G U ID E T O O P E R A T IO N A L R E S E A R C H …

1 GF-Operations-4 11/5/07 10:58 AM Page 2. GUIDE TO OPERATIONAL. RESEARCH IN PROGRAMS. SUPPORTED BY THE. GLOBAL FUND. GF-Operations-4 11/5/07 10:58 AM Page 3. What is operational research? Operational research provides decision-makers Examples of research topics in with information to enable them to improve the per- Global Fund-supported HIV, formance of their programs. Operational research tuberculosis and malaria programs helps to identify solutions to problems that limit program quality, efficiency and effectiveness, or to Systems for delivering antiretroviral treatment (ART);. determine which alternative service delivery strate- identifying needs and demand for ART and barriers to treatment seeking among different population groups.

2 Gy would yield the best outcomes. In simple terms, Tanzania Round 4 HIV grant: it is described as the science of better . search/ Operational research focuses on factors which are Integrating HIV and tuberculosis control. Ethiopia Round under the control of programs. It seeks to improve 6 tuberculosis grant: the number and quality of services and program outputs and outcomes by optimizing program inputs Rapid diagnostic tests vs. microscopy for malaria in ( , personnel, supplies) and processes ( , train- peripheral health facilities. Afghanistan Round 5. ing, supervision, promotion of services). Operational malaria grant: research can also determine cost-effective and sus- tainable ways to build service delivery capacity, test financing alternatives and make advocacy and com- munication strategies and tools more effective.

3 For example, a study to increase condom use among patients on antiretroviral (ARV) treatment might How to include operational research in a experiment with changes in provider training or proposal to the Global Fund? client counseling and measure the impact on the number of condoms distributed or frequency of Operational research should be described as an activity consistent condom use. (with the associated budget) in the proposal form, with a focus on explaining the link to program outcomes. Look Why is operational research important? for further guidance in the Round 8 guidelines, available as of 1 March 2008 on the Global Fund website. The Global Fund believes that operational research has an important role to play in the success of Further information is available in the Monitoring and the programs it funds, and strongly encourages Evaluation Toolkit available at: proposals with an operational research component.

4 En/apply/call7/documents/me/ and under Item 7 of Everyone writing a Global Fund application, and anyone concerned with improving their program's technical/. performance, should think about whether opera- tional research should be built into the application. Learning by doing is an essential element of improving program performance. Global Fund- supported programs are recommended to spend five to ten percent of their grant budget on monitoring and evaluation (M&E), which can include spending on relevant operational research. research capacity and ability to learn from data Operational research complements M&E and pro- and implementation, effectively serving as an vides both the host program and the Global Fund investment in future program efficiency and with solid information about which interventions performance.

5 In Global Fund grants, operational and service delivery models work (or do not work) in research components must be aligned with HIV, TB, and malaria programs. Global Fund sup- national research priorities, matching the port can also help build a program's overall country's evolving disease-control policies. GF-Operations-4 11/5/07 10:58 AM Page 4. Who does operational research? How to do operational research Operational research is commonly carried out by Either qualitative or quantitative methods can be any health-care provider, including the public sector, used. Qualitative methods include focus group discus- nongovernmental organizations (NGOs), and the sions or individual interviews with service providers or for-profit sector as a means of identifying and clients or observational studies, , observing health solving problems in hospitals, health centers, and care workers.

6 Quantitative methods include structured community programs. Most studies need not be questionnaires or the analysis of service statistics. elaborate, and they can be conducted within Formal epidemiological studies using qualitative or almost any program. quantitative methods are commonly performed. Operational research is most successful when it The research often follows a well-defined process: is carried out by a team of program implementers and researchers who work closely together during 1. Identification of the program problem every stage of the research, from the identification Identifying the problem is the most critical step of the problem to the dissemination and utilization in the operational research process.

7 Unless a of results. The role of the program implementers problem is clearly defined it is impossible to who know the program and its clients, includes: develop good solutions. (1) taking the lead in defining the program problem, (2) specifying when the study result is needed for 2. Identification of possible reasons and solutions decision-making, (3) ensuring that providers and and the testing of potential solutions facilities cooperate with the researchers, (4) utilizing Research is required when either the reason for the the findings in program decision-making and problem or the solution to the problem is not self-evi- (5) disseminating research findings. Researchers are dent. Once the problem has been identified, it is the responsible for translating the program problem into job of the program implementer and researcher to a researchable problem and for the quality of the determine the reasons for the problem and to gener- research.

8 It could also be useful to involve stakehold- ate possible solutions. Sources for thinking of possi- ers as advisors throughout the operational research ble reasons and solutions include program staff and process, for example representatives from civil clients, community members and literature on the society groups, NGOs, affected communities, the topic. Good solutions must be measurable, easy to government and technical assistance agencies. implement and sustainable. GF-Operations-4 11/5/07 10:58 AM Page 5. In some cases, operational research is used to determine the effectiveness of a proposed Many operational research projects follow a solution through comparison methods in an pattern similar to the one shown here.

9 Intervention study. Designs used for this are: quasi-experimental design: one where the situ- 1. ation is analyzed before and after introducing Consider 9. the possible solution to the service delivery further Identify ways of problem 2. unit, or between service delivery units with and improving without the proposed solution; and Monitor Identify changes in possible true experiment: one where service delivery, the revised reasons 8 programs or health outcomes, are compared between 3. randomly assigned experimental and control . Identify Disseminate groups. results possible solutions 3. Results utilization 7. Research Act on protocol Prior to beginning the study, it is necessary to findings of to test 4.

10 Research decide how its results are meant to be used. Conduct solution(s). This determines, to some extent, the informa- 6. research 5. tion that will be collected. For instance, a study might find that one way of delivering insecticide- treated bed nets is superior to another way in getting households to buy and use the nets, but the decision-maker will (and should) want to know, for example, if the new strategy is more Operational research is successful expensive; if information about cost was not col- if its findings are used in making a lected, a good decision cannot be made. program decision Let the program identify the problem to be solved or the 4. Results dissemination decision to be made Early in the operational research process, a Know who will make the decision and when strategy must be developed for disseminating Include a results utilization and dissemination plan in the results to stakeholders.