Box 3. Eleven tips for operational researchers working with health programmes: our experience based on implementing Tamil Nadu Kasanoi Erappila Thittam* (TN-KET), India.

Tips for an operational researcher		What we did in TN-KET
Broad principles
1	Design the OR on priority areas and make it a health system initiative	TN-KET focuses on reducing TB deaths and is implemented as a health system initiative involving the key directorates under the state health department.
2	Implement simple and holistic ideas	We made significant efforts to provide enabling environment to complete the care cascade (Figure 2) by identifying nodal inpatient care facilities, and nodal physicians and sensitizing them with an ‘inpatient care guide for adults with TB who are severely ill’. TN-KET is simple in a sense the data capture (paper-based and in e-tool) is limited to the variables essential for programmatic monitoring
3	Embed the new intervention and the OR within routine programme settings	The state and districts included the TN-KET monitoring indicators (Figure 3) in the routine monthly/quarterly reports, state internal evaluations and review meetings of the broader programme (NTEP in this case).
4	Aim for long-term engagement and not ‘one off.’	We intend to work together for two years
Strategic planning
5	A big team of investigators	All the partners, including all district-level programme managers, have been involved as a co-investigator (n > 60) under TN-KET’s OR component
6	Role of joint leadership	The state TB officer of Tamil Nadu and a senior Scientist (expert in operational research) from ICMR-NIE jointly lead TN-KET
7	Decentralized decision-making	Decentralizing decision-making at district-level through the technical support unit. At ICMR-NIE-level, weekly internal review meetings for technical supporters. In addition to updating the status of the districts under them, new ideas are brainstormed from time to time. Supportive supervision visits by technical supporters
8	Work well in advance	All the activities in the preparation phase (December 2021 to March 2022) of TN-KET were started well in advance including capacity building and training for state-level and district-level NTEP managers We informed all the 30 districts well in advance about deadline for the start of pilot and implementation phases
Implementation planning
9	Conduct pilot study	Large-scale pilots instead of small scale Report submitted and discussed at a state-level review meeting
10	Smart use of e-tools for sharing material, data capture and monitoring	The district TB cells are provided with three sets of e-tools. 1. TN-KET tools folder -shared over Google Drive 2. Severe TB Web Application (TB SeWA)- a simple case-wise web-based application to track the TN-KET care cascade (Figure 2) 3. an online monitoring tool – a spreadsheet stored in Google Drive
11	Plan operational research publications at frequent intervals	We identified various manuscripts across the study period, the lead and the deadline for submission

NTEP: National TB elimination programme; OR: operational research; ICMR-NIE Indian Council of Medical Research – National Institute of Epidemiology; *means TB death free project in Tamil language.