OPERATIONS RESEARCH IN HEALTH Dr. V.K. Tiwari M.

Sc, Ph,D, NET, JRF Professor and Head, Department of Planning And Evaluation, National Institute of Health and Family Welfare, New Delhi.

Definition of Operations Research(OR)

OR is the application of scientific methods, techniques and tools to problems involving the operations of a system so as to provide those in control of operations with optimum solutions to the problem. OR can also be defined as a process, a way of identifying and solving programme related problems Purpose of OR Provide program managers/policy makers with information to make decisions to improve program operations (to solve problems) either through (a) Increase efficiency, effectiveness and quality of service delivered by providers or (b) Increase availability, accessibility and acceptability of services desired by users Focus of OR Day-to-day activities or operations of Health and HIV/AIDS programs etc and search for solutions to day to day problems Defining a OR Problem Problem should be defined as difference between programme target and current level of achievements in terms of its occurrence, intensity, distribution, and other measures (such as impact) for which data are already available. It includes review of relevant literature, examine current service statistics, seeking educated opinion, obtain probable reason for the problem from social, economic, and health theory etc Do We need OR If the solutions already known, do not do OR Objectives of OR (i) (ii) (ii) ones Basis Steps of OR Yield answers to perceived program problems Seek practical solutions to problem situations Provide information to improve/scale up existing services and plan future

(i) (ii) (iii) (iv) (v)

Problem identification and diagnosis- situation analysis and other qualitative methods and triangulation. Strategy selection-cost effective, feasible, non interfering too much. Strategy experimentation and evaluation-field research. Information dissemination and utilization Replication and up scaling.

(i) Problem Justification The key aspects in justifying the research problem are knowing whether the problem is current and timely (topical), how widespread is the problem, does it affect key population, is it a problem related to ongoing program activities, does it relate to broad social, economic and health issues (unemployment, status of women etc) (ii) Strategy Selection Identify potential strategies that could be used to solve the program problem, indicate why the selected strategies are most appropriate, justify the selection by strategy, past success, simplicity of implementing the strategy, potential for sustaining the strategy C Criteria for Selecting Strategy Does the selected strategy have the potential to enhance HIV prevention and/or mitigation? Is there a perceived need for the strategy among stakeholders? Does the strategy build upon previous work and thus: (i) accelerate the scaling-up (ii) leverage existing research capacities and structures? Defining Study Objectives (a) Ultimate Objective (i) Describes expected contributions arising from the study (overall expected outcome) (ii) Contribute to the justification of why the research on the problem was required (relate purpose of study to larger health outcomes). For example Ultimate objective of the intervention study is to contribute towards improving the quality of life for PLHA and the effectiveness of prevention, care and support activities offered by CBOs to PLHA (b)Immediate Objective (state what will happen)(i) Relate directly to the research problem situation (ii) Indicate the variable that will be examined and measured (iii) Should be stated in behavioral terms (iv) Specify-Who will do; How much of what; To whom; When; Where, and What purpose?

For example: 1. By 2008, the national program in India will develop a youth- friendly program to provide comprehensive VCT to youth aged 16-18 years. 2. Assess program in terms of utilization of services by youth, costeffectiveness of services and reduction in sexual risk behaviours. Defining Study Hypothesis Statement about an expected relationship between two or more variables that permit empirical testing. It specifies the expected relationship among variables. Most appropriate when conducting field intervention studies Framing the Hypothesis Hypotheses of most importance are those that consider program activities as the independent variable IEC effort, Training, VCT services, STI prevention efforts, condom promotion programs and relates to one or more Outcome variables Example of Hypothesis: PLHA who receive comprehensive counseling on ART that includes discussion of side effects and their management before ARV treatment begins are more likely to adhere effectively after a year than PLHA who have not received counseling on ARV before they begin therapy Community-based HIV/AIDS organizations that actively involve PLHA in planning and implementation of programs will be more likely to achieve their objectives that similar organizations that do not involve PLHA in planning and implementation of programs Dual protection programs that focus on counseling women together with their male partners will be more successful than dual protection programs that focus only on counseling women Independent and Dependent Variable Independent variable causes, determines or influences the dependent variables (direct relationship). Dependent variables is the central concern of the research proposals problem statement. Independent variable acts on the dependent variable through intervening variables which increase or decrease the effect the independent variable has on dependent variable. Example: To increase condom use (dependent variable) a program initiates a large BCC program (independent variable). Campaign alone can not increase condom use. The intervening variables that might influence the dependent variable would be peoples knowledge, attitudes, sexual risk behaviors and risk perception. Most HIV/AIDS behavioral research studies are based on a model that includes intervening variables

(iii) Experimentation and Evaluation Who will be responsible for implementing the intervention: indicate organization(s) responsible and categories of people eg teachers, doctors, peers etc. Where will the intervention activities take place: be as specific eg in 30 clinics, 20 slums etc. What activities will be initiated: describe sequence of events eg may start with training of health providers (describe nature and duration of training); next a series of meetings in the health facilities (describe frequency and purpose of meetings) (iv) Testing OR Intervention Intervention study designs range from: True-experimental (one arm and more than one arm), Quasi-experimental 9no randamisation), Non-experimental( pre-post or post only type study) Study Methods for Intervention D Data Collection Quantitative numerical based -Survey/structured questionnaire S Qualitative descriptive -In-depth interviews -Key-informant interviews -Focus group discussions Issues for Operations Research f Reducing stigma and Discrimination of HIV/AIDS at workplace o H Higher and consistent level of condom use among youths R Risky sexual behaviour among secondary school students Improving Quality of care for people living with HIV and AIDS Q S Sustaining participation of Private Practitioners in RNTCP W What is most feasible and effective model to integrate PPTCT with RCH Programme How to improve linkages can be developed among PPTCT,HIV/AIDS,TB and ICDS