What is Operations Research (OR) and Implementation

Research (IR)? What isn't?

George SchmidWorld Health Organization/Centers for

Disease Control and Prevention

wolfhoundsamerica@yahoo.com

Format • Informal• Practical—if you want to hear about modelling (a legitimate,

important part of OR), run out the door now• The session is for you, and us• You will forget 90% of what you hear today. So, we've given

you materials on a CD-ROM:– Designing HIV/AIDS Intervention Studies (and other materials) (Pop

Council);– Framework for Operations and Implementation Research in Health and

Disease Control Programmes (and other materials) (Global Fund and WHO)

– Other materials (note the FHI guide to qualitative research)

What is OR? What is Implementation Research? What is (Public Health)

Evaluation? What is Translation Research?

OR

PHE

IR

TR

OR

• "Provides decision makers with information to improve the performance of their programs."

• "…helps to identify solutions to problems that limit effectiveness, efficiency or quality of programs"

Guide to OR in Programs supported by the Global Fund

Operations Research (OR) is the study of factors under the control of program managers.

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

Research Focus

Independent variables:

manipulated by managers

Dependent variables:

program outcomes

Independent variables:

manipulated by managers

Dependent variables:

program outcomes

Factors controlled by managers Outcomes desired by managers and clients

Managerial Control

Factors Under Control

Program systems: training, information, counseling …

Factors Not Under Control

Cultural beliefs, location, economic status, religion, education…

OR Supports Evidence-Based Programs

Allows programs to make evidence-based decisions

1. Identifies service delivery problems

2. Tests service delivery innovations (effectiveness)

3. Tests service delivery costs (efficiency)

How?

Costs are a Key Program FactorStudy Them!

• Cost-effectiveness—what is the least-expensive way to get the desired outcome– e.g., can nurses do the same job as a

doctor?

• Affordability

What is OR? What is Implementation Research? What is (Public Health)

Evaluation? What is Translation Research?

OR

PHE

IR

TR

What is OR? What is Implementation Research?

Programme

Not implemented(or just starting)

Implemented

Effective? Efficient?

IR OR

Implementation Research

• "IR provides the crucial link between the findings of OR of how to optimize a system of care and treatment and the effective application of these findings in a local program."1

• "…focuses on how to promote the uptake and successful implementation of evidence-based interventions…that have been identified through systematic reviews*."2

1Hirschorn LR et al. Clin Infect Dis 2007;196(S3):S516 2Sanders D, Haines A. PLoS Med 2006;3:e186

*Drs. Sanders and Haines are Cochrane Collaboration experts

Implementation Research

• "…focuses on how to promote the uptake and successful implementation of evidence-based interventions…that have been identified through systematic reviews."1

1Sanders D, Haines A. PLoS Med 2006;3:e186

Who does this?

What is OR? What is Implementation Research?

Programme

Not implemented(or just started)

Implemented

Effective? Efficient?

IR OR

What is the International Climate Towards OR?

• The Sydney Declaration (IAS—July 2007)– 10% of HIV programme funds for research

• The Global Fund suggests 5-10% of funds for M&E, including OR

Favorable!

Global Fund Grants and "OR and Information Systems"

Rounds 1-6

0

50

100

150

200

250

300

350

400

Rounds1-5

Round 6

Grants

Grants with ORcomponent

Grants with ORbudget

If OR budget, %19%

52%

2.6%

4.4%

Korenromp E et al 5th European Congress on Tropical Medicine and International Health

34% HIV

56% TB

74% Malaria

What is the International Climate Towards OR?

• The Sydney Declaration (IAS—July 2007)– 10% of HIV programme funds for research

• The Global Fund suggests 5-10% of funds for M&E, including OR

• PEPFAR February 2008 • WHO/World Bank/IAS/GF March 2008 meeting and 4

August Consensus Statement– Extends Sydney Declaration into capacity building and

implementation capability• IAS meeting October 2009• Mexico City, Cape Town meetings with OR as Track D

Favorable!

Translation Research?

• =~ "Knowledge translation"1

• Bridging the "know-do gap"1

• "The synthesis, exchange, and application of knowledge…."

• =~ Implementation research

1Cordero C et al. Funding agencies in low- and middle-income countries: Support for knowledge translation. Bull WHO 2008;86:524

What isn't OR?

What isn't OR?

OR

PHE

IR

TR

M (&E)"formative eval"

Clinicalresearch

Quality assurance

Thoughts?

Tony? Rony?

What Skills Do You Need to Do OR?

• An enquiring mind• Effective (epidemiology, statistics, public

health, relevant science expertise to the project, e.g., behavioural science, medicine….)

• Efficient (economics, health services management….)

• Courses in OR– CDC– Population Council…and….

Format of Session

• This introduction

• What is OR?

• Some practical steps in OR

• Is it formative or operational research?

• Your thoughts/discussion

Questions!