Subodh S GuptaWHO Country Off ice for Ind ia

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 researchIt requires collaboration between managers and

researchers; andIt 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 problemsTests 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 issuesFailure to scale-upEquity issuesNot reaching those

who are stigmatizedInsufficient staff

Quality issuesPoor quality of

services and target group avoiding the services

Diagnostic and dispensing services

Technical problemsPoor information

regarding programsNo job aids/ poor use

Examples of OR Potential issues:

Managerial issuesPoor adherence to

policy recommendations

Poor record keeping, reporting

Poor supportive supervision

Poor information dissemination

Ethical issuesMarketing/ advocacy

Community/ societal issues

Community mobilization

AffordabilityStigmaBarriers to accessPerceptions

Wanting to knowWanting to actHaving the ability to act

First, You Must Recognize a Problem

Who identifies problems for OR?

1. The patient2. The programme staff3. The programme manager4. The District manager5. 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 villagesPoor newborn care practicesMost of the Blood Pressure equipments are not

functional in subcentersNewborns are brought late during their illness to the

health facilitiesThe 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 formalFlexibility needed and desired, to meet the

objectives of what you need to do

The OR Process

Problem identificationSolution generationSolution testingResults disseminationResults utilization

The OR Process

Implementation

8. Monitor project9. Pre-test10. Quality control11. Stakeholder

discussions

Follow through12. Dissemination

plan13. Disseminate

results14. Document

changes15. Monitor

changes16. Consider

further improvement

Planning1. Research team2. Determine

Issues3. Develop

proposal4. Ethical

clearance5. Funding 6. Budget7. Capacity

building

Points to remember

OR is not a mysteryOR need not be difficultYou can—and should—do OR in every

programme when you encounter a problem you cannot solve by experience or common sense

Thank You