Operations research (OR) aims to improve health programs through scientific problem solving. OR was first used in WWII and later applied to health in the 1960s. OR involves 5 steps: 1) defining problems through data analysis, 2) selecting strategies to test, 3) experimenting with and evaluating strategies, 4) disseminating results, and 5) replicating successful strategies. Example OR topics include reducing HIV stigma, managing risky sexual behaviors, and improving quality of HIV care. OR studies test interventions through experimental, quasi-experimental, or non-experimental designs to measure impact on outcomes through data collection methods like surveys, interviews and observations.

1. Operations Research in Health and Family Planning byProf V. K. Tiwari, NIHFW, N DelhiXIII Annual Conference of Indian Association of Preventive & Social Medicine, UP-UK Chapter, HIHT Dehradun25-9-2010

2. Background of OROR Used in second world war to precisely hit enemy targets by AmericansThereafter, focus shifted to Management problems in business and industriesDuring 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. Goals of operations research Provide program managers/policy makers with information to make decisions to improve program operations (to solve problems) eg:Increase efficiency, effectiveness and quality of service delivered by providers

5. Increase availability, accessibility and acceptability of services desired by usersFocus and Objectives of OR Focuses on:Day-to-day activities or ‘operations’ of Health, FP and HIV/AIDS programs etc

6. Search for solutions Objectives: To yield answers to perceived program problems

7. To seek practical solutions to problem situations

8. To provide information to improve/scale up existing services and plan future onesFive basic steps of ORProblem identification and diagnosis-situation analysis and other qualitative methods including triangulation.

9. Strategy selection-cost effective, feasible, non interfering too much.

10. Strategy experimentation and evaluation-field research/computer simulation or analysis.

11. Information dissemination and utilization.

12. Replication and up-scaling.Step IProblem identification and diagnosis

13. Problem definitionProblem should be defined in terms of its - 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 parametersDefining a problem includes -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

14. Problem justificationThe key aspects in justifying the research problem are:Knowing whether the problem is current and timely (topical) and perceived by programme managers

15. How widespread is the problem?

16. Does it affect key population?

17. Is problem related to ongoing program activities?

18. Solutions not known

19. Does it relate to broad social, economic and health issues (unemployment, status of women, HIV, FP etc)?

20. Is solution replicable?Step IIStrategy selection

21. Selecting a strategyIdentify potential (alternate) strategies that could be used to solve the program problemIndicate why the selected strategies are most appropriate

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. Criteria for selecting strategy-example Does the selected strategy have the potential to enhance HIV prevention from parents to children?

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. Defining study objectives and hypothesisUltimate objective - - 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”

27. Defining study objectivesImmediate objective (state what will happen) - 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.

28. Defining study hypothesesStatement about an expected relationship between two or more variables that permit empirical testing

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