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Operations Research in Health and Family Planning byProf V. K. Tiwari, NIHFW, N Delhi XIII Annual Conference of Indian Association of Preventive & Social Medicine, UP-UK Chapter, HIHT Dehradun 25-9-2010
Background of OR OR Used in second world war to precisely hit enemy targets by Americans Thereafter, focus shifted to Management problems in business and industries During sixties, WHO and Population Council started OR applications in Health and Family Planning.
What is operations research? 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.
Goals of operations research  	Provide program managers/policy makers with information to make decisions to improve program operations (to solve problems) eg: ,[object Object]
Increase availability, accessibility and acceptability of services desired by users,[object Object]
Search for solutions	Objectives:  ,[object Object]
To seek practical solutions to problem situations
To provide information to improve/scale up existing services and plan future ones,[object Object]
Strategy selection-cost effective, feasible, non interfering too much.
Strategy experimentation and evaluation-field research/computer simulation or analysis.
Information dissemination and utilization.
Replication and up-scaling.,[object Object]
Problem definition ,[object Object],	- Occurrence, intensity, distribution, and other 	measures (such as impact) for which data are already available.       -It emphasises on performance problem ie gap           between desired and existing parameters ,[object Object],	-Review of relevant literature, examine current 	service statistics, seeking educated opinion from programme managers, obtain probable reasons for the problem from social, economic,  and health perspectives/theory
Problem justification The key aspects in justifying the research problem are: ,[object Object]
How widespread is the problem?
Does it affect key population?
Is  problem related to ongoing program activities?
Solutions not known
Does it relate to broad social, economic and health issues (unemployment, status of women, HIV, FP etc)?
Is solution replicable?,[object Object]
Selecting a strategy Identify potential (alternate) strategies that could be used to solve the program problem ,[object Object]
Justify the selection of strategy by:-Past success 	-	Simplicity of implementing the strategy 	-	Potential for sustaining the strategy        -       Cost effectiveness of strategy        -      Technical feasibility of strategy etc
Criteria for selecting strategy-example  ,[object Object]
Is there a perceived need for the strategy among stakeholders?
Does the strategy build upon previous work and thus:-accelerate the scaling-up, 	-	leverage existing research capacities and structures?  Is the strategy sustainable?
Defining study objectives and hypothesis ,[object Object],	-	Describes expected contributions arising from the 	study (overall expected outcome)  	-	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”
Defining study objectives ,[object Object],-	Relate directly to the research problem situation  	-	Indicate the variable that will be examined and measured  	-	Should be stated in behavioral terms 	-	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, cost-	effectiveness of services and reduction in sexual risk behaviours.
Defining study hypotheses ,[object Object]
It specifies the expected relationship among variables
Most appropriate when conducting field intervention studies
They serve to direct and guide our research

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Dr V K Tiwari

  • 1. Operations Research in Health and Family Planning byProf V. K. Tiwari, NIHFW, N Delhi XIII Annual Conference of Indian Association of Preventive & Social Medicine, UP-UK Chapter, HIHT Dehradun 25-9-2010
  • 2. Background of OR OR Used in second world war to precisely hit enemy targets by Americans Thereafter, focus shifted to Management problems in business and industries During sixties, WHO and Population Council started OR applications in Health and Family Planning.
  • 3. What is operations research? 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.
  • 4.
  • 5.
  • 6.
  • 7. To seek practical solutions to problem situations
  • 8.
  • 9. Strategy selection-cost effective, feasible, non interfering too much.
  • 10. Strategy experimentation and evaluation-field research/computer simulation or analysis.
  • 12.
  • 13.
  • 14.
  • 15. How widespread is the problem?
  • 16. Does it affect key population?
  • 17. Is problem related to ongoing program activities?
  • 19. Does it relate to broad social, economic and health issues (unemployment, status of women, HIV, FP etc)?
  • 20.
  • 21.
  • 22. Justify the selection of strategy by:-Past success - Simplicity of implementing the strategy - Potential for sustaining the strategy - Cost effectiveness of strategy - Technical feasibility of strategy etc
  • 23.
  • 24. Is there a perceived need for the strategy among stakeholders?
  • 25. Does the strategy build upon previous work and thus:-accelerate the scaling-up, - leverage existing research capacities and structures? Is the strategy sustainable?
  • 26.
  • 27.
  • 28.
  • 29. It specifies the expected relationship among variables
  • 30. Most appropriate when conducting field intervention studies
  • 31. They serve to direct and guide our research
  • 32.
  • 33. 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
  • 34.
  • 35. Dependent variables is the central concern of the research proposal’s problem statement
  • 36. Independent variable acts on the dependent variable through intervening variables which increase or decrease the effect the independent variable has on dependent variableEg – 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 people’s knowledge, attitudes, sexual risk behaviors and risk perception.   Most HIV/AIDS behavioral research studies are based on a model that includes intervening variables
  • 37.
  • 38. Immediate objective (state what will be done immediately)
  • 39. Hypotheses (state the expected relationship between two or more variables)
  • 40.
  • 41. Quality of care for people living with HIV and AIDS
  • 42. Reducing transmission of HIV from Parents to children
  • 43. Best ways to introduce ECPs
  • 44. Optimum cost of injectible contraceptives
  • 45. Best ways to involve PPs in FP/RNTCP etc
  • 46. Thinking points?- Provide 3-4 points to define and justify the problem -      Identify strategy - State objectives (at least) and frame hypotheses
  • 47. Step III Experimentation and Evaluation
  • 48.
  • 49.
  • 50. Common notation RA- Random assignment Experimental group receives intervention Control group –does not receive intervention X – program intervention; denotes experimental Q – observation measurement passage of time Experimental Group Control Group RA X O Notation of Study Designs
  • 51. Time 01 X1 02 03 04 Experimental Group 1 RA Control Group True Experimental Design I
  • 52. Time 01 X1 02 03 X2 04 05 06 Experimental Group 1 Experimental Group 2 Control Group RA True Experimental Design II
  • 53. Time 01 X1 02 03 X2 04 05 X1+X2 06 Experimental Group 1 RA Experimental Group 2 Control Group True Experimental Design III
  • 54.
  • 55. Non-experimental designs   Time   Posttest only X 01   Pretest-Postest 01 X 02
  • 56.
  • 57.