Operational Research:
Scope and relevant issues
Dr Rajesh Khanna
Coordinator, NCHRC
Outline of presentation
• Scope of Operational Research (OR)
• Domains and levels
• Examples from the field
• Criterion for prioritizing OR
Scope of OR
Characteristics of OR
• addresses specific problems within specific programs
• deals with problems that are under control of
managers
• uses systematic procedures for data collection and
evidence generation
Is the scope so limited ??
Scope – another perspective
• “Any research producing practically usable knowledge
(evidence, findings, information etc) which can improve
program implementation (eg. effectiveness, efficiency,
quality, access, scale up, scalability) regardless of the
type of research (design, methodology, approach) falls
within the boundaries of operations research.”
Global Fund (working group), 2008
Scope – narrow or broad?
- specific problems within any research prod. practically
specific programs usable knowledge (evidence,
findings, information) which can
- problems under control improve program
of managers implementation (effectiveness,
efficiency, quality, access, scale)
- uses systematic - regardless of the type of
procedures for data research (design, methodology,
collection and evidence approach)
generation
Domains of OR: quite wide
• Issues related to prevention and control of
diseases or specific condition
• Health system – service issues or policy issues
• Community/societal issues
When to consider OR - levels
Identify problems/issues related to
program implementation (Level 1)
Assess underlying reasons for the
problems/issues (Level 2)
Explore possible solutions and test
them (Level 3)
Example 1: Gadchiroli trial
• Main concern: Static decline in IMR due to significant
& disproportionate no. of neonatal deaths
• Problem identification (Level 1): Observational &
ethnographic studies for 2 years
- 95% home deliveries, more than 50% newborns
require attention but only 2.6% recd, 43% LBW
• Assessment of underlying reasons (Level 2):
- distance to hospitals, shortage of money/transport,
traditional values/beliefs, quality of hospital services
J Perinatol 2005 Mar; 25 Suppl 1: S92-107
Example 1: Gadchiroli trial
• Exploring solutions and testing them (Level 3):
- CHWs introduced & trained for NB care, initiation of
home visits for postnatal care, counseling, early
identification & Rx of sepsis
Integrated package of HBNC interventions tested in a
field cluster trial (7 years of intervention)
• Results: Significant reduction in
- NMR (both early & late), PMR, IMR
- cause-specific NMR due to sepsis, asphyxia
- case-fatality rate in LBW & premature babies
J Perinatol 2005 Mar; 25 Suppl 1: S92-107
Example 2: IMNCI training strategy
• Main concern: Full coverage with existing training
package (8 days) will require long timeframe to cover
the entire country
• Problem identification (Level 1) and underlying
reasons (Level 2): Known from existing studies and
evaluations
- logistics, funds, shortage of trainers, strategy,
administrative issues
Health Policy & Planning 2009; 24: 94-100
Example 2: IMNCI training strategy
• Exploring solutions and testing them (Level 3):
- Revised Training strategy (5-days interrupted)
compared to conventional strategy
reduced time for lunch/tea, early start, field-based
assessments replaced by assignments, reduced no. of
hospital and community training sessions
• Results:
- No difference for increase in knowledge score
and increase in skill score
- decreased cost and time
Health Policy & Planning 2009; 24: 94-100
Criteria for prioritizing areas of OR (1)
• Is the problem/issue related to a Program, that is, is it
relevant for Operational Research?
- the problem/issue is specific for program and not a
general health issue (absent policy, lack of facilities)
- the problem/issue is under control of the managers
or the health team (like training, service delivery)
- solving the problem is expected to improve the
program
Criteria for prioritizing areas of OR (2)
• Magnitude & distribution of the problem
- how big is the problem? (widespread or localized
problem)
- how severe is the problem? (is it a serious problem
requiring urgent attention or not?)
- who is the target group affected? (community,
health workers)
Criteria for prioritizing areas of OR (3)
• Feasibility (or practicality) of conducting study
- has the topic been investigated or studied before?
(sufficient information already existing)
- are the required resources available? (HR, finances,
time, equipments for conducting study)
- how urgently are the results required? (timeliness
of results)
- ethical issues
Criteria for prioritizing areas of OR (4)
• Impact & Applicability of results
- what would be the impact of the study result on
the program? (problem complex and dependant on
many factors or on a single factor)
- would it be possible to implement or apply the
study results? (management capability, availability
of resources for implementation)
- would the study be supported by the community
and decision makers?
Thank you