Remya.G

OPERATIONAL RESEARCH

Dr Remya.GGuide- Dr

Althaf

Contents- Operational Research(OR)

1. Overview2. History of OR3. Definition OR4. Scope of OR5. Phases of OR6. OR in public health7. Societies and journals of OR8. Other Relevant forms of research9. Gaps& Challenges10.Conclusion

Overview-Operational Research Operations- The activities carried out in an organization

related to attain its goals and objectives

Kargil Operation

Research- Any form of systematic and organized investigation to establish facts

Overview- Operational Research

I need a washing machine Should I buy it now?Is it affordable now?Which company should I go for?

Decision making is a key part of our daily life.

Final decision should be to maximise benefits and minimise effort and time

Overview - OR

Operational research is the scientific study of operations to make better decisions

In simple terms OR is described as “The science of better”

History During 2 nd World War how to use the

limited military resources effectively to win the battle by UK?

They studied strategic and tactical problems associated with air and land defense of the country, and won the war

This technique was named OR (British Air Ministry official named A. P. Rowe )

History

Immediately following World War II, O.R. grew rapidly

Scientists realized these principles can be equally applicable to many problems in the civilian sector.

History

That ranged from

Short-term problems such as scheduling (PERT/CPM)

Long-term problems such as strategic planning and resource allocation in various fields

History

The technique of OR have been applied and proven in many industries under various names

Lean ,six sigma in manufacturing

Supply chain in logistics

Yield management in airlines

Definitions

(WHO 2003)

The use of systematic research techniques for programme decision making to achieve a specific outcome

Definition OR

OR is also defined as the search for knowledge

on interventions, strategies, or tools that can

improve the quality, effectiveness, or coverage

of programs in which the research is being done

“(Zachariah and colleagues 2009)”

Goals of OR

Identifying areas that could be improved

Solve problems in timely manner

Strengthen the programme

Scale up programme

Scope of OR Health services & national health

programmes Public sector- Govt development Private sector- Industrial establishment National defense service Engineering Business management Agriculture Education & training Transportation and communication

Phases of OR

Different OR techniques Multi- criteria decision analysis

Simulation technique

Linear and non linear programming

Optimization method

Queuing and stochastic process modeling

Data - Analysis method

Useful in Public Health

Model Solution

How believable is the Solution

Design field tests

ExperimentalNonexperimentalQuasi experimental

Implementation of results

Beauty OR process lies in obtaining, results  which are implementable

o Results of OR technique are information which helps in making a decision

The OR process

OR in Public Health

“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”

Global Meeting Geneva April 2008

How OR differes from Basic Research?

OR

Examines a

system

Systematic data

collectionTreatin

g the system in its real

environment

Collaboration b/w

researchers and

programme

managers

Deals with specific health issues

Successful when results implemente

d

Basic Reserac

h

Not implementd in to practice

Focusing on

an individ

ual Routinel

y collected data can be used

Deals general health issues

Research

under control

led conditi

ons

May be only

researcher/s

involved

Operation Research

Models

Techniques

Analysis

Too complicate

d?

OR in Public Health In management science OR Systems modeling Analytical techniques.

Operational research in global health does not use these complicated tools

The simple epidemiological tools and designs aptly can be applied in health

Operational Research Team

Varies with the type of research.

public health administrator/Programme Manager

Epidemiologist Statistician Social scientist. Field workers Clerks, Peons

In health OR - Steps Defining the problem

Collect relevant data- formulate a hypothesis(Model)

Derive solution from hypothesis/Model

Choosing the optimal solution.

Testing of solution eg : Pilot projects.

Implementing the solution in the whole system.

Example of developing an OR

Reports at a health clinic showed opportunistic infection in HIV positive clients on ART are risen.

WHY?

Because HIV positive clients are not adhering to their treatment.

Problem

Why they are not adhering to their treatment regimen?

. .Poor communication Between the client and

staff

Poor patients can not afford transportation to clinic

Clients cannot afford missing their work at day

Reluctant to visit clinic- Social stigma

Frequent drug shortages

Solutions In-service training for staff to improve drug

forecasting.

Develop clinic based performance standers for problem solving among staff.

Here an OR can be designed to find the effectivenss of both these approaches

Types of OR in Public health 4 types of operation research

(Defined by Population Council)

1. Exploratory/diagnostic 2. Field intervention 3. Evaluative4. Cost effectiveness studies.

1. Exploratory/diagnostic First step in research. Carried out to find out the extent of

problem. Both Qualitative & Quantitative

methods

Interviews cross-sectionalgroup discussions case control observations cohort

studies

2. Field intervention

Truly randomized, Intervention studies Non randomized (Quasi-experimental)

3.Monitoring and evaluation

Monitoring - Looking after inputs, processes and outputs in programmes.

Evaluation - Outcome/Impact evaluation

Important in National Health Programmes

Data collection on continuous basis

Implementation of program at different sites is measured.

4.Economic analysis

Costing and calculating cost effectiveness ratios of the interventions

Less expensive pathways for achieving optimal outcomes

Operational Researches in India

Implementation of DOTS by RNTCP. Diagnosis and Treatment of Malaria Immunisation,Antenatal,Postnatalca

re,neonatal Care – In RCH Integration of health system and

ICDS Joint home visits by AWW and ASHA Institutional Deliveries – ‘HUTS’ in

subcentre and PHCs PPP Decentralisation

Operational Researches in India cont

Delivery of ORS packets

Delivery of contraceptives at village level

Peoples participation in Primary health

care

Alternate model of adolescent health

(Teachers to adolescent, adolescent to

teachers)

Optimal size of area and population to be covered by a midwife, or basic health unit.

Ideal vehicle for local health worker.

Architectural design of hospitals and health centers.

Queuing problem in OPD and hospital waiting lists.

Study of bed load and nursing services in hospitals.

Length of stay in hospitals, length of sickness absence.

Operational Researches in India cont

ORs in RNTCP by ICMR

Increased yield of smear positive

pulmonary TB patients by screening

patients with > 2 weeks cough,

compared to > 3 weeks and adequacy of

2 sputum for diagnosis of sputum

positive patients

Aims:

To assess the yield of sputum positive

cases among CSs with cough of >2 weeks compared to cough of > 3 weeks

To compare the efficacy of 2 smear examination instead of 3 smears, among CSs

Methods: cross sectional multicentric study carried out in

five states.

Andhra Pradesh, Maharashtra,Orissa, West Bengal and Rajasthan.

From each of these states, three districts were selected.

A convenient sample of 90 primary and secondary level health facilities.

10,000 samples from each state.

Other OR studies in RNTCP Implementation of DOTS

Reliability of involving community volunteers as DOTS providers

Involving private practitioners in the RNTCP

HIV seroprevalence in TB patients.

MDR TB management

Assessing relapse among cat 1 patients who have successfully completed DOTS.

ORs by NVBDCP in Malaria (2012-2017)

To ensure by 2017 that, at least 80% of malaria cases in targeted districts receive prompt and effective treatment as per national drug policy within 24 hours of first contact with the health care provider.

To strengthen the capacity for managing severe malaria cases and reducing deaths.

ORs by NVBDCP in Malaria To ensure that at least 80% of people in high-risk areas (target areas) sleep under effective ITNs/ LLINs by 2017.

To place 80% of the sanctioned staff in target areas and ensure they are trained in malaria control.

To ensure that 100% of districts in target areas will collect, analyse, and effectively

use routine data and estimate their impact.

Ethical Informed consent should be received

The use of medical records without informed consent justified When

There is minimal risk of harm to the individuals.

Access to the records is essential to achieve the objectives of the research.

There is a public benefit to undertaking the research.

Informed consent is logically or economically impracticable

There is consent to use the data from the custodian of the records

The data are protected against those not involved in the research

The research is approved by an ethics committee

Other Relevant Forms of Researches

Action Oriented Research○Participatory Action Research○Empowerment Research

Formative research

Implementation Research

Health Services Research

Action Oriented Researches

Research trying to change the system at the same time generating knowledge.

Action research may not have any prescribed methodology.

Collaboration with non researcher participants.

Sensitive to needs and perspectives of non researcher collaborators

Participatory Action Research

= Community Based Participatory Research

CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community (health).

CBPREgs- promotion of sanitary latrines in rural

area(1986)- Demand Driven ApproachSteps followed ….. Behavioural research promote behavior

to use SL Promote low cost and affordable SL-

requring less amount of H2O Generate demand for SL Involve community/Leaders for

popularization of SL

Empowerment Research

Diarrhoea prevention and managemnt

Continue breast feeding/feedingPromotion of ORSAvoid unncessary antibiotis

When women groups and mother groups are empowered/trained by health workers most mothers succeeded in preventing diarrhoea.

Formative Research When a new intervention is designed

for a relatively new population

Formative research finds out what will work for them(needs and acceptability of clients)

Formative research occurs before a program is designed and implemented

Implementation Research

“Research to significantly improve access to efficacious interventions by developing practical solutions to common implementation problems” (TDR)

IR - Intervention specific

Strategies of ImplementationFactors affecting implementation, Processes of implementationOutcomesEnd-products of implementation .

Health Services Research

Health services research (HSR) examines how people get access to

health care practitioners

health care services,

how much care costs,

what happens to patients as a result of

this care

Examples for 3 research Domains

Researches to improve Health Systems

Socities and Journals of OR IFORS- International Federation of

Operational Research Society

ORSI- Operational Research Society of India- Journal Opsearch.

CORT- Centre for Operational Research and Training in India.

 

CORT Is an NGO – Vadodhara Gujarat

It covers health,Demography,Social and Development issues

Special interest operations research in reproductive health, HIV/AIDS and violence.

CORT runs state Training and Resource Centre.

Institutions in Kerala undertaking OR Medical Colleges

State TB Cell

(Eg-Evaluation of the use of fluorescent smear microscopy in high‐workload settings)

Funding and capacity Building in OR UNAID Global Fund to fight AIDS,Malaria

and TB allows up to 10% each grant for OR

WHO CTD ICMR NACO RNTCP Training cources in OR MCH and Public

Health Institutions in India (NIHFW,Public health Foundation India)

Funding and capacity Building in OR - RNTCP

State OR committees and Zonal OR committees

PGs in MCH are allotted funds( Rs 20,000) by RNTCP for doing their thesis on OR topics related to the programme.

Gaps & Challenges of OR

Shortage of funding. (But under use of OR in global health - average of 3%

or less for OR and actually spend).

Trained work force.

Researchers

Managers

Time constaints

Conclusion Operational research and management

science approaches can lead to a better health system in terms of four A’s— accessibility, affordability, availability and acceptability.

Countries should become producers of

research, as well as consumers (WHO report 2013)

References WHO Bulletin ICMR Reports India Medcial Times Indian Journal of Public Health Lancet Global Health UNICEF/UNDP/ World Bank/WHO The Global Fund to Fight AIDS,Tuberculosis and

Malaria tropical Diseases Research. Operational Research in Management AFMC community Medicine Text Book

‘Family Farming’ “Feeding the world Caring for the Earth” World Food Day – OCT 16