1. World Health Organization/Centers for Disease Control and Prevention
Why Don't We Do OR?
George Schmid
World Health Organization/Centers for Disease Control and Prevention

2. You Tell Me—Why Don't We Do OR?

3. Why Don't We Do OR?
We do not think of it—we accept things the way they are
Even if we did know how to change things, we do not have the power to do that (why do OR if we cannot change anything?)
People are not empowered to perform OR
We cannot interest high-level decision makers in the value of OR
OR is not a formal discipline--e.g., epidemiology, surveillance, M&E—and programs do not "need" to have OR
We think studies must be big and complicated
We do not have the training, or, think we do not have the skills

4. Goals We hope you will 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
THINK OF OPERATIONS RESEARCH AS A WAY TO PRODUCE EVIDENCE BASED PROGRAMS
PROVIDES EMPIRICAL EVIDENCE
COMPARES ALTERNATIVES TO DETERMINE BEST
EVALUATES THE SUCCESS OF NEW ACTIVITIES AND PROCEDURES
WHEN GENERALIZABLE CAN LEAD TO DIFFUSION OF IMPORTANT INNOVATIONS 4

7. OR Study Type #1—Recognizing Problems

8. Identifying Problems The role of anyone who works in the programme!
But, primarily, the role of the manager
Identifying problems requires a team approach
Managers must be present in their programmes
Managers must have good relationships with their staff

9. What Skills Do You Need to Do OR?
An enquiring mind
Effective (epidemiology, statistics, public health, relevant science expertise to the project, e.g., behavioural science, medicine….)
Efficient (economics, health services management….)
Quantitative vs qualitative research skills
Courses in OR
CDC
Population Council…and….

10. You've Identified a Potential Problem
Patients may not be taking their ART
People may not be using condoms
Patients may not be returning for follow-up visits
Your home-care programme cannot get enough workers
Your health care workers have high rates of absenteeism
You tell me….

12. Statistical Approach—Can I Be Sure I Have a Problem?
What are the chances the first rose leans to right?
The second? …
Let's say we have 10 roses
½ x ½ x ½…=one chance out of 512
What was the source of the problem?

15. OR Study #2—The Intervention
Once you've identified a problem, you want to eliminate it, or make it less of a problem…you study interventions
EVERYTHING WE DO IS
ABOUT INTERVENTION

16. What was the intervention?

17. Summary We don't do OR for a variety of reasons—none of them good
Every program can be made more effective, and more efficient
The two types of OR studies—diagnostic, and intervention—should always be on our minds