this presentation mainly deals with operational research giving more focus on pERT and CPM techniques. this two methods are very useful and very confusing while reading but the examples in this presentation makes it very easy to understand this methods and for more study the end slide is provided with references.

1. OPERATIONAL
RESEARCH

2. My Talks Today
 History
 Definitions
 Operational Research(OR) Approach
 Impact of OR on Policies
 Critical Path method(CPM)/PERT
 Queueing Model( Waiting Line Model)
 Opportunities for OR in Health
 Societies for OR
 Funding Agencies for Operational Research
 How to Obtain OR proposals
 Conclusion

3. History
 Even before India started its first five
year plan, World had to witness the
destruction and devastation of six years
of Harakari during 2nd World War in
1939-45.

4.  In this six year devastation millions of deaths
occurred and entire world in ruins, but it
taught so many lessons to human being for
human kind
 And it led to the formal evolution of scientific
tool that was going to revolutionized the
research methodology in future.
Operational
Research

5.  During World War OR flourished for disaster
but later on it flourished for development of
Nation.
 Prior to formal start of OR early work in OR
was carried out by Charles Babbage in 1840
 In relation to cost of transportation and
sorting of mail that led to formation of England
Universal Penny Post.

6.  Main credit for Operational Research
goes to AP Rowe, who analyzed and
improved the working of UK early
warning radar system Chain
Home.(1937)
History

7.  Patrick Blackett is regarded as Father of OR.
 Royal aircraft establishment through OR reduced
no. of Anti Aircraft artillery rounds needed to
shoot down enemy.
 His team at Coastal Command’s OR section(CC-
ORS) concluded that
 A few large convoys are more defensible than
many small ones.

8.  Aircrafts with white undersurfaces are not
easily detected under clear clouds.
 Bomber Command’s OR Section(BB-ORS)
made logical recommendation that
 Armor should be placed in the areas which
were completely untouched by damage in
the bombers which returned.
History

9.  So till now we have discussed about the
evolution of OR in fields other than
Health.
 OR came into action in Health, decades
after its evolution just like timings of
Indian railways.
History

10.  Operational Research was first studied in
Health Care settings in 1952.
 In England , Norman Bailey published
“Operational Research in Medicine” in the
June issue in Operational Research Quarterly.
(Bailey June 1952).
 In the same year “Journal of the Operations
Research Society” was launched in America.
History

12. DEFINITION
 WHO defines OR as the Systematic
Research Techniques for program to
achieve a specific outcome.
 It provides policy makers and managers
with evidence that they can use to
improve program operations.

13.  Operational Research helps to identify
solution to bottleneck that limit program
quality, efficiency and effectiveness or
 To determine which alternative service
delivery strategy would yield the best
outcomes.
 Synonym of OR is Management Science.

14.  How OR is distinguished from other kinds of
research?????
1. It addresses specific problem with specific program
not general health issues.
2. Addresses problems that are under control of
managers such as program system, training, pricing
and provision of information.
3. It requires collaboration between managers and
researchers in identification of the study and
analysis & interpretation of results.

15.  In layman’s terms OR is defined as the
application of scientific methods,
techniques and tools
 To problems involving the operations of
a system so as to provide those in
control of system with optimum solutions
to problems.

16. Operational Research
Approach

17. Impact of OR on Policies in US
and CHINA
 In US prevalence of Hepatitis B among
general population is 0.1% as compared to
10% in Asian and Pacific Islanders.
 An OR was done by INFORMS to evaluate
cost-effectiveness of
 Hepatitis B screening, vaccination, and
treatment policies for adult Asian and
Pacific Islanders in the US.

18. Policies for Decision Model
1. Status Quo – No formal policy.
2. Universal Immunization.
3. Screen, Treat and Vaccinate.
4. Screen and Treat.
5. Screen, treat and Ring Vaccinate.

19. Universal
Immunization
Screen, treat and
vaccinate
Screen and treat
Screen, treat and ring
vaccinate

20. Results

21. Dissemination and Impact
 Shared results with US CDC
 Published in a indexed medical journal
 CDC changed screening recommendations
in September 2008
1. − Persons born in geographic regions with
chronic HBV prevalence>2%.
2. − US-born persons not vaccinated as
infants whose parents were born in
regions with >8% HBV prevalence.

22. HEPATITIS B in CHINA
 Evaluate cost-effectiveness of HBV
catch-up vaccination for children and
adolescents in China.
 140 million children unprotected

23. Vaccination
Screen and
Vaccinate

24. Results
 Catch-up vaccination provides
1. − Better health outcomes
2. − Lower overall costs
 Screening before vaccination is not cost-
effective

25. Dissemination and Impact
 April 2009: China changed its policy to
provide free catch-up vaccination to all
school age children
1. − Prevent ~70,000 deaths, save $900
million in health costs
2. − Reduce social injustice from
discrimination

26. Critical Path method(CPM)
 Critical path is the one which is having
longest duration from starting to finish
node.
Program Evaluation and Review
Technique(PERT)
 Both CPM and PERT are nearly similar
OR techniques except that duration is
non deterministic in PERT.

27. Critical Path method(CPM)
 Used in project management.
 Shows how earlier project can be
completed.
 Inputs:
1. Activities
2. Duration (deterministic)
3. Precedence relationship
 Outputs: Earliest time to finish project
So while taking the example of Interns Hostel
Chiri CHC which is under construction, lets
suppose.

28. Expected time

29. Total = 79 weeks

30. Questions
 1. How can the project be displayed graphically to
better visualize the flow of the activities?
 2. What is the total time required to complete the
project if no delays occur? (44weeks)
 3. When do the individual activities need to start and
finish (at the latest) to meet this project completion
time? (next slide)
 4. When can the individual activities start and finish
(at the earliest) if no delays occur? (next slide)

31.  5. Which are the critical bottleneck activities
where any delays must be avoided to prevent
delaying project completion? (A,B,C,E,F,J,L,N)
 6. For the other activities, how much delay can
be tolerated without delaying project
completion?(Next slide)
 7. Given the uncertainties in accurately
estimating activity durations, what is the
probability of completing the project by the 47
weeks? (PERT)

38.  Now Question 7
 To find out probability of finishing project
by 47 weeks ???
 As we know that Variance = SD2
 Therefore SD = 3
 Z value
= Due date–Estimated date/ SD
= 47 – 44/ 3 = 1
Probability = 84.1%

40. Queueing Model( Waiting Line
Models)
Finite Queue
Infinite Queue
Single server
Multiple Server
Finite population
Infinite
population
Balking
Reneging
Jockeying
Lives on the Line

41.  Queueing principle FIFO
 Lets assume Arrivals of clients = ƛ
 Service provided = µ
 Length of system/Queue = Ls, Lq
 Waiting time in system/Queue= Ws, Wq
Input
ƛ , µ
Output
Ls, Lq, Ws, Wq

42. Questions
 In immunization clinic suppose clients arrival is
8/hr, serving time is 9/hr then:
1. What is probability that no one is in system
or server is free or server is not free? (Po=
11%) or (1-Po= 89%)
2. What is probability that there is no one in
queue? (Po+P1= 21%)
3. What will the length of system/ queue? (Ls= 8
or Lq= 7.11)
4. What will be waiting time in system/ queue?
(Ws= 1hr or Wq= 53 min)

43. Opportunities for OR in Health
 Public health
− Programs, policies making, disease prevention and control,
health promotion, preparedness, ….
 Health operations
− Efficient operations of healthcare facilities, manpower
planning and scheduling, supply chain management and
contract design, infection control, …
 Clinical decision making
− Disease diagnosis and treatment, drug surveillance, individual
patient decision making, …

44. Societies for OR
 International federation of OR society
(IFORS).
 OR Society of India (ORSI).
 Institute of OR and Management
Science (INFORMS).
 Centre of OR and Training (CORT).

45. Funding Agencies for OR
1. Bill and Melinda Gates Foundation
2. Council for Development of Social Science
Research in Africa.(CODESRIA)
3. Global Fund to Fight AIDS, Tb, Malaria.
4. International Development Research
center.(IDRC)
5. The US President’s Emergency Plan for
AIDS Relief.(PEPFAR)
6. Rockfellar Foundation.
7. Wellcome Trust.

46. How to Obtain OR
proposals
Central
Tuberculosis
Division(CTD)
Research Cell
1. Chief Medical Officer
2. Epidemiologist
3. Statistician
4. Data entry operator
5. Supporting consultant
National Standing
Committee on OR
1. Head of Prominent
Institutes
2. Eminent Persons from the
:
• Centre of Excellence in
field of medicine and
research
• CTD
• Technical agencies

47. Zonal OR
Committee
1. Zonal task force Chairman
and member secretary
2. Member of State Task
force from Zone
3. Member from Central Tb
Institute
4. Statistician
5. Social scientist
State OR
Committee
State Task Force chairman
Medical College
Representatives

51. Conclusion
 Well the Silver Linings is that Operational
Research is being more and more
integrated as an essential part of
monitoring and evaluation efforts in Public
Heath.
 Thus concept of M’OR’E could become a
new paradigm for enhancing the practice of
integrated monitoring and evaluation
dimensions as one common component
into program management system.

52. References
 WHO. Modern management methods and the organization of
health services, public health papers.
 “Epidemiology and Management for Healthcare for All” By PV
Sathe.
 Framework for Operations and Implementation Research in
Health and Disease Control Programs.
 Malhotra S, Zodpey P. operation research in public health.Ind
Journal Pub Health.2010:54(3)
http://en.wikipedia.org/wiki/Operations_research#cite_note-
hsor.org-3
 Malhotra VM. Role of Game theory in Public Health.
Online J Health Allied Scs. 2012;11(2):2.

53.  Thank you