Meeting Global Health Challenges through Operational Research and Management science/Relever Les Defis De la Sante Mondiale Par la Recherche Operationnelle et a la Science De gestion/Cumplimiento De Los Retos Sanitarios Globales a Traves De la Investigacion Operativa Y Las Ciencias Administrativas

By Royston, Geoff | Bulletin of the World Health Organization, September 2011 | Go to article overview

Meeting Global Health Challenges through Operational Research and Management science/Relever Les Defis De la Sante Mondiale Par la Recherche Operationnelle et a la Science De gestion/Cumplimiento De Los Retos Sanitarios Globales a Traves De la Investigacion Operativa Y Las Ciencias Administrativas


Royston, Geoff, Bulletin of the World Health Organization


Introduction

The historic international health conference at Alma-Ata in 1978 first identified the need for research on "operation, control and evaluation problems" in primary health care. (1) Since then, successive reports from the World Health Organization (WHO) have expressed the need for improvements in organization and delivery and have called for research, both on particular interventions and on entire health systems. (2) Penetrating the "fog of delivery" clearly presents a major global health research challenge.

Operational research (also known as operations research) and management science have made major contributions in improving organization and delivery in many fields of human activity. Operational research originated in the military arena with the design of an integrated information and control system for the British air force in World War II, work which was estimated to have doubled the efficacy of its fighter command. Since then its use has spread, often providing big returns on investment. Two recent examples are: the world's largest logistics company redesigned its overnight delivery network which was estimated to yield savings of more than 270 million United States dollars (US$) and a global automobile manufacturer streamlined its prototype vehicle testing, saving US$ 250 million annually. These examples and more are available at: http:// www.scienceofbetter.org.

However, operational research and management science are underused in the health field, certainly in global health. For example, the Global Fund to Fight AIDS, TB and Malaria allows 5-10% of each grant for monitoring, evaluation and operations research. However, recent estimates are that projects only budget an average of 3% for operational research and actually spend considerably less. (3)

Missing links

Despite the low priority that global health has given operational research, some valuable work has been and is being done. Some examples include: a 32-country programme on primary-care operations research established in 1981 by the US Agency for International Development; (4) a sustained operational research effort over several decades underpinning the development of a global strategy on tuberculosis control; (5) and an established body of operational research around HIV/AIDS. (6)

In global health, operational research has an extremely broad interpretation. The term is used for almost any type of improvement-oriented investigation into a programme's operations. Where management science generally uses systems modelling and related analytical techniques, operational research in global health does not use these tools sufficiently. Almost two decades ago a review of this field noted this gap and stated that many operational research studies in global health "do not carry the full flavour of operational research." (7) With some exceptions, such as for HIV/AIDS where there has been a good deal of operational research modelling work, (8,9) that gap clearly remains, particularly for neglected tropical diseases. (10) For example, guides on operational research published by WHO and the Global Fund to Fight AIDS, TB and Malaria focus mainly on the use of interviews, questionnaires and observations, with less emphasis on experimentation and no coverage of modelling or other analytical methods. (11) Stronger links between the practical and analytical approaches would bridge this gap.

Strengthening the use of management science in global health would also improve communication between operational research workers in global health and development. A recent review of operational research in developing countries provides useful detail. (12)

Analytical tools

Management scientists use a range of analytical tools, from quantitative prediction and optimization techniques to qualitative problem structuring and solution search approaches (Fig. 1). (13) The tools listed on the top left side of the figure are predominantly qualitative and are typically used with groups of people in participative sessions while those on the bottom right are predominantly quantitative and are typically used by individual analysts in desk-based work. …

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