Framework for Operations and Implementation Research in Health

1. Framework for Operations and Implementation Research in Health

2. 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.

3. 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

4. Framework Components • Concepts and Background • Framework Flow Chart • Toolkit and References

5. 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

6. SECTION A - CONCEPTS

7. 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.

8. 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.

9. 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

10. 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

11. SECTION B – METHODS AND MANAGEMENT FLOWCHART

12. Phases of the Processes • Planning • Implementation • Follow Through

13. 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

14. 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

15. 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

16. SECTION C – CASE STUDIES, TOOLKITS and RESOURCES

17. 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

18. Toolkits – handbooks, guidelines

19. References, Resources, Examples

20. Annexes

21. 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

22. 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