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Opportunities and Challenges of Operational Research Training in Population Health in India

Ashish Joshi1 MD, PhD, MPH and Shruti Murthy2 MPH 

1Director, Center for Program Informatics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA

2Public Health Researcher, Foundation of Healthcare Technologies Society, New Delhi, India

I. Background

Operational research (OR) is defined as an interdisciplinary branch of applied mathematics or formal science that uses advanced analytic methods to make better decisions or research that provides optimal solutions to complex decision-making.1,2 OR is defined as the use of systematic research techniques for program decision-making to achieve a specific outcome (WHO 2003).3-5 OR is also defined as the search for knowledge on interventions, strategies, or tools that can improve the quality, effectiveness, or coverage of programs in which the research is being done (Zachariah and colleagues 2009)”.4 Research producing practically usable knowledge which can improve program implementation regardless of the type of the research falls within the boundaries of OR. At a time when economic resources are scarce, the need for evidence is imminent to prioritize these scarce resources into public health areas which need them the most. This evidence is offered only by research which uses systematic techniques to demonstrate the optimal use of scarce resources. This is a need fulfilled undeniably by OR. Thus, OR in public health is the research into some or all aspects of conducting or operating a system, or a service, while treating the system as a live entity in its actual, real environment; thus differentiating itself from research under controlled conditions.6 It involves research components integrated with analytical methods in routine real-life situations to help improve public health interventions and programs.6, 7

II. Current state-of-the-art of operational research

OR in public health has been limited not only in India, but even globally. This is in spite of the fact that it has a rather broader interpretation in global health than in management science.8 OR in low income countries have been particularly used for tuberculosis. The Global Fund to Fight AIDS, TB and Malaria allows 5–10% of each grant for monitoring, evaluation and OR. However, the under use of OR in global health is evident, recent estimates are that projects only budget an average of 3% for OR and actually spend considerably less.9 There is a growing interest among both International and National agencies to invest resources in OR and guide program implementation in public health. Limited literature is available in various public health journals about operations research in India.8This has been attributed partly due to limited trained manpower, capacity and skills to conduct and publish in peer-reviewed journals. This is an area requiring urgent attention by the public health fraternity and by the agencies that fund such research activities in India such as Indian Council of Medical Research (ICMR). ICMR has stated the need of operational research in India for development of public health protocols and guidelines, for which the capacity needed are public health researchers trained in operations research (ICMR).10-12 In India too, public health programs provide an opportunity to researchers to undertake OR projects. The Revised National Tuberculosis Program (RNTCP) has set a lead example for formulating guidelines for enhancing OR studies in India relevant to TB research. Financial support is given to researchers by Central TB division, Government of India, if proposals are passed through its respective OR committees. Postgraduates in medical colleges are also encouraged to do their thesis in field of TB, and small grant is allocated to them for supporting their research expenses.9, 13 National AIDS Control Organization also promotes OR studies and a provision of research fellowship exists for young scientists to be supported by it for intervention and OR context to AIDS.14 Importance of OR and its conduct in specific areas has also been highlighted in other Indian health and family welfare programs. Many state governments are now realizing the need for carrying out more OR to answer their health service delivery priority concerns. Indian Council of Medical Research, the major research body of Government of India, also commissions and invites proposals on OR in different thematic areas from time to time.15-19

III. Existing OR training programs in India

Capacity building initiatives in India, although on a limited scale, currently in OR are gaining momentum in the country. Short-term training courses are organized as a part of national health programs and as other short-term training projects. Many medical colleges and public health institutions such as National Institute of Health and Family Welfare, Public Health Foundation of India have organized such courses for researchers. A novel TB operations research training project has been initiated by WHO—India and USEA (UNION South East Asia regional office) aiming to develop capacity of the professionals associated with RNTCP to undertake programmatically relevant OR to generate appropriate evidence to enhance TB control efforts in the country. The training will be imparted through series of three workshops each of 5–7 days in duration spread over a period of 1 year and candidates will be expected to undertake an OR project under the training.9 Short-term training courses are organized as a part of national health programs and as other short-term training projects (Table1.)

Organization

Course description

Duration/

Frequency

Evaluation indicator

WHO-India and USEA9

Workshops

3 each year 5-7 days Participants undertake OR project
Population Council15,16,18 Literature preparation, lectures, writing proposals 6 months Develop research proposalMake presentations
Indian Institute of Population Sciences (IIPS)16,18 Material development; incorporated into master’s course curriculum 20 hour advanced course in MPS/ MPhil curriculum Course modified based on participants’ feedback
Center for Operations Research and Training (CORT), Vadodara20 Special focus on sexual and reproductive health and HIV/AIDS

NA

Course modified based on participants’ feedback
Institute of Health and Family Welfare15,16,18 Replicated IIPS course to train reproductive health program officers, Introduced OR into its hospital management and epidemiology programs

NA

Course modified based on participants’ feedback
Medical College, Ahmedabad16,18 Curriculum

NA

Course modified based on participants’ feedback
Public Health Foundation of India (PHFI)21 Interactive OR workshop, Develop an original, implementable and evaluable quality OR in lung health, tuberculosis, HIV/SIDS, NCDs

4 days

Submit at least one original research paper for publication
South Asian Operations Research Course13 Recommended changes in the policy and practice 19 days-3 modules Course modified based on participants’ feedback
Research institutes, RNTCP units22 Workshops and model proposal on operations research given as a reference 2 and 4 hour course

NA

Table1. Few short term training programs in operational research in India

IV. Gaps and Challenges of conducting Operational Research

There is a need to pay more attention to success factors and to draw on a broader range of analytical methods, with more interchange with wider OR work. However, the process of OR is not complete without a team trained in OR knowledge and skills. Impossible to perform effectively by a single individual, an interdisciplinary team is essential for the successful and relevant use of OR techniques to give evidence on the relevance, effectiveness, scalability and improvement of health policies and programs in the most equitable and efficient manner. Thus there is a need to develop workforce trained and proficient in operations research planning, implementation and evaluation. Some of the other challenges for operational research capacity building have been outlined below (a) Shortage of funding, (b) Turnover of trained staff, (c) difficulty of implementing research skills in program settings, (d) reluctance or inability of managers to use findings, (e) need to evaluate capacity building procedures, (f) length of time needed to achieve critical mass of trained researchers and consumers, (g) need for more consumer-oriented training and (h) need to improve linkages between researchers and managers.15-19,23,24

Teams of academicians, policy makers, program managers, epidemiologists, biostatisticians, community health specialists, and health economists should join hands to execute quality OR to answer public health system relevant problems and solve them timely.4-6, 9, 12

V. Operational Research in Population Health: Foundation of Healthcare Technologies Society (FHTS) Perspective (www.fhts.ac.in)

FHTS is a research based organization with a mission to improve population outcomes through innovative multispectral and evidence based practices using informatics applications that can empower individuals, communities and institutions for their overall wellbeing. FHTS has made an attempt to fill this gap in training by initiating a unique, online, live synchronous, 6 month OR certificate program. The program offers academic training and allows individuals to apply skills into practice by identifying research gaps, generate new knowledge through use of appropriate study designs, analysis of quantitative and qualitative data and interpretation and dissemination of research results. Participants submit their manuscript to an International Peer Reviewed journal. Some of the unique features of the FHTS research program include being live, synchronous, weekly modular lectures, mandate Research project, weekly discussion participation, weekly quizzes, assignments and including case studies. Currently there are 131 medical college students enrolled in the OR program. To our best knowledge, this is for the first time in India that students of medical college are publishing their research papers in scientific peer reviewed journals.

VI. Significance of Operational Research

OR approaches can inform a range of important design and delivery issues. OR can also deal with wide ranging issues in public health- health systems, disease prevention, and control along with community issues. The problems of poor coverage of interventions, quality deprived systems, not reaching vulnerable population with services, difficulty in scaling are solved by innovative mechanisms through OR.4,9,25-27 The mandate of XII five year plan (2012-2017) in India places immense thrust on the need of OR in all areas of health and disease control activities. To meet this need, incorporation of OR training in universities and research organizations in developing countries is important to increase the technical capacity of researchers in operational research.12

If you have any questions, please do not hesitate to contact at Email: ashish.joshi@unmc.edu or Shruti Murthy shrutimurthy@fhts.ac.in

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