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This is the stage where process of OR is initiated. In health-care settings, an ongoing health program often fails to achieve its expected objective and the program managers are faced with problems factors responsible for which are not apparent. It succeeds only if the research is conducted in the existing environment and study results are implemented in true letter and spirit. It requires close interaction between program managers and researchers It tests more than one possible solution and provides rational basis, in the absence of complete information, for the best alternative to improve program efficiency It involves research into the problem using principles of epidemiology It focuses on a specific problem in an ongoing programme The keyword in all the definitions is improvement, which is to be brought about by means of research in the operation of an ongoing program. In addition, ethical issues, which form an integral part of all clinical and epidemiological research, have their role poorly defined in OR, more so if it is based on secondary data. On the other hand, clinical or epidemiological research studies individuals and groups of individuals in search of new knowledge. It examines a system, for example, health-care delivery system, and experiments in the environment specific to the program with alternative strategies to find the most suitable one and has an objective of improvement in the system. It addresses a specific problem within a specific program. OR, however, is different from clinical or epidemiological research. A global meeting held in Geneva in April 2008 to develop the framework of OR, defined the scope of OR in context to public health as “ Any research producing practically usable knowledge (evidence, finding, 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 OR.” From a health program perspective, OR is defined as the search for strategies and interventions that enhance the quality and effectiveness of the program. Dictionary of Epidemiology defined it as a systematic study of the working of a system with the aim of improvement. In its report on “The Third Ten Years of the WHO,” WHO has highlighted the usefulness of OR in improvement of health-care delivery in terms of its efficiency, effectiveness, and wider coverage by testing alternative approaches even in countries with limited national resources. Described as “the science of better,” it helps in identifying the alternative service delivery strategy which not only overcomes the problems that limit the program quality, efficiency, and effectiveness but also yields the best outcome.
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The kind of research that Alma Ata Declaration recommended for improvement of health-care delivery is essentially OR. A number of issues were yet to be resolved and researched before primary health care was operationalized under local conditions. In 1978, Alma Ata Declaration acknowledged that primary health care was well known globally but, at the same time, also noted that modalities of its implementation were likely be different in different countries depending on their socioeconomic conditions, availability of resources, development of technology, and motivation of the community. It emphasized the need of identifying health-related issues needing research and thereby generation, dissemination, and utilization of the newly acquired knowledge for health promotion. The world soon realised the potential of this kind of research and many disciplines especially management sciences, started applying its principles to achieve better returns on their investments.įollowing World War II in 1948, the World Health Organization (WHO) came into existence with research as one of its core functions. Origin of the term operational research (OR), also known as operations research, can be traced back to World War II when a number of researches carried out during military operations helped British Forces produce better results with lesser expenditure of ammunition.