Subodh S Gupta WHO Country Office for India What is Operational Research

Operations Issues Community participation Training Home-visits by ASHASocial marketing Human Resources Outreach services

Logistics Medical Waste Laboratory Pharmacy Operations Issues Out-patient service Inpatient service

What is OR? “The use of systematic research techniques for program decision-making to achieve a specific outcome. OR provides health care providers, managers and policy-makers with evidence that they can use to improve program operations.” “generating evidence - specifically to inform operations” “learning by doing – how to do things better in the real world”

What is OR? Any research producing practically-usable knowledge (evidence, findings, information, etc.) which can improve program implementation regardless of the type of research (design, methodology, approach) falls within the boundaries of operations research - Working group meeting on OR/IR

Characteristics of OR Addresses specific problems within specific programs, not general health issues; Addresses those problems that are under control of managers It utilizes systematic data collection procedures, both qualitative and quantitative, to accumulate evidence supporting decision-making; It is Multi-disciplinary research It requires collaboration between managers and researchers; and It succeeds only if the study results are used to make program decisions

OR Supports Evidence-Based Programs Helps programs to make evidence-based decisions Identifies service delivery problems Tests service delivery innovations (effectiveness) Tests service delivery costs (efficiency)

Research Focus Independent variables: manipulated by managers Dependent variables: program outcomes Independent variables: manipulated by managers Dependent variables: program outcomes Factors controlled by managers Outcomes desired by managers and clients

Different domains of Research Source: Remme et. al. Defining Research to Improve Health Systems. PLoS 2010 Nov

Formative Research Formative Research identifies health or program problems that need correction. Unlike operations research it does not test solutions to the problem.  Describe target audience  Understand the factors which influence behavior of target beneficiary of a program  Understand populations in the need of the service  Create programs which are specific to the needs of the target population  Ensure programs are acceptable to the clients Formative research diagnoses program problems, operational research treats program problems

Examples of OR Potential issues: Coverage issues Failure to scale-up Equity issues Not reaching those who are stigmatized Insufficient staff Quality issues Poor quality of services and target group avoiding the services Diagnostic and dispensing services Technical problems Poor information regarding programs No job aids/ poor use

Examples of OR Potential issues: Managerial issues Poor adherence to policy recommendations Poor record keeping, reporting Poor supportive supervision Poor information dissemination Ethical issues Marketing/ advocacy Community/ societal issues Community mobilization Affordability Stigma Barriers to access Perceptions

Wanting to know Wanting to act Having the ability to act First, You Must Recognize a Problem

Who identifies problems for OR? 1. The patient 2. The programme staff 3. The programme manager 4. The District manager 5. National staff Identifying problems requires a team approach. The role of anyone who works in the programme! But, primarily, the role of the manager

You've Identified a Potential Problem Children with diarrhea are not treated properly in OPD setting ORS is not available in the villages Poor newborn care practices Most of the Blood Pressure equipments are not functional in subcenters Newborns are brought late during their illness to the health facilities The members of Village Health and Sanitation Committee are not active because they do not understand their roles The district team finds it difficult to get Pediatricians for SCNU

Find out solutions Problem: Children with diarrhea are not treated properly in OPD setting Reason: Facility for observation not available within OPD setting Intervention: Have an ORS corner within OPD Some issues simply need some common sense, and initiative

Examples: Operational Research Will involvement of SHG for social marketing of ORS improve the ORS use in villages of Maharashtra? Will strong interpersonal communication through ‘Yashoda’ improve the newborn care practices in NIPI districts? Will training of a person for repair of BP instruments at district level help availability of functional BP instruments in subcenters Will giving mobiles to ASHA/ ANM and referral linkage with district hospitals result in timely referral of sick newborns and children? Do medical officers with Facility-based IMNCI training gain requisite skills for management of more than 60% of sick newborns and children admitted in FRU?

There are Lots of Ways to Approach OR Some are simple, others more formal Flexibility needed and desired, to meet the objectives of what you need to do

The OR Process Problem identification Solution generation Solution testing Results dissemination Results utilization

The OR Process Implementation 8. Monitor project 9. Pre-test 10. Quality control 11. Stakeholder discussions Follow through 12. Dissemination plan 13. Disseminate results 14. Document changes 15. Monitor changes 16. Consider further improvement Planning 1.Research team 2.Determine Issues 3.Develop proposal 4.Ethical clearance 5.Funding 6.Budget 7.Capacity building

Points to remember OR is not a mystery OR need not be difficult You can—and should—do OR in every programme when you encounter a problem you cannot solve by experience or common sense

Thank You