Framework for Operations and Implementation Research in Health

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Framework for Operations and Implementation
Research in Health
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Purpose of the Framework

• The purpose of this document is to serve as a
  primary reference for people who plan and carry
  out operations research (OR) in order to improve
  the implementation and management of disease
  control and other health programs
• The overall approach is that of a framework that
  helps researchers and program managers identify
  the steps needed
• to set a research question and then work through
  the steps of research design, implementation,
  management and reporting,
• ultimately leading to the use of the findings to
  improve health policies and programs in order to
  attain the desired impact.

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Framework Methodology

• Review of existing guidelines, handbooks, case
  studies and grant proposals
• Site visits to countries that have incorporated
  OR into an overall proposal for disease control
• Consultative meeting with experienced people from
  partners and the field

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Framework Components

• Concepts and Background
• Framework Flow Chart
• Toolkit and References

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Added Value

• The added value of this document is to produce
  the analysis of practical OR experiences in the
  field, and based on the analysis of these
  evidences to create a one-stop shop document
  which
• identifies good practices
• identifies typical (i.e. common) weaknesses
• provides practically usable step-by-step
  description of the entire OR process from A to Z,
  and
• demonstrates what kind of practical applications
  (e.g. linking OR to improvement of quality and
  quantity of services) OR might have

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SECTION A - CONCEPTS
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Terminology of OR-IR

• The terminology for such research may vary by
  setting and sponsor, but the intent of OR and
  this framework is to learn about management,
  administrative, cultural, social, behavioral,
  economic and other factors that either exist as
  bottlenecks to effective implementation or could
  be tested to drive insights into new, more
  effective approaches to programming
• By its very nature, this research is usually
  specific to the environment in which the program
  operates, although there are multi-country
  research projects that address a problem common
  to several countries in a region.

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Scope of Operational Research

• Any research producing practically usable
  knowledge (evidence, findings, information, etc)
  which can improve program implementation (e.g.,
  effectiveness, efficiency, quality, access,
  scale-up, sustainability) regardless of the type
  of research (design, methodology, approach) falls
  within the boundaries of operational research.

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OR/IR can accomplish the following

• Identify and solve program problems in a timely
  manner
• Help policy-makers and program managers make
  evidence-based program decisions
• Improve program quality and performance using
  scientifically valid methods
• Help program managers and staff understand how
  their programs work

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Examples from the Field

• Nicaragua Examining the Effectiveness of Testing
  and Treatment Programs for Malaria
• Zimbabwe Identifying Gaps in HIV Prevention
  among Orphans and Young People in Hwange District
• The Gambia Testing Effectiveness of ACTs to
  Treat Malaria
• Mekong Region Improving Malaria Control Among
  Vulnerable Populations
• Cambodia Treating Tuberculosis in the Private
  Sector

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SECTION B METHODS AND MANAGEMENT FLOWCHART
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Phases of the Processes

• Planning
• Implementation
• Follow Through

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Flow Chart Components Planning

• Organize the research group and advisory
  committee
• Determine issues or problems to study and frame
  research questions around these
• Develop a research proposal to answer OR/IR
  questions
• Obtain ethical clearance
• Identify funding sources and obtain support for
  OR/IR
• Establish a budget and financial management
  procedures
• Plan for capacity building and technical support

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Flow Chart Implementation

• Monitor project implementation and maintain
  quality
• Pre-test all research procedures
• Establish and maintain data management and
  quality control
• Explore together with stakeholders
  interpretations and recommendations arising from
  the research findings

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Flow Chart Follow Through

• Develop a dissemination plan
• Disseminate results and recommendations
• Document changes in policy and/or guidelines that
  resulted from the research
• Monitor changes in the revised program
• Consider ways of improving the program that can
  be tested through further research

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SECTION C CASE STUDIES, TOOLKITS and RESOURCES
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Case Study Nicaragua Example

• Example of Research Question
• Study on the acceptation and impact of
  impregnated mosquito nets in P. falciparum
  transmission areas
• Those responsible for the IR/OR work are also
  responsible for implementing control actions and
  to a large extent, national policies
• Need for key competencies for data collection
  preparation, data cleaning and entry and analysis
  was not fully appreciated during the planning
  phase
• PAHO, WHO and others should play a very proactive
  role to provide support

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Toolkits handbooks, guidelines
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References, Resources, Examples
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Annexes
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List of Annexes

• Annex A
• Definitions of Operations and Implementation
  Research
• Annex B
• Examples of Organizations that Fund/Support
  Operations Research
• Annex C
• Literature Review Procedures and Relevant
  Journals
• Annex D
• Sample Consent Forms and Independent Review Board
  Checklists
• Annex E
• Linkage between Researchers and Public Health

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Conclusion

• OR-IR provides tools to identify new directions
  in health programming and to conquer
  implementation bottlenecks
• OR-IR strengthens our public health efforts
• Thank you for attending, and please access and
  use the OR-IR Framework at
• http//www.theglobalfund.org/documents/rounds/9/CP
  _Pol_R9_FrameworkForOperationsResearch_en.pdf