1. Operational research began in the 1930s to help optimize resource allocation for problems in defense, industry, education, and health services. 2. It uses scientific techniques to help policymakers and program managers review, redirect, and restructure programs to improve efficiency, effectiveness, and evidence-based decision making. 3. Some examples of operational research include optimizing tuberculosis screening and treatment, improving adherence to HIV/AIDS treatment, and evaluating new interventions through implementation research before scaling up programs.

1. P.Parameshwari

2. Scientific approach for problem solving & decision making
Management science ,Operations research, System Analysis
“Science of better “
Operate efficiently with optimal resources
Introduced in World war II (1930)
Applied in defense, industry , education ,health services…..

3. The operational research society of India since 1957
International federation of operational research societies (IFORS)
Headquarters in Kolkata
Promotion and propagation of knowledge in operational research
Establishment & maintenance of professional and academic
standards
Journal- OPSEARCH

4. Any research that produces practically usable knowledge (evidence,
information, findings) which can improve program implementation
(effectiveness, efficiency, quality, access, scale up, sustainability)
regardless of the type of research (design, methodology, approach) falls
within the boundaries of operation research
The use of systematic (or) analytical research techniques for decision making to
achieve a specific outcome(WHO)
Operations research helps policy-makers and program managers to review,
redirect and restructure programs using social science and other research
methods with empirically-based and scientifically-valid answers to service
delivery problems
DEFINITION

5. Optimal allocation of resources in terms of man, money & material
Based on social & management science
Balance conflict of interest to make decisions
Complements monitoring & evaluation( mORe)
Inventive & experimental
Deals on specific problems within specific programs

6.  Develop new knowledge about the program & its utilization
 Identify & solve program problems in a timely manner
 Help policy-makers & program managers to make decision
with evidence based answers
 Improve efficiency & effectiveness of program using scientifically
valid methods

7. SERVICE ISSUES
Quality
Safety
Access
Distribution
Affordability
Drug availability
Skills of health workers
POLICY ISSUES
Policy guidelines
Regulations
Applicability
COMMUNITY ISSUES
KAP Studies
PREVENTIVE
&
CONTROL MEASURES

8.  National programs for communicable diseases like
• Tuberculosis
• HIV/AIDS
• Malaria
 National family welfare program
Global fund to fight against AIDS, Malaria &
Tuberculosis
Bill & Milenda group
Wellcome trust

9. 1. Access to screening and diagnosis of TB
2. Developing sustainable collaboration with all practitioners for TB care
and control
3. Prevention of TB in HIV patients and combined HIV/TB treatment
4. Treatment of Drug‐susceptible and MDR/XDR‐TB: optimal access,
delivery and community participation
5. Capacity Building for Operational Research
OPERATION RESEARCH IN TUBERCULOSIS

10. LQAS of sputum AFB smears stored under ambient conditions for
2 to 15 months for assessment of quality of reading in microscopy
centres
Monitoring of the DOTS programme
Involving private practitioners in the RNTCP
Assessing relapse among Category I patients who have
successfully completed treatment
Risk of tuberculosis infection and disease in different economic
strata

11.  Health planning
Demand forecasting
Location selection – Health care centre / immunisation /ambulance
 Health care management & Logistics
Patient scheduling
Resource scheduling
Logistics in health care
 Health care practise
Disease diagnostics & treatment planning
 Preventive health care
OPERATION RESEARCH IN MANAGEMENT

12. How to decide on the best locations of health centres for providing
maximum Healthcare coverage to a given population?
How many base locations of medical ambulances are needed if the
total distance from the locations to the hospitals must be less than
a given number?
How should radiation treatment be planned for minimising the
treatment time of a cancer patient?
How should the nurses in a trauma centre be scheduled to
maintain an adequate service level even in the worst-case scenario?

13.  To improve the program performance & outcome
To identify the deficiencies in the program
Correct the problem by technical & managerial intervention
 Study the new intervention to improve the program
To assess the effectiveness of new intervention in real environment
Implementation OR
 To guide policy recommendations
Evidence based answers for decision making
To support new intervention that are beneficial when scale up

15. Director (Head of the project)
 Epidemiologist
 Public health administrator
 Statistician
 Sociologist
 Experts in Mathematics & Economics
 Ancillary workers

16. Formulation of the problem
Collection of relevant data
Analysis of data & formulate hypothesis
Deriving solutions from hypothesis or “model”
Choosing the optimal solution & forecasting results
Testing of solutions
Implementing the solution in whole system

17. PHASES IN OPERATIONAL RESEARCH

18. Critical step
Clearly defined to get good solutions
Relevant to the program
What the policy makers need to know to improve the program..
 How to improve access of screening to diagnose MDR /XDR TB
 How to improve adherence of ART treatment
 Study on increase condom use among ARV treatment

19. Economical
Extensive for decision making
Purposeful and based on objective & hypothesis
Using quantitative or qualitative methods

20. Construct a model to represent the system under study
Think mathematically & logically in making formulation
Hypothesis , assumptions, parameters & prognosis

21. Theoretical input changes in model & calculation of probable output
changes
Trying to solve problems with number of possible combinations of
interventions
Limited combinations due to selected & few key variables
Theoretical restriction to few combination by team members
Creative imagination of team members but should be real & practical
Iterative process till optimal combinations is obtained

22. INPUT
Resources – Man, money ,material
Services
Administrative
Decision making
Geographical distribution of
resources
OUTPUT
Operational achievement
Public participation in services
Relevant health personnel actions
Geographical distribution of services
Customer satisfaction
Economic effects

23. Model is a simplified explicit description of existing public health
service
Competitive relationship between public health investment &
alternative investment
Model with manageable number of key variables
Identify the key variable that brings largest change in system with
insight & intuition
Logistics & methodology by mathematician & statistician
Material knowledge epidemiologist ,economist & sociologist

24. MODELS
IN
OPERATION RESEARCH

25. SIMULATION MODEL
A model is a symbolic representation of an idealised system
Allows to try out approaches
Ability to conduct sensitivity studies to search for improvement
To test ideas of improvement
 Planning & evaluation of immunisation & sanitation programme for
control of typhoid fever

26. OPTIMISATION MODEL
To search among possible choices in efficient & effective manner
Narrowing our choices to very best when many immeasurable options are
feasible
To maximize profit & minimize loss
 Linear programming
 Non linear programming
 Integer programming

27.  Linear programming
 To solve problem with million of variable & thousands of constraints
 Objective & constraints should be linearly related
 Feasible decision to represent single objective function
 Budget allocation ,staff scheduling
 Integer programming
 Variable with pre determined discrete values
 Discrete values 0 or 1
 Solve binary decision than large magnitude problem
 To locate ambulance, radiation beam for cancer patients

28. DECISION ANALYSIS/THEORY MODEL
Quantitative method to analyze decisions based on probability theory
Decision tree-key interaction among decision & chance events
Uncertainity & multiple conflicting objective
Limited directly relevant data
Systematic approach to make better decisions

29. QUEING THEORY
 Objective is to minimize cost of waiting & increasing the cost of
servicing
 Goal is to derive an explicit expression to queue length or waiting
time distribution usually in steady state
Eg : Waiting list & Bed allocation
NETWORK FLOW PROGRAM
 Diagrammatic representation of sequence of different events
 Set of points connected by lines or arrows to show direction
 Program evaluation review technique & Critical path method

30. PERT CPM
Identify events necessary to achieve
objective
Long term/first time project with
time uncertain
Probabilistic & linear programming
Planning schedule ,cost & forecasting
Expected time for activity
= Optimistic time + (4 X Most likely
time )+ Pessimistic time / 6
Identify activity than events
Project with prior experience &
known time
Critical path- activity with longest
time
Float
Maximum time the activity can slip if
critical path not managed

31. Team may select one of the solution to be put to a test
Team ends up with a set of proposals for intervention with details
of changes needed in the system & its consequences
Implement the decided choice with changes
Initiate test run
Emphasis on training changes & manuals for personal engaged in
public health service in the test area

32. FORECASTING RESULT
Forecast the changes in operational achievements & indices
Forecasting the results in terms of objective
Delay in obtaining the output
Prognosis in statistical & conditional terms

33. Test run plays vital role in operational research of public health
Defined geographic area (60-100 centres,dispenseries)
Observer effect
Comparison & analysis of feed back with test run and control
Test run requires additional investigators

34. Implementing solution in whole system
Obstacles to implement rational solution to work
May not be successful as test run
Modified solution of test run to put to final test

35. Low level of mathematical/ engineering background in health sector
Limited OR literature in health care
Lack of OR expertise
Lack of optimal dissemination & utilization of operation research
results for programme strengthening

36. This is just a common sense – with a superstructure of fine
words
Operations research can never replace experience

37. Rational bases for decision making
Provide information to provide valuable insight & guidance
Discipline of both management & social science
Improves efficiency & effectiveness of program

38. THANK
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