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OPERATIONAL RESEARCH

Moderator-Dr Subhod Gupta

Presenter-Dr Rashmi Gode

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FRAMEWORK

Introduction Objective of OR History Features of OR Methodology of OR Approach to carry OR Types of OR study OR examples from India Importance of OR OR and Public Health of India Organisations funding/supporting OR References.

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INTRODUCTION

Terminology-Operational research / Operations research / Management science/Industrial engineering/decision science/problem solving.

Single term-OR An interdisciplinary mathematical science that focuses

on the effective use of technology by organizations. OR arrives at optimal or near-optimal solutions to

complex decision making problems. Science of better

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WHAT IS OR? Definition- Any research producing practically usable

knowledge (evidence, findings, information, etc.) which can improve program implementation (e.g. effectiveness, efficiency, quality, access, scale up, sustainability) regardless of the type of research (design, methodology, approach) falls within the boundaries of operations research”

OR uses research techniques to help choose among alternative uses of resources to meet program objectives

.

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OBJECTIVE OF OR

To provide the information to program managers and policy decision makers to improve and expand existing services.

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HISTORY Charles Babbage –(1791-1871) Believed to be father of OR 1940- World war II –team of UK scientists applied scientific

techniques to research military operations to win the war and the technique was named as OR

World war II- Aim of OR was to discover most efficient usage of limited military resources by application of quantitative techniques.

Conclusion of war- defence research in US was increased and OR expanded to other departments.

1951- 1st Book On “Methods of Operations Research” by Morse & kimball

India-Operational research society was founded in 1957

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FEATURES OF OR

Decision-making: Every organisation faces multifaceted problems to identify best possible solution to their problems.

OR aims to help the executives to obtain optimal solution with the use of OR techniques.

Also helps the decision maker to improve his creative and judicious capabilities, analyse and understand the problem situation leading to better control, better co-ordination, better systems and finally better decisions

Scientific approach- Scientific methods, techniques and tools for analysis and solution of complex problems.

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Inter-disciplinary Team Approach : Every problem needs team effort to handle it. It needs Study Between various parameters and evaluate the outcome

System Approach.-To trace for each proposal all significant and indirect effects on all sub-system and to evaluate each action in terms of outcome

Use of Computers– Possible to handle complex problems requiring large amount of analysis /calculations.

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WHO IDENTIFIES OR PROBLEMS The patient The programme staff The programme manager The district manager National staff Team approach is needed to identify the problem

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OR METHODOLOGY

Operations Research

Problem Solution Analysis Development

Solution Validation

Evaluation Implementation

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APPROACH TO CARRY OR

Approach Definition Advantage ExamplePrimary level research

as factual, first hand accounts of the study written by a person who was part of the study▪Written by researcher

▪ Original study▪ Addresses the issues specific to the situation

Surveys,(FP)Interviews,Screening,Personal talk,Observations

Secondary data analysis as retrospective record reviews

defined as an analysis and interpretation of primary research▪Re-examination

▪Getting information easily in least possible time,▪Minimum ethical challenges

*Switch over from 3 sputum examination to-2 smear in diagnosing Pulmonary TB

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TYPES OF OR STUDIES

Exploratory or diagnostic Field intervention Monitoring and Evaluative Cost effectiveness

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EXPLORATORY STUDY

Help in problem identification Gathers information about interests , attributes ,and need

of population. Methods

Qualitative Quantitative ▸Interviews Cross-sectional▸ ▸ Observations Case control▸ ▸ Group discussions Cohort studies▸

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INTERVENTION STUDY

Quasi experimental study Intervention and comparison Pre-post test studies Randomized experiments Highest level of

evidence on effectiveness and efficiency best Choice for implementation.

Eg: cluster randomised trial In AP –evaluate neonatal mortality reduction

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MONITORING AND EVALUATION

Input , processes Outcome /Impact and outputs evaluation

Eg: RAHI-Rapid appraisal of innovative health interventions under NRHM

M’ OR E’

Continuous Data collection Implementation Measuring the implementation

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ECONOMIC ANALYSIS

Costing and calculating cost effectiveness Looking for less expensive pathways Eg. Can nurses do the same job as a doctor ?

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SCOPE OF OR National Planning And Budgeting-Preparation of

Five years plans, health services and national health Programmes.

Defence services Industrial establishment and Private sector units Research and development and Engineering Business management Agriculture and irrigation Education and training- In Training out the

participatory to meet the national project requirements.

Transportation

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OR STUDIES IN INDIA

1) Author--Babu et al. (2008) Study type—Cross sectional Objective--To evaluate reasons for Treatment non-initiation

in smear positive pulmonary TB patients diagnosed and reported as initial defaulters (ID) in 20 dist.. Of AP

Result-1304 ID, 619 (47.5%) place on Treatment. Out of confirmed (685) ID, 51% were untraceable, 22 % -died before initiation, 5.5% Treated Privately, & 13.5%- had other reasons

Program relevance/Policy -Inadequate documentation of referrals, delays in treatment initiation and registration along with deficiencies in address, documentation were highlighted areas for programme improvement

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2) Authors- Bang & co-workers (1993-2003) Study type- Field trial Objectives- Reduction of neonatal mortality in

Gadchiroli by Home Based Neonatal care( HBNC) by capacity building of village level workers Results- Study was conducted in 39 interventions

and 47 control villages in district Demo significantly declined neonatal, infant and

perinatal mortality rates Programme /policy relevance-These study with

International evidence on same -2 projects were Initiated

ANKUR (2001-05)-In 7 sites in Maharashtra ICMR-5 sites HBNC is adopted in few dist.

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3) Author- Patel et al.(2003) Study type- Economic analysis Objectives- To ascertain the efficiency of zinc and

copper supplementation in the treatment of acute diarrhoea under 5 years.

Results- The study demonstrated lower cost of treating acute diarrhoea, lower cost per unit health and incremental cost effectiveness ratio

Programme / policy relevance- Cost savings as evidenced by the study makes a stronger case for micronutrients supplementation as an adjunct therapy to ORS management

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IMPORTANCE OF OR Global fund believes OR has important role to

play in success and strengthening of health program

GF support helps to build program’s overall research capacity and ability from data and implementation-helps

Eg.1.Systems for delivering antiretroviral treatment (ART) identifying seeking among different population groups, Tanzania

2.Rapid diagnostic test vs. microscopy for malaria in peripheral health facilities , Afghanistan

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OUTCOME MEASURES OF OR Publications Capacity building of service providers and

academic researchers Changes in practice and /or policy

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OR AND PUBLIC HEALTH INDIA

Organises Short term training courses as a part of National Health programmes

Short-term training projects Medical colleges also organises research workshops Public health institutions-NIHFW,PHFI WHO-India and USEA initiated TB-OR to develop capacity

of professional associated with RNTCP

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ORGANISATIONS FUNDING/SUPPORTING OROrganisation Web Links

Bill & Melinda Gates foundation

Grand challenges explorations website

www.gatesfoundation.org/default.htmwww.gcgh.org/explorations/pages/introduction.aspx

Council for the development of Social science research in africa

CODESRIA-pioneer African social research organization

www.codesria.org/french/default.htmTraining Grants and Fellowshipswww.codesria.org/training_grants.htm

Global fund to fight AIDS,TB and Malaria

Finances AIDS Tb and MalariaOr proposal must be as part of national disease control proposals

www.theglobalfund.org/en/

International development Research centre

IDRC-Canada-buil healtheier,equitable and prosperous societies

www.idrc.org/en/ev-1-201-1-DO_TOPIC.html

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REFERENCES

1. Malhotra S, Zodpey SP. Operations research in public health. Indian J Public Health. 2011; 54(3) :145–50. 2. The Global fund, USAID, WHO, framework for operations and Implementation research in Health and Disease Control Programs,2013 3. The Global WHO, Guide to operational Research in Programs Supported by the Global Fund,2010 4. Y.Liker Topcu, PhD & Ozgur kabak, Ph.D, Operations research Lecture Notes ( 2015-2016)