meet certain milestones, including submitting research protocols, showing evidence of ongoing data collection and manuscript submissions along fixed timelines. For those who are not part of the SORT IT cohort but would like to learn skills for operational research, open-access video resources are also available online.
A diverse network of expert mentors
Throughout the modules, support is provided by mentors who have extensive expertise in conducting operational research in LMICs. Mentors come from diverse sectors and organisations, including academia, NGOs, and WHO offices. While research expertise is key, crucially mentors must also possess strong interpersonal skills required to train SORT IT participants with a hands-on approach, many of whom are publishing scientific papers for the first time. Mentors guide participants in the complete research journey from formulating research questions and submitting papers in peer-reviewed journals to effectively communicating findings to decision-makers to influence policy and practice.
A “train-the-trainer” component is also in-built into the SORT IT programme, with around 40% of SORT IT alumni becoming mentors by assisting with the facilitation, mentoring, and paper reviews of subsequent SORT IT participants.
Building self-sustaining and practitioner-led capacity
Most academic-practitioner collaboration models focus on making the expertise available within academic institutions more relevant and accessible to practitioners. In contrast, the SORT IT model prioritises building practitioner-led research capacity in LMICs, aiming to foster localised decision-making in public health and reduce dependency on external expertise. SORT IT also follows an iterative model, where each cohort identifies problems in healthcare and makes recommendations to stakeholders. Subsequent cohorts then assess the changes made to the health service, enabling the programme to directly measure the practical impact of SORT IT research and inform future areas of study. This creates a cyclical structure that allows the continuous implementation and measurement of changes to health systems. Around half of trainees also conduct their own independent research after a SORT IT cycle, demonstrating that operational research capacity is effectively built past the requirements of the course.
– Rony Zachariah, Scientist, TDR“Most research is conducted by researchers based in academic institutions. While their work is invaluable and complementary, there is a pressing need for building research capacity at the frontline. Our goal is to empower frontline health workers with the tools of research, enabling them to analyse their challenges, address constraints, and use evidence to improve their programmes and outcomes.”
An in-built metrics system for monitoring real-world impact
In academia, publication is often a critical milestone, which can sometimes overshadow the pursuit of practical, real-world applications of research. The SORT IT model addresses this challenge by treating publication as the beginning of a process, with the final milestone being practical impact – measured by improvements in health systems and their effects on people’s livelihoods. SORT IT closely monitors the practical impact of its research using an in-built metrics system and an alumni network that tracks participants’ progress.
In past cohorts, 95% of students have published a paper and around 70% have reported an impact on policy or practice. For example, a study by a SORT IT participant found gaps in the humanitarian response of male migrants travelling alone to Europe, exposing them to health and protection risks. As a result, violence prevention and care strategies were devised to more effectively incorporate men into assistance programs. Another recent survey of past SORT IT participants who are currently involved in mpox preparedness and response found that 93% are applying the skills they acquired through the course.
Better integration and collaboration with academia
One of the strengths of the SORT IT programme is its ability to align the practices and objectives of operational research with the realities faced by practitioners in their work environments. Recognising this strength, the model has also been expanded and integrated into academic institutions. At the University of Nairobi, for example, the SORT IT framework is embedded within the Master’s in Public Health programme. Students are matched with disease control programmes and collaborate to develop research questions that are directly relevant to programme managers. This fosters a shared understanding of the context and purpose for the research, ensuring that it remains relevant and timely for practitioners.
For past SORT IT participants interested in continuing their research, the initiative has evolved to allow arrangements with universities for them to pursue PhDs while remaining embedded within their health systems. This is valuable for healthcare practitioners in LMICs, where staffing shortages are common. Frameworks like these can be applied to humanitarian academic contexts to ensure humanitarian research remains practically relevant.
Providing tailored support to enable real-time data collection in humanitarian settings
Conducting research and collecting data in humanitarian settings will involve additional challenges compared to other public health research. These may include security risks, ethical considerations, logistical constraints, rapidly changing contexts, or challenges with data reliability.
Nevertheless, rapid real-time data collection, analysis, and communication to decision makers is crucial in humanitarian settings to steer health systems when services are at breaking point. For practitioners working in humanitarian contexts, the SORT IT programme offers support with designing and setting up effective and responsible data collection processes, especially in places where health systems are not set up to collect data. Importantly, this includes obtaining national ethics clearance for publications which can be especially difficult in humanitarian contexts.
By focusing on strengthening the operational research capacity of practitioners, the SORT IT model demonstrates a sustainable approach to translating academic research tools and approaches into practice, especially in particularly challenging environments.