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Dr Ajay Tyagi
JR, Deptt. of community medicine,
          PGIMS, Rohtak
Contents
•   History
•   Introduction and Definitions
•   Difference from Other Researches
•   Purpose of OR
•   Scope of OR
•   Uses of OR
•   OR Potential Issues
•   Flow chart of the OR Process
•   A Case Study of Operations Research
Contents
•   Societies and journals of OR
•   Centre for Operations Research and Training (CORT)
•   Conclusion
•   References
History
• As a formal discipline, operational research
  originated in the efforts of military planners during
  World War II.
• The analytical study of military problems undertaken
  to provide responsible commanders and staff
  agencies with a scientific basis for decision on action
  to improve military operations.
• Also k/a operations research or operations analysis
History
• In the decades after the war, the techniques began to
  be applied more widely to problems in business,
  industry and society.
• Since that time, operational research has expanded
  into a field widely used in industries, finance,
  logistics, and government, moving to a focus on the
  development of mathematical models that can be
  used to analyze and optimize complex systems, and
  has become an area of active academic and
  industrial research.
Introduction and Definitions
• “OR is a process, a way of identifying and solving
  program problems.” As currently applied in health,
  family planning and other development programs,
• OR can be defined as a continuous process with five
  basic steps:
   –   1) problem identification and diagnosis,
   –   2) strategy selection,
   –   3) strategy experimentation and evaluation,
   –   4) information dissemination, and
   –   5) information utilization.
Ref: Fisher, Andrew A. et al. 1991. Handbook for
Family Planning Operations Research Design: Second
Introduction and Definitions
• The Population Council (2000) explains that,
      “Operations research helps policy-makers and
        program managers to review, redirect and
    restructure programs that have been in place for
                       many years.”
• OR uses social science and other research methods
  to provide decision-makers with empirically-based
  and scientifically-valid answers to service delivery
  problems.
Introduction and Definitions
• WHO (2003) defines OR as
• “the use of systematic research techniques for
  program decision-making to achieve a specific
  outcome.”
    OR provides policy-makers and managers with
   evidence that they can use to improve program
                     operations.
Introduction and Definitions
• The International Food Policy Research Institute
  (2005) considered that,
• “OR aims at studying the processes by which
  programs are implemented and interventions are
  delivered to intended beneficiaries.”
Introduction and Definitions
• Finally, during the working meeting on OR held in
  Geneva as part of the development of “Framework for
  Operations and Implementation Research in Health
  and Disease Control Programs”, participants agreed on.
         “Any research producing practically-usable
     knowledge (evidence, findings, information, etc.)
    which can improve program implementation (e.g.,
     effectiveness, efficiency, quality, access, scale-up,
     sustainability) regardless of the type of research
     (design, methodology, approach) falls within the
             boundaries of operations research.”
Difference from other Researches
• It is distinguished from other kinds of research by the
  following characteristics:
 It addresses specific problems within specific
  program, not general health issues;
 It addresses those problems that are under control
  of managers, such as program systems, training,
  pricing and provision of information;
 It utilizes systematic data collection procedures, to
  accumulate evidence supporting decision-making;
Difference from other Researches
 It requires collaboration between managers and
  researchers in identification of the research problem,
  development of the study design, implementation of
  the study and analysis and interpretation of results;
  and
 It succeeds only if the study results are used to
  make program decisions; publication alone is not a
  valid indicator of successful OR.”
Purpose of OR
• The main purpose is to identify, as early as possible
  in the life of a program, any shortcomings in the
  process that may affect the effective delivery of the
  intervention, and as a result, its potential impact on
  the expected outcomes.
• Thus, the overall goal of OR is to generate the
  necessary information to program planners and
  implementers that will allow them to design and test
  potential solutions to improve program delivery and
  will lead to the timely implementation of corrective
  actions.
Scope of OR
• The intent of OR is to learn about management,
  administrative, cultural, social, behavioral, economic
  and other factors that either exist as bottlenecks to
  effective implementation or could be tested to drive
  insights into new, more effective approaches to
  programming.
Uses of OR
• OR can accomplish the following:
  – Identify and solve program problems in a timely
    manner
  – Help policy-makers and program managers make
    evidence-based program decisions
  – Improve program quality and performance using
    scientifically valid methods
  – Help program managers and staff understand how
    their programs work
OR Potential Issues
• Examples of OR Potential Issues:
• The Challenges of Obtaining and Delivering
  Commodities
 The delivery system is not reaching sufficient
  numbers of the target group because of:
• Low coverage
• Failure to scale-up
• Equity issues
• Not reaching those who are stigmatized
• Insufficient staffing
OR Potential Issues
 The delivery system may be having quality issues
• Poor quality of services
• Poor diagnostic and dispensing services
• Poor information/education/communication (IEC)
  programs
• Poor referral systems
OR Potential Issues
 Managerial issues may be the main bottleneck
• These may include:
• Poor adherence to policy recommendations
• Poor record-keeping and reporting, M&E
• Poor information dissemination
• Ethical issues
• Interaction or competition with other interventions
  for other diseases
• Marketing and advocacy
OR Potential Issues
 Issues may be at the community/societal and
  individual levels
• Levels of household income that influence
  affordability
• Stigma
• Other participation barriers
• Perceptions and misperceptions
Flow chart of the OR Process
          I. PLANNING



       II. IMPLEMENTATION



      III. FOLLOW-THROUGH
Planning
1. Organize the research group and advisory committee
2. Determine issues or problems to study and frame
research questions around these
3. Develop a research proposal to answer OR questions
4. Obtain ethical clearance
5. Identify funding sources and obtain support for OR
6. Establish a budget and financial management
procedures
7. Plan for capacity building and technical support
Implementation
8. Monitor project implementation and maintain
quality
9. Pre-test all research procedures
10. Establish and maintain data management and
quality control
11. Explore together with stakeholders interpretations
and recommendations arising from the research
findings
Follow-through
12. Develop a dissemination plan
13. Disseminate results and recommendations
14. Document changes in policy and/or guidelines that
resulted from the research
15. Monitor changes in the revised program
16. Consider ways of improving the program that can
be tested through further research
Step 1: Organize the research group
a) Selecting the researchers
• Because of their major work responsibilities,
   program managers and staff will rarely conduct the
   OR themselves, but may contract with a university,
   research institute, NGO or even another unit within a
   health ministry.
• An important criterion for choosing an appropriate
   research team will likely be the availability of
   members with multidisciplinary backgrounds.
Step 1: Organize the research group
b) Form an advisory committee or working group
• After researchers are chosen, the program managers
   and staff still have an important role to play in the OR
   to ensure the results meet program needs.
• A simple advisory committee or working group that
   consists of five to six people including researchers,
   program managers and if possible, constituencies of
   people affected by the issue/problem could meet on a
   regular basis (e.g., monthly) to ensure that there is
   ownership of the results by all concerned parties and
   that the results are put to use in a timely fashion.
Step 2: Determine issues or problems to study
 and frame research questions around these

• Questions addressed by OR should arise out of the
  actual implementation of a health or disease control
  program and should emerge from discussions with
  program managers, researchers and clients of the
  services.
Step 2: Determine issues or problems to study
 and frame research questions around these

• OR questions may be defined at three levels.
  – 1. Identifying the health program implementation
    issue or problem- from basic M&E reports
  – 2. Considering underlying reasons for the issue or
    problem that can be examined through OR, and
  – 3. Proposing possible solutions that can be tested
    to address the issue or problem.
Example of Developing the OR Questions

• 1. Identifying the Problem
• Reports at a health clinic may show that despite the
  presence of a program offering anti-retrovirals (ARVs)
  to HIV-positive clients, the prevalence of
  opportunistic infections (OI) such as diarrhea and
  pneumonia among clients has risen.
• An OR question arising at this stage may be “Why are
  HIV-positive clients experiencing poorer health
  outcomes?”
Example of Developing the OR Questions

• An OR study examining this question might discover
  that HIV-positive clients are not adhering to their
  treatment regimens and are therefore more
  susceptible to developing other illnesses.
Example of Developing the OR Questions
• 2. Considering the Reasons
• An OR question at this level may be “Why are HIV-
  positive clients not adhering to their treatment
  regimens?”
• Research might discover that clients are not adhering
  to their regimens for several reasons,
   – such as poor communication between clients and
     staff;
   – low-income clients do not have enough money to
     afford transportation to the clinic to refill their
     prescriptions;
Example of Developing the OR Questions

– Clinic hours are too short and clients cannot afford
  to miss work to visit the clinic during the day;
– clients are reluctant to visit the clinic because of the
  perceived stigma associated with seeking services
  there;
– or clients are discouraged from returning to refill
  their prescriptions because of frequent drug
  shortages.
Example of Developing the OR Questions
• 3. Testing the Solutions
• For example, in regards to the barriers to drug
  adherence discussed above, one possible solution to
  address the problem of drug stock-outs may be to
  conduct an in-service training for clinic staff to
  improve drug forecasting.
• Another potential solution may be to develop clinic-
  based performance standards that inform the basis
  for problem solving among staff.
• Also, OR could be designed to examine and compare
  the effectiveness of both of these approaches.
Step 3: Develop a research proposal to
           answer OR questions
• A research proposal is a document that outlines- in
  as much detail as possible –
   – what the research is about,
   – why it is important,
   – how the researchers plan to carry it out and
   – how the results may be used.
Step 4: Obtain Ethical Clearance
• Any research that studies human beings – whether they
  are community members or health workers – may put
  those people at risk.
• Even with “simple” interviews there are costs involved,
  such as time of the respondent and risks involved in
  sharing personal information with a stranger (the
  interviewer).
• As part of the proposal, researchers need to spell out
  the details of how they will explain research procedures
  and risks to potential participants and obtain evidence
  (a signature, a mark) that participants agree to take part
  in the research.
Step 4: Obtain Ethical Clearance
• Note that consent forms must be written in a
  language that research participants can understand.
• Most research institutions in particular have an
  “institutional review board” (IRB) or a “committee
  on human subjects” that reviews and approves the
  ethical and safety issues surrounding a research
  proposal before it can be implemented.
Step 5: Identify funding sources and
           obtain support for OR
• Several large international donor partners have been
  sponsoring OR in the context of their support for
  national health and disease control programs
• Tropical Disease Research Program
• USAID
• Global Fund to Fight AIDS , Tuberculosis and Malaria
• International Bank for Reconstruction and
  Development (IBRD, the World Bank),
• Rockefeller Foundation
Step 5: Identify funding sources and
           obtain support for OR
• Council for the Development of Social Science
  Research in Africa (CODESRIA)
• Bill & Melinda Gates Foundation
• International Development Research Center
• Wellcome Trust
• Pharmaceutical companies and others who produce
  disease control products often offer small grants for
  OR in the countries where they work .
Step 6: Establish a budget and
     financial management procedures
• Funding agencies will expect that the researchers will
  have devised a comprehensive budget and can
  justify the need for each item.
• Since researchers are planning OR, researchers may
  have budget items that relate to the research itself as
  well as to any programming activities that are being
  tested.
• Any research project should include on its
  administrative staff a financial officer (accountant).
Step 7: Plan for capacity building and
             technical support
• Capacity building for OR means ensuring that all
  persons involved in carrying out the research have
  the skills and knowledge necessary to perform their
  roles.
• capacity-building plans should not consider sending
  people off to another country for a five-year
  doctorate program but rather find ways to help
  those involved in the project right now do their jobs
  better.
• In implementation - as in planning - there is a need
  to continue to involve key program managers, staff
  and communities in the process (e.g., through the
  advisory committee) to ensure that the OR remains
  based in and addresses the needs of the health or
  disease control program.
Step 8: Monitor project implementation
          and maintain quality
• A key issue of quality control in research is
  maintaining fidelity (faithfulness) to implementation
  of the research as planned.
• One role of the small advisory committee can be
  regularly checking that the protocol procedures are
  being followed correctly and in a timely manner.
• The research team must have a plan of action or
  work plan.
• Regular progress meetings are needed among the
  research team members to ensure that the research
  plan is being implemented as intended.
Step 8: Monitor project implementation
          and maintain quality
• It is important to stress again that monitoring of the
  research should also be done as part of regular team
  meetings.
Step 9: Pre-test all research procedures

• Research instruments, whether quantitative
  (questionnaires, observation checklists) or qualitative
  (FGDs, in-depth interviews) should be both valid and
  reliable.
• Test out the instruments under the type of
  circumstances where they will be used in the field,
  possibly in a different community not within the
  study area with similar characteristics to the study
  community.
Step 10: Establish and maintain data
      management and quality control
• Quality data management begins with the design of
  the research instruments.
• In short, one needs to ensure that the study
  variables are operationalized to reflect the objectives
  of the study.
• The instruments must be easy for the data collectors
  to use.
• Ambiguities for both respondents and data collectors
  should be removed.
Step 10: Establish and maintain data
      management and quality control
• During field work, research supervisors should be
  trained to observe the data collectors regularly.
• Senior researchers must be in the field to ensure
  that the data collectors take the project seriously.
• Data entry (computer entry of survey results, typing
  of interview transcripts) should begin while data
  collectors are still in the field.
• Data entry clerks should be trained on the job with
  actual completed instruments.
Step 10: Establish and maintain data
      management and quality control
• Missing values should be caught at all stages – daily
  review, data entry, and simple frequency analysis.
• One should be sure there are no missing values.
Step 11: Explore together with stakeholders
 interpretations and recommendations arising
           from the research findings
• The next phase, the “follow-through”, involves the
  actual dissemination and use.
• Prior to dissemination it is important for the research
  team and the stakeholders (e.g., community leaders,
  program managers/ staff, donors) who were
  members of the project advisory committee or
  working group to review the results and have a clear
  and shared understanding of the implications of
  these findings.
Step 11: Explore together with stakeholders
 interpretations and recommendations arising
           from the research findings
• The first meeting about the findings should occur
  within a week after data entry is finished and a set of
  preliminary frequency tables or qualitative interview
  summaries can be produced.
• By the second meeting, the group should start listing
  the key findings and the related implications for
  improving the program.
• They can brainstorm about appropriate audiences
  with whom to share this information in a timely
  manner.
Step 11: Explore together with stakeholders
 interpretations and recommendations arising
           from the research findings
• Feedback to communities is essential
• An important consideration is reviewing the key
  stakeholders that can act on the information and
  recommendations
• Those who provide financial and technical support
  for OR, including national stakeholders, are
  concerned about the long-term effects of that
  research.
• Collaboration with policy-makers, provisions for
  sustainability, and responsiveness to local needs are
  among the ways of ensuring sustainability of
  program changes that result from OR
Step 12: Develop a dissemination plan
• Dissemination activities must be matched to key
  audiences, including policy-makers, program
  managers, service providers, program beneficiaries
  and donors
   – Annual presentation of research findings at
     national and international conferences
   – Publication of research findings in national and
     international peer-reviewed journals
   – Meetings with local and national stakeholders to
     discuss research findings
   – Press releases and briefings
Step 12: Develop a dissemination plan
• Regardless of audience the team needs to think
  about the advocacy process.
• This entails determining who has the best “voice” to
  promote the results with the audience most likely to
  act on the findings
Step 13: Disseminate results and
             recommendations
• Issues like timing, venue and opportunity need to be
  considered.
• There are several elements to timing, including
  presenting the results after the research has been
  fully concluded.
• Dissemination must take into consideration the
  convenience of the audience/stakeholders
• Hold an event in the ministry auditorium.
Step 14: Document changes in policy and/or
   guidelines that resulted from the research
• OR teams should ask, “Did the implementing/
  collaborating organization(s) “act on” the results
• “acting on the results” consists of implementing the
  actual services of the intervention or the activities to
  support those services (e.g., training courses,
  development of service delivery guidelines, changes
  in allocation of personnel, production and testing of
  IEC materials, supervision, monitoring)
Step 15: Monitor changes in the
              revised program
• For example, an OR field test may have found that in
  several communities, distribution of ITNs by
  community-chosen volunteers achieved greater
  coverage and use than campaigns based at the district
  health facilities.
• If the national malaria control program adopted and
  implemented this new approach, one would want to
  monitor whether in fact after scale-up the coverage
  increased uniformly across the country. The original OR
  team could still be involved in conducting coverage and
  use surveys around the country, even though this
  activity would be part of routine M&E activities.
Step 16: Consider ways of improving the program that
       can be tested through further research

• The regular program monitoring surveys just
  mentioned may find that in most areas of the
  country ITN coverage and use increase and reach
  program targets.
• Unfortunately, the surveys might have found that in a
  riverine/coastal area or among a group of primarily
  nomad people the new strategy did not work any
  better than the previous campaign approach.
• This finding raises new OR questions and can start
  the OR process over again with a new focus.
A Case Study of Operations Research

Malawi : Linking Civil Society with Care for
               Tuberculosis
• An OR study was conducted by the Research for
  Equity and Community Health (REACH) Trust to
  explore barriers experienced by the poor in one
  squatter area in the capital city of Malawi, Lilongwe.
• Although TB services are free at the point of delivery,
  it was found that the poor incur much higher
  transport and opportunity costs than the non-poor.
• REACH Trust went back to the community to make
  the findings known.
• Stakeholders at community level and local leaders
  were briefed about the research findings.
• REACH Trust posed the question to the community in
  order to include their views and opinions about how
  to solve their problem.
• Based on the suggestions from the community,
  REACH Trust then developed the intervention,
  “Linking Civil Society with TB Care” to bring TB
  services closer to the people.
• A main objective of this program was to reduce
  transport and opportunity costs incurred by the poor
  in the area in order to improve use of TB services.
Societies and journals
                     Societies
• The International Federation of Operational Research
  Societies (IFORS) is an umbrella organization for
  operational research societies worldwide,
  representing approximately 50 national societies
  including those in the US, UK, France,[Germany,
  Canada, Australia, New Zealand, Philippines,
  India, Japan and South Africa.
Societies and journals
• The Operational Research Society of India (ORSI)was
  founded in 1957, the Society is affiliated to the
  International Federation of Operational Research
  Societies (IFORS).
• The headquarter of the Society is located in Kolkata
  at 39, Mahanirvan Road, Kolkata 700029, India.
• The Society publishes a quarterly journal OPSEARCH.
Societies and journals
• In 2004 the US-based organization- Institute
  for Operations Research and the Management
  Sciences (INFORMS) began an initiative to market
  the OR profession better, including a website entitled
  “The Science of Better” which provides an
  introduction to OR and examples of successful
  applications of OR to industrial problems. This
  initiative has been adopted by the Operational
  Research Society in the UK, including a website
  entitled “Learn about OR”
Societies and journals
                              Journals
• INFORMS publishes twelve scholarly journals about
  operations research, including the top two journals
  in their class, according to 2005 Journal Citation
  Reports. They are:
   – Decision Analysis
   – Information Systems Research
   – INFORMS Journal on Computing
   – INFORMS Transactions on Education (an open access journal)
   – Interfaces: An International Journal of the Institute for Operations
     Research and the Management Sciences
   – Management Science: A Journal of the Institute for Operations
     Research and the Management Sciences
Centre for Operations Research and
          Training (CORT)
Centre for Operations Research and
              Training (CORT)
• CORT established in 1991, is one of the leading
  research and training organization in India.
• Its headquarter is in Vadodara, Gujarat
• Broadly its thrust areas are health, demography,
  social and development issues, such as education,
  rural development, non-conventional energy which
  have immediate policy relevance.
• CORT is actively involved in building research
  capacity of NGOs and other research organizations
  by regularly organizing training workshops and
  understanding collaborative research with NGOs.
Centre for Operations Research and
              Training (CORT)
• CORT is responsible for running State Training and
  Resource Center (STRC) to provide training and build
  capacity of all NGO partners who are implementing
  targeted intervention among high risk groups in the
  state of Gujarat and Daman and Diu.
• Other areas in which CORT is pro-actively involved
  are enhancing utilization of research findings by
  promoting a culture of evidence based decision
  making and strengthening advocacy activities.
Conclusion
• OR needs to be integrated as an essential part of
  monitoring and evaluation (M&E) efforts.
• Thus, the concept of M’OR’E could become a new
  paradigm enhancing the practice of integrating
  monitoring, research and evaluation dimensions as
  one common component into program management
  systems.
References
 Framework for Operations and
  Implementation Research in Health and
  Disease Control Programs
 Fisher, Andrew A. et al. 1991. Handbook for
  Family Planning Operations Research Design:
  Second Edition. New York: Population Council
 Oxford Dictionary of the US Military
 http://en.wikipedia.org/wiki/Operations_research
  #cite_note-hsor.org-3
 http://www.hsor.org/what_is_or.cfm
 http://www.orsi.in/
Operational research dr ajay tyagi

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Operational research dr ajay tyagi

  • 1. Dr Ajay Tyagi JR, Deptt. of community medicine, PGIMS, Rohtak
  • 2. Contents • History • Introduction and Definitions • Difference from Other Researches • Purpose of OR • Scope of OR • Uses of OR • OR Potential Issues • Flow chart of the OR Process • A Case Study of Operations Research
  • 3. Contents • Societies and journals of OR • Centre for Operations Research and Training (CORT) • Conclusion • References
  • 4. History • As a formal discipline, operational research originated in the efforts of military planners during World War II. • The analytical study of military problems undertaken to provide responsible commanders and staff agencies with a scientific basis for decision on action to improve military operations. • Also k/a operations research or operations analysis
  • 5. History • In the decades after the war, the techniques began to be applied more widely to problems in business, industry and society. • Since that time, operational research has expanded into a field widely used in industries, finance, logistics, and government, moving to a focus on the development of mathematical models that can be used to analyze and optimize complex systems, and has become an area of active academic and industrial research.
  • 6. Introduction and Definitions • “OR is a process, a way of identifying and solving program problems.” As currently applied in health, family planning and other development programs, • OR can be defined as a continuous process with five basic steps: – 1) problem identification and diagnosis, – 2) strategy selection, – 3) strategy experimentation and evaluation, – 4) information dissemination, and – 5) information utilization. Ref: Fisher, Andrew A. et al. 1991. Handbook for Family Planning Operations Research Design: Second
  • 7. Introduction and Definitions • The Population Council (2000) explains that, “Operations research helps policy-makers and program managers to review, redirect and restructure programs that have been in place for many years.” • OR uses social science and other research methods to provide decision-makers with empirically-based and scientifically-valid answers to service delivery problems.
  • 8. Introduction and Definitions • WHO (2003) defines OR as • “the use of systematic research techniques for program decision-making to achieve a specific outcome.” OR provides policy-makers and managers with evidence that they can use to improve program operations.
  • 9. Introduction and Definitions • The International Food Policy Research Institute (2005) considered that, • “OR aims at studying the processes by which programs are implemented and interventions are delivered to intended beneficiaries.”
  • 10. Introduction and Definitions • Finally, during the working meeting on OR held in Geneva as part of the development of “Framework for Operations and Implementation Research in Health and Disease Control Programs”, participants agreed on. “Any research producing practically-usable knowledge (evidence, findings, information, etc.) which can improve program implementation (e.g., effectiveness, efficiency, quality, access, scale-up, sustainability) regardless of the type of research (design, methodology, approach) falls within the boundaries of operations research.”
  • 11. Difference from other Researches • It is distinguished from other kinds of research by the following characteristics:  It addresses specific problems within specific program, not general health issues;  It addresses those problems that are under control of managers, such as program systems, training, pricing and provision of information;  It utilizes systematic data collection procedures, to accumulate evidence supporting decision-making;
  • 12. Difference from other Researches  It requires collaboration between managers and researchers in identification of the research problem, development of the study design, implementation of the study and analysis and interpretation of results; and  It succeeds only if the study results are used to make program decisions; publication alone is not a valid indicator of successful OR.”
  • 13. Purpose of OR • The main purpose is to identify, as early as possible in the life of a program, any shortcomings in the process that may affect the effective delivery of the intervention, and as a result, its potential impact on the expected outcomes. • Thus, the overall goal of OR is to generate the necessary information to program planners and implementers that will allow them to design and test potential solutions to improve program delivery and will lead to the timely implementation of corrective actions.
  • 14. Scope of OR • The intent of OR is to learn about management, administrative, cultural, social, behavioral, economic and other factors that either exist as bottlenecks to effective implementation or could be tested to drive insights into new, more effective approaches to programming.
  • 15. Uses of OR • OR can accomplish the following: – Identify and solve program problems in a timely manner – Help policy-makers and program managers make evidence-based program decisions – Improve program quality and performance using scientifically valid methods – Help program managers and staff understand how their programs work
  • 16. OR Potential Issues • Examples of OR Potential Issues: • The Challenges of Obtaining and Delivering Commodities  The delivery system is not reaching sufficient numbers of the target group because of: • Low coverage • Failure to scale-up • Equity issues • Not reaching those who are stigmatized • Insufficient staffing
  • 17. OR Potential Issues  The delivery system may be having quality issues • Poor quality of services • Poor diagnostic and dispensing services • Poor information/education/communication (IEC) programs • Poor referral systems
  • 18. OR Potential Issues  Managerial issues may be the main bottleneck • These may include: • Poor adherence to policy recommendations • Poor record-keeping and reporting, M&E • Poor information dissemination • Ethical issues • Interaction or competition with other interventions for other diseases • Marketing and advocacy
  • 19. OR Potential Issues  Issues may be at the community/societal and individual levels • Levels of household income that influence affordability • Stigma • Other participation barriers • Perceptions and misperceptions
  • 20. Flow chart of the OR Process I. PLANNING II. IMPLEMENTATION III. FOLLOW-THROUGH
  • 21. Planning 1. Organize the research group and advisory committee 2. Determine issues or problems to study and frame research questions around these 3. Develop a research proposal to answer OR questions 4. Obtain ethical clearance 5. Identify funding sources and obtain support for OR 6. Establish a budget and financial management procedures 7. Plan for capacity building and technical support
  • 22. Implementation 8. Monitor project implementation and maintain quality 9. Pre-test all research procedures 10. Establish and maintain data management and quality control 11. Explore together with stakeholders interpretations and recommendations arising from the research findings
  • 23. Follow-through 12. Develop a dissemination plan 13. Disseminate results and recommendations 14. Document changes in policy and/or guidelines that resulted from the research 15. Monitor changes in the revised program 16. Consider ways of improving the program that can be tested through further research
  • 24. Step 1: Organize the research group a) Selecting the researchers • Because of their major work responsibilities, program managers and staff will rarely conduct the OR themselves, but may contract with a university, research institute, NGO or even another unit within a health ministry. • An important criterion for choosing an appropriate research team will likely be the availability of members with multidisciplinary backgrounds.
  • 25. Step 1: Organize the research group b) Form an advisory committee or working group • After researchers are chosen, the program managers and staff still have an important role to play in the OR to ensure the results meet program needs. • A simple advisory committee or working group that consists of five to six people including researchers, program managers and if possible, constituencies of people affected by the issue/problem could meet on a regular basis (e.g., monthly) to ensure that there is ownership of the results by all concerned parties and that the results are put to use in a timely fashion.
  • 26. Step 2: Determine issues or problems to study and frame research questions around these • Questions addressed by OR should arise out of the actual implementation of a health or disease control program and should emerge from discussions with program managers, researchers and clients of the services.
  • 27. Step 2: Determine issues or problems to study and frame research questions around these • OR questions may be defined at three levels. – 1. Identifying the health program implementation issue or problem- from basic M&E reports – 2. Considering underlying reasons for the issue or problem that can be examined through OR, and – 3. Proposing possible solutions that can be tested to address the issue or problem.
  • 28. Example of Developing the OR Questions • 1. Identifying the Problem • Reports at a health clinic may show that despite the presence of a program offering anti-retrovirals (ARVs) to HIV-positive clients, the prevalence of opportunistic infections (OI) such as diarrhea and pneumonia among clients has risen. • An OR question arising at this stage may be “Why are HIV-positive clients experiencing poorer health outcomes?”
  • 29. Example of Developing the OR Questions • An OR study examining this question might discover that HIV-positive clients are not adhering to their treatment regimens and are therefore more susceptible to developing other illnesses.
  • 30. Example of Developing the OR Questions • 2. Considering the Reasons • An OR question at this level may be “Why are HIV- positive clients not adhering to their treatment regimens?” • Research might discover that clients are not adhering to their regimens for several reasons, – such as poor communication between clients and staff; – low-income clients do not have enough money to afford transportation to the clinic to refill their prescriptions;
  • 31. Example of Developing the OR Questions – Clinic hours are too short and clients cannot afford to miss work to visit the clinic during the day; – clients are reluctant to visit the clinic because of the perceived stigma associated with seeking services there; – or clients are discouraged from returning to refill their prescriptions because of frequent drug shortages.
  • 32. Example of Developing the OR Questions • 3. Testing the Solutions • For example, in regards to the barriers to drug adherence discussed above, one possible solution to address the problem of drug stock-outs may be to conduct an in-service training for clinic staff to improve drug forecasting. • Another potential solution may be to develop clinic- based performance standards that inform the basis for problem solving among staff. • Also, OR could be designed to examine and compare the effectiveness of both of these approaches.
  • 33. Step 3: Develop a research proposal to answer OR questions • A research proposal is a document that outlines- in as much detail as possible – – what the research is about, – why it is important, – how the researchers plan to carry it out and – how the results may be used.
  • 34. Step 4: Obtain Ethical Clearance • Any research that studies human beings – whether they are community members or health workers – may put those people at risk. • Even with “simple” interviews there are costs involved, such as time of the respondent and risks involved in sharing personal information with a stranger (the interviewer). • As part of the proposal, researchers need to spell out the details of how they will explain research procedures and risks to potential participants and obtain evidence (a signature, a mark) that participants agree to take part in the research.
  • 35. Step 4: Obtain Ethical Clearance • Note that consent forms must be written in a language that research participants can understand. • Most research institutions in particular have an “institutional review board” (IRB) or a “committee on human subjects” that reviews and approves the ethical and safety issues surrounding a research proposal before it can be implemented.
  • 36. Step 5: Identify funding sources and obtain support for OR • Several large international donor partners have been sponsoring OR in the context of their support for national health and disease control programs • Tropical Disease Research Program • USAID • Global Fund to Fight AIDS , Tuberculosis and Malaria • International Bank for Reconstruction and Development (IBRD, the World Bank), • Rockefeller Foundation
  • 37. Step 5: Identify funding sources and obtain support for OR • Council for the Development of Social Science Research in Africa (CODESRIA) • Bill & Melinda Gates Foundation • International Development Research Center • Wellcome Trust • Pharmaceutical companies and others who produce disease control products often offer small grants for OR in the countries where they work .
  • 38. Step 6: Establish a budget and financial management procedures • Funding agencies will expect that the researchers will have devised a comprehensive budget and can justify the need for each item. • Since researchers are planning OR, researchers may have budget items that relate to the research itself as well as to any programming activities that are being tested. • Any research project should include on its administrative staff a financial officer (accountant).
  • 39. Step 7: Plan for capacity building and technical support • Capacity building for OR means ensuring that all persons involved in carrying out the research have the skills and knowledge necessary to perform their roles. • capacity-building plans should not consider sending people off to another country for a five-year doctorate program but rather find ways to help those involved in the project right now do their jobs better.
  • 40. • In implementation - as in planning - there is a need to continue to involve key program managers, staff and communities in the process (e.g., through the advisory committee) to ensure that the OR remains based in and addresses the needs of the health or disease control program.
  • 41. Step 8: Monitor project implementation and maintain quality • A key issue of quality control in research is maintaining fidelity (faithfulness) to implementation of the research as planned. • One role of the small advisory committee can be regularly checking that the protocol procedures are being followed correctly and in a timely manner. • The research team must have a plan of action or work plan. • Regular progress meetings are needed among the research team members to ensure that the research plan is being implemented as intended.
  • 42. Step 8: Monitor project implementation and maintain quality • It is important to stress again that monitoring of the research should also be done as part of regular team meetings.
  • 43. Step 9: Pre-test all research procedures • Research instruments, whether quantitative (questionnaires, observation checklists) or qualitative (FGDs, in-depth interviews) should be both valid and reliable. • Test out the instruments under the type of circumstances where they will be used in the field, possibly in a different community not within the study area with similar characteristics to the study community.
  • 44. Step 10: Establish and maintain data management and quality control • Quality data management begins with the design of the research instruments. • In short, one needs to ensure that the study variables are operationalized to reflect the objectives of the study. • The instruments must be easy for the data collectors to use. • Ambiguities for both respondents and data collectors should be removed.
  • 45. Step 10: Establish and maintain data management and quality control • During field work, research supervisors should be trained to observe the data collectors regularly. • Senior researchers must be in the field to ensure that the data collectors take the project seriously. • Data entry (computer entry of survey results, typing of interview transcripts) should begin while data collectors are still in the field. • Data entry clerks should be trained on the job with actual completed instruments.
  • 46. Step 10: Establish and maintain data management and quality control • Missing values should be caught at all stages – daily review, data entry, and simple frequency analysis. • One should be sure there are no missing values.
  • 47. Step 11: Explore together with stakeholders interpretations and recommendations arising from the research findings • The next phase, the “follow-through”, involves the actual dissemination and use. • Prior to dissemination it is important for the research team and the stakeholders (e.g., community leaders, program managers/ staff, donors) who were members of the project advisory committee or working group to review the results and have a clear and shared understanding of the implications of these findings.
  • 48. Step 11: Explore together with stakeholders interpretations and recommendations arising from the research findings • The first meeting about the findings should occur within a week after data entry is finished and a set of preliminary frequency tables or qualitative interview summaries can be produced. • By the second meeting, the group should start listing the key findings and the related implications for improving the program. • They can brainstorm about appropriate audiences with whom to share this information in a timely manner.
  • 49. Step 11: Explore together with stakeholders interpretations and recommendations arising from the research findings • Feedback to communities is essential • An important consideration is reviewing the key stakeholders that can act on the information and recommendations
  • 50. • Those who provide financial and technical support for OR, including national stakeholders, are concerned about the long-term effects of that research. • Collaboration with policy-makers, provisions for sustainability, and responsiveness to local needs are among the ways of ensuring sustainability of program changes that result from OR
  • 51. Step 12: Develop a dissemination plan • Dissemination activities must be matched to key audiences, including policy-makers, program managers, service providers, program beneficiaries and donors – Annual presentation of research findings at national and international conferences – Publication of research findings in national and international peer-reviewed journals – Meetings with local and national stakeholders to discuss research findings – Press releases and briefings
  • 52. Step 12: Develop a dissemination plan • Regardless of audience the team needs to think about the advocacy process. • This entails determining who has the best “voice” to promote the results with the audience most likely to act on the findings
  • 53. Step 13: Disseminate results and recommendations • Issues like timing, venue and opportunity need to be considered. • There are several elements to timing, including presenting the results after the research has been fully concluded. • Dissemination must take into consideration the convenience of the audience/stakeholders • Hold an event in the ministry auditorium.
  • 54. Step 14: Document changes in policy and/or guidelines that resulted from the research • OR teams should ask, “Did the implementing/ collaborating organization(s) “act on” the results • “acting on the results” consists of implementing the actual services of the intervention or the activities to support those services (e.g., training courses, development of service delivery guidelines, changes in allocation of personnel, production and testing of IEC materials, supervision, monitoring)
  • 55. Step 15: Monitor changes in the revised program • For example, an OR field test may have found that in several communities, distribution of ITNs by community-chosen volunteers achieved greater coverage and use than campaigns based at the district health facilities. • If the national malaria control program adopted and implemented this new approach, one would want to monitor whether in fact after scale-up the coverage increased uniformly across the country. The original OR team could still be involved in conducting coverage and use surveys around the country, even though this activity would be part of routine M&E activities.
  • 56. Step 16: Consider ways of improving the program that can be tested through further research • The regular program monitoring surveys just mentioned may find that in most areas of the country ITN coverage and use increase and reach program targets. • Unfortunately, the surveys might have found that in a riverine/coastal area or among a group of primarily nomad people the new strategy did not work any better than the previous campaign approach. • This finding raises new OR questions and can start the OR process over again with a new focus.
  • 57. A Case Study of Operations Research Malawi : Linking Civil Society with Care for Tuberculosis • An OR study was conducted by the Research for Equity and Community Health (REACH) Trust to explore barriers experienced by the poor in one squatter area in the capital city of Malawi, Lilongwe. • Although TB services are free at the point of delivery, it was found that the poor incur much higher transport and opportunity costs than the non-poor.
  • 58. • REACH Trust went back to the community to make the findings known. • Stakeholders at community level and local leaders were briefed about the research findings. • REACH Trust posed the question to the community in order to include their views and opinions about how to solve their problem. • Based on the suggestions from the community, REACH Trust then developed the intervention, “Linking Civil Society with TB Care” to bring TB services closer to the people.
  • 59. • A main objective of this program was to reduce transport and opportunity costs incurred by the poor in the area in order to improve use of TB services.
  • 60. Societies and journals Societies • The International Federation of Operational Research Societies (IFORS) is an umbrella organization for operational research societies worldwide, representing approximately 50 national societies including those in the US, UK, France,[Germany, Canada, Australia, New Zealand, Philippines, India, Japan and South Africa.
  • 61. Societies and journals • The Operational Research Society of India (ORSI)was founded in 1957, the Society is affiliated to the International Federation of Operational Research Societies (IFORS). • The headquarter of the Society is located in Kolkata at 39, Mahanirvan Road, Kolkata 700029, India. • The Society publishes a quarterly journal OPSEARCH.
  • 62. Societies and journals • In 2004 the US-based organization- Institute for Operations Research and the Management Sciences (INFORMS) began an initiative to market the OR profession better, including a website entitled “The Science of Better” which provides an introduction to OR and examples of successful applications of OR to industrial problems. This initiative has been adopted by the Operational Research Society in the UK, including a website entitled “Learn about OR”
  • 63. Societies and journals Journals • INFORMS publishes twelve scholarly journals about operations research, including the top two journals in their class, according to 2005 Journal Citation Reports. They are: – Decision Analysis – Information Systems Research – INFORMS Journal on Computing – INFORMS Transactions on Education (an open access journal) – Interfaces: An International Journal of the Institute for Operations Research and the Management Sciences – Management Science: A Journal of the Institute for Operations Research and the Management Sciences
  • 64. Centre for Operations Research and Training (CORT)
  • 65. Centre for Operations Research and Training (CORT) • CORT established in 1991, is one of the leading research and training organization in India. • Its headquarter is in Vadodara, Gujarat • Broadly its thrust areas are health, demography, social and development issues, such as education, rural development, non-conventional energy which have immediate policy relevance. • CORT is actively involved in building research capacity of NGOs and other research organizations by regularly organizing training workshops and understanding collaborative research with NGOs.
  • 66. Centre for Operations Research and Training (CORT) • CORT is responsible for running State Training and Resource Center (STRC) to provide training and build capacity of all NGO partners who are implementing targeted intervention among high risk groups in the state of Gujarat and Daman and Diu. • Other areas in which CORT is pro-actively involved are enhancing utilization of research findings by promoting a culture of evidence based decision making and strengthening advocacy activities.
  • 67. Conclusion • OR needs to be integrated as an essential part of monitoring and evaluation (M&E) efforts. • Thus, the concept of M’OR’E could become a new paradigm enhancing the practice of integrating monitoring, research and evaluation dimensions as one common component into program management systems.
  • 68. References  Framework for Operations and Implementation Research in Health and Disease Control Programs  Fisher, Andrew A. et al. 1991. Handbook for Family Planning Operations Research Design: Second Edition. New York: Population Council  Oxford Dictionary of the US Military  http://en.wikipedia.org/wiki/Operations_research #cite_note-hsor.org-3  http://www.hsor.org/what_is_or.cfm  http://www.orsi.in/

Notes de l'éditeur

  1. Research is the systematic investigation into existing or new knowledge, used to establish or confirm facts.
  2. Research is the systematic investigation into existing or new knowledge, used to establish or confirm facts.
  3. Research is the systematic investigation into existing or new knowledge, used to establish or confirm facts.
  4. The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. IFPRI is one of 15 centers supported by the Consultative Group on International Agricultural Research (CGIAR), an alliance of 64 governments, private foundations, and international and regional organizations. Director General:Shenggen FanHeadquarters: 2033 K Street, N.W. Washington, D.C. 20006, U.S.A.
  5. intent : An anticipated outcome that is intended or that guides your planned actions
  6. Accomplish: Cause to happen; complete successfully, To gain with effort
  7. Advocacy: Active support of an idea or cause etc.; especially the act of pleading or arguing for something
  8. The research team must have a plan of action or work plan. The plan can include the following components:• A comprehensive listing of all activities to be implemented• Indication of date of commencement for each activity• Indication of expected date of completion of the activity• Indication of responsible person/s for each activity• Indication of important milestones for each activity
  9. Valid instruments elicit the “truth” from respondents.Reliableinstruments provide consistent information.
  10. Advocacy: Active support of an idea or cause etc.; especially the act of pleading or arguing for something
  11. Malawi: A landlocked republic in southern central Africa; achieved independence from the United Kingdom in 1964Squatter: Someone who settles lawfully on government land with the intent to acquire title to itIncur: Make oneself subject to; bring upon oneself; become liable to
  12. CORT specializes both in qualitative and quantitative research. Some of the areas in which CORT has special interest, include operations research in sexual and reproductive health, contraceptive use dynamics, gender and women empowerment, health financing and child labour, old age, abortion seeking behavior and, adolescents and HIV/AIDS.