Operational research

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

2. Overview 2 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 3 4. 4 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. 5. 5 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) 6 The use of systematic research techniques for program decision making to achieve a specific outcome. 7. 7 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 8 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 9 Decision making. Identify optimum solution. Integrating the systems. Minimize the cost and maximize the profit. Improve the productivity. 10. 10 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 11 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. 12 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. 13 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. 14 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. 15 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. 16 17. Steps: 1. Exploratory Study 2. Intervention Study 3. Evaluation study 4. Cost Effectiveness Study 17 18. Operational Research in Public health 18 19. 19 Planning Implementation Follow through 20. PLANNING 20 21. STEP 1:ORGANIZE THE RESEARCH GROUP 21 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 22 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 24 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 25 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 26 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 27 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 28 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 29. 29 Step 6: Establish A Budget And Financial Management Procedures Step 7: Plan For Capacity Building And Technical Support 30. IMPLEMENTATION 30 31. Step 8: Monitor project implementation and maintain quality 31 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 32 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 33 34. 34 Step 11: Explore together with stakeholders interpretations and recommendations arising from the research findings 35. FOLLOW THROUGH 35 36. Step 12/13: Develop a dissemination plan & result dissemination 36 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 37 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 38 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 39 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 40 41. IFORS 41 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 42 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 43 44. INFORMS 44 Institute for Operations Research and the Management Sciences USbased 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 . 45. 45 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. 46 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 47 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 48 49. Challenges 49 (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 50 Operational Research needs to be integrated as an essential part of monitoring and evaluation efforts in Public Heath. Thus concept of MORE 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 51 The Global Fund: [email protected] 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 52. 52