Operational research basics in public health

1. GUIDE: Prof(Dr).B.K. Behera
Dept . Of Community Medicine KIMS
Presentation By: Dr.Shalini Ray
1st Year PG
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OPERATIONAL RESEARCH

2. Overview
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 It is a discipline that deals with application of
advanced analytical methods to facilitate better
decisions .
 It represents the study of optimal resource
allocation.

3. HISTORY
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 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 with a scientific basis for
decision on action to improve military operations.

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But now a days the principles and techniques of
Operational Research are being applied in every
field of human research and development
including Health Care Sciences.

6. Definition by WHO (2003)
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“The use of systematic research techniques for
program decision making to achieve a specific
outcome.”

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Geneva on -
“Framework for Operation and Implementation Research in Health and
Diseases Control Program”
All participant were agreed on -
“Any research producing practically usable
knowledge ( evidence , finding , information)
which can improve program implementation
(effectiveness , efficiency , quality , access ,
scale-up, sustainability) regardless the type of
research (design, method, approach) falls within
the boundaries of Operational Research.”

8. Difference from other Researches
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 It succeeds only if the study results are used to
make program decisions; publication alone is not a
valid indicator of successful OR.”
 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

9. Objectives
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Decision making.
 Identify optimum solution.
 Integrating the systems.
 Minimize the cost and maximize the profit.
 Improve the productivity.

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 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

11. METHODS OF OPERATIONAL
RESEARCH
Operational Research Methods
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12. Methods
Despite the number of technical labels like-
- multi-criteria decision analysis,
- linear and non linear programming,
- discrete-event simulation,
- queuing and stochastic process modeling,
- conjoint analysis or
- neural networking.
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13. METHODS
Most projects of Operational Research apply one
of three broad groups of methods :-
1.Simulation methods.
2.Optimization methods.
3.Data-analysis methods.
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14. 1.Simulation method
It gives ability to conduct sensitive study to -
(a). Search for improvements and
(b). Test the improvement ideas that are being
made.
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15. 2.Optimization methods
 Here goal is to enable the decision makers to
identify and locate the very best choice, where
innumerable feasible choices are available and
comparing them is difficult.
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16. 3.Data-analysis methods
 The goal is to aid the decision-maker in detecting
actual patterns and inter-connections in the data set
 Use of this analysis for making solutions.
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17. Steps:
1. Exploratory Study
2. Intervention Study
3. Evaluation study
4. Cost Effectiveness Study
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18. Operational Research in Public health
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• Planning
• Implementation
• Follow through

20. PLANNING
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21. STEP 1:ORGANIZE THE RESEARCH
GROUP
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 Selecting the researchers
Composition of O. R. team in Public Health
1. A Public Health Administrator.
2. An epidemiologist.
3. A mathematician.
4. A statistical scientist and
5. A social scientist.
 Form an advisory committee or working group

22. STEP 2:DETERMINE ISSUES OR PROBLEMS
TO STUDY AND FRAME RESEARCH
QUESTIONS AROUND THESE
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 Arise out of the actual implementation of a health
or disease control program .
 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.

23. Identification
of the problem
Possible
solutions of
the
problems
are listed
Best
alternative solution
becomes the piece of
research
Note- Sometimes just the
identification of the problem
becomes the topic of research.23

24. Example: Identifying the Problem
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 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?”
 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.

25. 2. Considering the Reasons
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 Poor communication
 Low-income clients cannot afford transportation
 Clinic hours are too short and clients cannot afford to
miss work to visit the clinic during the day.
 Perceived stigma associated with seeking services .
 Clients are discouraged from returning to refill their
prescriptions because of frequent drug shortages.

26. 3.Testing the Solutions
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 For example, in regards to the barriers to drug
adherence 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.

27. Step 3: Develop a research proposal
to answer OR questions
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 What the research is about
 Why it is important
 How the researchers plan to carry it out
 How the results may be used.
Step 4: Obtain ethical clearance

28. Step 5: Identify funding sources and
obtain support
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 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
 CODESRIA
 International Development Research Center

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 Step 6: Establish A Budget And Financial
Management Procedures
 Step 7: Plan For Capacity Building And
Technical Support

30. IMPLEMENTATION
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31. Step 8: Monitor project implementation
and maintain quality
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 Maintaining fidelity to implementation of the research
as planned.
 Role of the small advisory committee .
 Work plan and regular meetings.

32. Step 9: Pre-test all research procedures
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 Research instruments:
Valid? (Do data collection instruments capture
the desired information reliably?)
Reliable? (Do data collection instruments
capture the desired information consistently?)

33. 10. Establish and maintain data
management and quality control
 Forms should be easy to use
 Observe data collectors regularly, supervisors
review all data collection instruments daily for
completeness and accuracy, have regular
meetings of the data collectors
 Data entry into computers preferably as study is
ongoing, so errors by data collectors can be
quickly fixed
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Step 11: Explore together with stakeholders
interpretations and recommendations arising from
the research findings

35. FOLLOW THROUGH
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36. Step 12/13: Develop a dissemination plan
& result dissemination
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Annual presentation of research findings at national and
international conferences
Step 14: Document changes in policy and/or
guidelines that resulted from the research
“Did the implementing/ collaborating organization(s)
“act on” the results.

37. Step 15: Monitor changes in the
revised program
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 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.

38. Step 16: Consider ways of improving the
program that can be tested through further
research
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In most areas of the country ITN coverage and use
increase and reach program targets.
 Unfortunately, the surveys might have found that in a
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.

39. Uses in Public Health
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1. Identify and solve the problems of program in
timely manner.
2. Helps policy maker and program manager to
make evidence based program decisions.
3. Improve program quality and performance by
using scientifically valid methods.

40. SOCIETIES AND JOURNAL OF
OPERATIONAL RESEARCH
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41. IFORS
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International Federation of Operational Research
Society
 IFORS is an umbrella organization for
Operational Research societies world-wide .
 It represents 50 national societies including those
in US, UK , France , Germany, Canada , Australia ,
New Zealand, Philippines , India , Japan and
South-Africa.

42. ORSI
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Operational Research Society of India
 Founded in 1957.
 The society is affiliated to the IFORS.
Head quarter of ORSI is located in Kolkata
at 39, Mahanirvan Road , Kolkata 700029.
The society publishes a quarterly journal
OPSEARCH.

43. OPSEARCH
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44. INFORMS
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Institute for Operations Research and the
Management Sciences
 US–based organization.
 INFORMS started an initiative to market the
Operations Research profession .
 website : ” The Science of Better”.
 This initiative has been adopted by Operational
Research Society in UK.
 website : “Learn about OR” .

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INFORMS publishes twelve Scholarly journals
about Operational Research.
Including-
1. Decision Analysis.
2. Information System Research.
3. INFORMS journal on computing.
4. Interfaces: An International Journal of the
Institute for Operations Research and the
Management Sciences.
5. Management Science: A Journal of the Institute
for Operations Research.

46. C.O.R.T.
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Center for Operations Research and Training
CORT established in 1991 is one of the leading
research and training organization in India.
Its headquarter is in Varodara ,Gujarat.
Broadly it covers area of health , demography and
social and development issues.

47. CORT
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 CORT is responsible for running State Training
and Resource Center (STRC)
 CORT is actively involved in building research
capacity of NGOs by organizing training
workshops

48. CORT
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49. Challenges
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 (a) Shortage of funding,
 (b) Turnover of trained staff,
 (c) Difficulty of implementing research skills in
program settings,
 (d) Reluctance or inability of managers to use
findings,
 (e) Need to evaluate capacity building procedures,
 (f) Length of time needed to achieve critical mass of
trained researchers and consumers,
 (g) Linkages between researchers and managers.

50. SUMMARY
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Operational Research needs to be integrated as an
essential part of monitoring and evaluation efforts
in Public Heath.
Thus concept of M’OR’E could become a new
paradigm for enhancing the practice of integrated
monitoring and evaluation dimensions as one
common component into program management
system.

51. References
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The Global Fund: OR@theglobalfund.org
 Framework for Operations and Implementation
 Research in Health and Disease Control Programs
 http://en.wikipedia.org/wiki/Operations_research
#cite_note-hsor.org3
 http://www.hsor.org/what_is_or.cfm
http://www.orsi.in/
www.indiamedicaltimes.com/2013/12/10/opportunities
-and-challenges-of-operational-research-training-in-
population-health-india

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