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MODULE – 1- COURSE ORIENTATION
MODULE – 1- COURSE ORIENTATION
COURSE OBJECTIVES:
1. Describe what HSR is and understand the contribution
it can make toward solving priority problems in health
care within the local context.
The course is thorough out the semester and will include
three main components;
i) HSR proposal development
ii) Implementation of proposal (field work)
iii) Analysis, interpretation and reporting.
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COURSE ORIENTATION CONT…
COURSE ORIENTATION CONT…
The discussion will include;
1. Course review
2. Basic concepts
3. Steps in developing a Research proposal.
AIM OF THE COURSE
Equip participants with knowledge and skills in preparing research
proposals, data collection, analysis and report writing.
TEACHING METHODS
Learning by doing
- Lecture/discussion
- Individual assignment
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TEACHING METHODS CONT…
TEACHING METHODS CONT…
- Group work
- Presentation in plenary
COURSE SCHEDULE
- Proposal development – one month
- Data collection – two/three weeks
- Data analysis & Dissertation writing – one month
ASSESSMENT
- Tests and individual assignments
- Defense of dissertation
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INTRODUCTION
INTRODUCTION
The ultimate goal of any national health-development process is to
enable its people to reach a level of health that at least enables
them to participate actively in the social and economic life of the
community in which they live. To attain this objective, existing health
systems must be redirected to achieve equitable reallocation of
resources for health-total coverage, increased accessibility to
primary health care services, and effective referral to secondary and
tertiary levels of care. It is also relevant to develop appropriate
mechanisms to promote effective community participation in the
promotion and maintenance of health.
Such redirection of health systems may require changes in health-
care planning and government policy; in the organization and
administration of health and related services; in the financing and
budgeting of systems and procedures; and in the selection and
application of appropriate technology.
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INTRODUCTION CONT…
INTRODUCTION CONT…
To effect the necessary changes, countries must decide on the best
approaches to adopt. This requires detailed and accurate information on
needs, possibilities, and consequences of recommended actions. Such
information is often lacking, inadequate, or unreliable. As a result, decisions
are based on assumptions and unjustified conclusions and often result in
inappropriate policy choices, the consequences of which are only
discovered after implementation.
Research is a systematic search for information and new knowledge. It
serves two essential and powerful purposes in accelerating advances in
health. First, basic or traditional research is necessary to generate new
knowledge and technologies to deal with major unresolved health problems.
Second, applied research is necessary to the process of identifying priority
problems and to designing and evaluating policies and programs that will be
of the greatest health benefit, using existing knowledge and available
resources, both financial and human.
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CONT…
CONT…
These two purposes together, in what has now been defined as
essential national health research, must catalyze the generation of
new knowledge and the application of existing knowledge, an
essential link to equity in development.
THE END
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COURSE OBJECTIVES (from slide 2)
COURSE OBJECTIVES (from slide 2)
2. Prepare a health systems research proposal by completing the
following steps:
- Problem identification;
- Review of literature and other available information;
- Formulation of research objectives;
- Development of an appropriate research methodology;
- Development of a strategy for distribution and utilization of
results;
- Preparation of work plan; and
- Identification of resources required and preparation of a
budget.
3. Implement this proposal in your own working situation during a
period of 4-6 months.
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CONT…
CONT…
4. Analyze and interpret results.
5. Prepare and present a final report including recommendations
for implementation of the research findings.
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BASIC CONCEPTS
BASIC CONCEPTS
At the end of this session, the Health Officer students should be
able to define the following terms;
1. a) Research
b) Variables
c) Data
d) Health System Research
e) Operational (Applied) research
f ) Fundamental (Basic) research
g) Quantitative research
h) Qualitative research
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Cont…
Cont…
2. a) State the characteristics of research
b) State two purposes of research
c) Describe health system
d) List the stakeholders in Health System Research
e) State the guidelines for Health System Research.
DEFINITIONS:
Research is a systematic collection, analysis, and interpretation of
data to answer a certain question or solve a problem.
Variable is a characteristic of a person, object or phenomenon,
which is measurable and thus has different values.
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DEFINITIONS CONT…
DEFINITIONS CONT…
Data is the collected information. Usually people or organizations
collect data from different sources such as industries, agriculture,
medicine, academic disciplines and many other occupations. This is
collected through measurements, observations and experimentation.
Health System Research is ultimately concerned with improving the
health of a community, by enhancing the efficiency and effectiveness
of the health system as an integral part of the overall process of
socioeconomic development.
Operational (Applied) research is a type of research which is
necessary to identify priority problems and to design and evaluate
policies and programs that will deliver the greatest health benefit,
making optimal use of available resources.
- Aim at finding solution or answer to a problem.
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CONT….
CONT….
Fundamental (Basic) research is a type of research which is
necessary to generate new knowledge and technologies to deal with
major unresolved health problems.
- New knowledge without defined goals
- Aim at gathering new knowledge that has a broad based
application (knowledge for knowledge’s sake).
Quantitative research is used to quantify the size, distribution, and
association of certain variables in a study population.
- Concerns with quantity/amount
- Numbers are important (Answers are given in figures i.e.
numbers).
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CONT…
CONT…
Qualitative research involve the identification and exploration of a
number of often related variables that give insight into the nature
and causes of certain problems and into the consequences of the
problems for those affected.
- Concerns with meaning of phenomena
- Numbers are not important (Behaviour is studied much).
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BASIC CONCEPTS CONT…
BASIC CONCEPTS CONT…
CHARACTERISTICS OF RESEARCH;
- It demands a clear statement of the problem
- It requires a plan (it is not aimlessly “looking” for something in the hopes
that you will “come across a solution”).
- It builds on existing data, using both positive and negative findings; and
- New data should be collected as required and be organized in such a way
that they answer the original research question (s).
PURPOSES OF RESEARCH
- Necessary to generate new knowledge and technologies to deal with
major unresolved health problems.
- Necessary to identify priority problems and to design and evaluate policies
and programs that will deliver the greatest health benefit, making optimal
use of available resources.
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CONT….
CONT….
HEALTH SYSTEM
May be described as:
- A set of cultural beliefs about health and illness that forms the basis for
health-seeking and health-promoting behaviour;
- The institutional arrangements within which that behaviour occurs; and
- The socioeconomic/political/ physical context for those beliefs and
institutions.
STAKEHOLDERS IN HEALTH SYSTEM RESEARCH
+ Policy makers
+ Health managers
+ Health care providers
+ The community
+ The professional researchers.
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STAKEHOLDERS CONT…
STAKEHOLDERS CONT…
- If decision/policy makers are involved only after completion of the
study, the report may just be shelved.
- If health staff are involved only in data collection and not in the
development of the proposal or in data analysis, they may not be
motivated to collect accurate data or carry out the
recommendations.
- If the community is only requested to respond to a questionnaire,
the recommendations from the study may not be acceptable.
- If professional researchers are not involved in the implementation
of recommendations, they may have little concern for the feasibility
of the recommendations.
Note: Because of the participatory nature of HSR, in the modules
that follow we will use the term RESEARCHER to mean anyone
actively involved in planning and conducting the research.
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CONT…
CONT…
GUIDELINES FOR HEALTH SYSTEM RESEARCH
Bearing in mind that HSR is undertaken primarily to provide information to
support decision-making that can improve the functioning of the health
system, we summarize some essential guidelines for success:
1. HSR should focus on priority problems in health care.
2. It should be action-oriented, i.e. aimed at developing solutions.
3. An integrated multidisciplinary approach is required, i.e., research
approaches from many disciplines are needed because health is affected by
the broader context of socioeconomic development.
4. The research should be participatory in nature, involving all parties
concerned (from policymakers to community members) in all stages of the
project.
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GUIDELINES CONT…
GUIDELINES CONT…
5. Studies should be scheduled in such a way that results will be
available when needed for key decisions. Otherwise, the research
looses its purpose, i.e. research must be timely.
6. Emphasis should be placed on comparatively simple, short-term
research designs that are likely to yield practical results relatively
quickly. Simple but effective research designs are difficult to
develop, but much more likely to yield useful results when needed.
7. The principle of cost-effectiveness is important in the selection
of research projects. Program management and operational
research should focus, to a large extent, on low-cost studies that
can be undertaken by management and service personnel in the
course of daily activities. (There is a need for some larger studies as
well, however, that may require outside funding.)
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GUIDELINES CONT…
GUIDELINES CONT…
8. Results should be presented in formats most useful for
administrators, decision-makers, and the community. Each
report should include:
- A clear presentation of results with a summary of the major
findings adapted to the interests of the party being targeted by the
report.
- Honest discussion of practical or methodological problems that
could have affected the findings.
- Alternative courses of action that could follow from the results and
the advantages and drawbacks of each.
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CONT…
CONT…
9. Evaluation of the research undertaken should not be a measure
of the number of papers published but of its ability to influence
policy, improve services, and ultimately lead to better health.
Thus, an HSR project should not stop at finding answers to the
questions posed, but include an assessment of what decisions have
been made based on the results of the study.
THE END
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STEPS IN THE DEVELOPMENT OF AN HSR
STEPS IN THE DEVELOPMENT OF AN HSR
PROPOSAL
PROPOSAL
Questions you must askSteps you will take Important elements of each step
What is the problem and Selection, analysis, and - problem identification
why should it be studied statement of the research - prioritizing problem
problem - analysis
- justification.
What information is already Literature review - literature and other available information
Available?
Why do we want to carry out Formulation of objectives - general and specific objectives
The research? What do we hope - hypotheses
To achieve?
What additional data do we need Research methodology - variables
To meet our research objectives? - types of study
How are we going to collect this - data collection techniques
Information? - sampling
- plan for data collection
- plan for data processing and analysis
- ethical considerations
- pretest or pilot study
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STEPS CONT…..
STEPS CONT…..
Questions you must askSteps you will take Important elements of each step
Who will do what and when? Work plan - personnel
- timetable
How will the project be administered Plan for project - administration
How will utilization of results be administration and - monitoring
Ensured? Utilization of results - identification of potential users
What resources do we need to Budget - material support and equipment
Carry out the study? What - money
Resources do we have?
How will we present our proposal to Proposal summary N.B. Development of a research
proposal is
Relevant authorities and potential often a cyclical process. The arrows
indicate
Funding agencies? That the process is not always linear.
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STEPS IN THE DEVELOPMENT OF AN HSR
STEPS IN THE DEVELOPMENT OF AN HSR
PROPOSAL
PROPOSAL
By the end of the first part of the course, each student will have
developed a research proposal with the following chapters (For details,
module 18).
1. INTRODUCTION
1.1 Background information
1.2 Statement of the problem
1.3 Literature review
2. OBJECTIVES
3. METHODOLOGY
3.1 Study type, variables, and data collection techniques
3.2 Sampling
3.3 Plan for data collection
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CONT…
CONT…
3. METHODOLOGY
3.4 Plan for data processing and analysis
3.5 Ethical considerations
3.6 Pretest.
4. WORK PLAN ( including description of project staff)
5. BUDGET (including explanatory note on major budget items)
6. PLAN FOR ADMINISTRATION, MONITORING, AND UTILIZATION OF
RESULTS.
Annex 1. References
Annex 2. List of abbreviations (if applicable)
Annex 3. Data-collection instruments (including questionnaires)
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IDENTIFYING AND PRIORITIZING
IDENTIFYING AND PRIORITIZING
PROBLEMS FOR RESEARCH
PROBLEMS FOR RESEARCH
Objectives:
At the end of this session you should be able to:
1. Identify criteria for selecting health-related problems to be given
priority in research.
2. Work individually, using the criteria identified, to set priorities for
research.
3. Using a group consensus technique, select an appropriate
subject for a research proposal that will be developed by you during
the course.
Main concepts:-
I. Problem identification
II. Criteria for prioritizing problems for research.
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I. PROBLEM IDENTIFICATION
I. PROBLEM IDENTIFICATION
Definitions;
a) Problem is:-
- the difference between what exists and what is ideal situation.
- a gap between existing and ideal situations.
b) Problem identification;
- is a process of finding out the need of health system.
If the answer to the research question is obvious, we are dealing
with a management problem that may be solved without further
research. If, for example in the sanitation project essential building
materials, such as cement, have been unavailable for a large part of
the project period, one should try to ensure the supply of cement
rather than embark on research to explore the reasons why the
project did not reach its targets.
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CONT…
CONT…
These questions can be placed in three broad categories, depending
on the type of information sought:
1. Description of health problems required for planning interventions.
Planners need to know the magnitude and distribution of health
needs as well as of health resources, to formulate adequate
policies and plan interventions.
2. Information required to evaluate ongoing interventions with respect
to:
* Coverage of health needs
* Coverage of target groups
* Quality
* Cost
* Effects/impact.
to assess progress and the need for adjustment on a routine basis.
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CONT…
CONT…
3. Information required to define problems situations arising during
the implementation of health activities, to analyze possible causes
to find solutions.
Although research in support of planning and evaluation (categories
1 & 2 mentioned above) is an important focus for HSR, the modules
will concentrate on the third category, because mid-level managers
are frequently confronted with problems of this type. It is assumed,
however, that research skills acquired in the present course will be
of use in the broader field of planning and evaluation as well.
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CONT…
CONT…
Whether a problem situation requires research depends on three
conditions. (How do you decide whether the problem is
researchable):
1. There should be a perceived difference or discrepancy
between what exists and the ideal or planned situation.
2. The reason (s) for this difference should be unclear (so that it
makes sense to develop a research question); and
3. There should be more than one possible answer to the
question or solution to the problem.
How do you identify the problem?
a) Review available information
b) Interview key people/stakeholders
c) Observation.
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PROBLEM IDENTIFICATION CONT…
PROBLEM IDENTIFICATION CONT…
For example:
Problem situation
In District X (pop. 145,000), sanitary conditions are poor (5% of households
have latrines) and diseases connected with poor sanitation, such as
hepatitis, gastroenteritis, and worms, are very common. The Ministry of
Health has initiated a sanitation project that aims at increasing the number
of households with latrines by 15% each year. The project provides
materials and the population should provide labour. Two years later, less
than half of the target has been reached.
Discrepancy
35% of the households should have latrines, but only 15% do have them.
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CONT….
CONT….
Research question
What factors can explain this difference?
Possible answers
1. Service related factors, such as forgetting to adequately inform and
involve the population, bottlenecks in the supply of materials, differences in
training, and effectiveness of sanitary staff.
2. Population-related factors, such as situations where community
members lack an understanding of the relationship between disease and
sanitation or have a greater interest in other problems.
THE END
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II. CRITERIA FOR PRIORITING
II. CRITERIA FOR PRIORITING
PROBLEMS FOR RESEARCH
PROBLEMS FOR RESEARCH
Because HSR is intended to provide information for decision-making to
improve health care, the selection and analysis of the problem for research
should involve those who are responsible for the health status of the
community. This would include managers in the health services and in
related agencies, health-care workers, and community leaders, as well as
researchers.
Each problem that is proposed for research has to be judged according to
certain guidelines or criteria. There may be several ideas to choose from.
Before deciding on a research topic, each proposed topic must be
compared with all other options. The guidelines or criteria discussed on
the following page can help in this process:
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Criteria for selecting a research topic
Criteria for selecting a research topic
1. Relevance
2. Avoidance of duplication
3. Feasibility
4. Political acceptability
5. Applicability
6. Urgency of data needed
7. Ethical acceptability
1. Relevance
The topic you choose should be a priority problem. Questions to be asked include:
+ How large or widespread is the problem?
+ Who is affected?
+ How severe is the problem?
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CONT…
CONT…
Try to think of serious health problems that affect a great number of people
or of the most serious problems that are faced by managers in the area of
your work.
Also, consider the question of who perceives the problem as important.
Health managers, health staff, and community members may each look at
the same problem from different perspectives. Community members, for
example, may give a higher priority to economic concerns than to certain
public health problems. To ensure full participation of all parties concerned,
it is advisable to define the problem in such a way that all have an interest in
solving it.
NOTE: If you do not consider a topic relevant, it is not worthwhile to
continue rating it. In that case, you should drop it from your list.
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CRITERIA FOR SELECTING CONT…
CRITERIA FOR SELECTING CONT…
2. AVOIDANCE OF DUPLICATION
Before you decide to carry out a study, it is important that you find out
whether the suggested topic has been investigated before, either within the
proposed study area or in another area with similar conditions. If the topic
has been researched, the results should be reviewed to explore whether
major questions that deserve further investigation remain unanswered. If
not, another topic should be chosen.
NOTE: Also, consider carefully whether you can find answers to the
problem in already available, unpublished information and from common
sense. If so, you should drop the topic from your list.
3. FEASIBILITY
Look at the project you are proposing and consider the complexity of the
problem and the resources you will require to carry out your study. Thought
should be given first to personnel, time, equipment, and money that are
locally available.
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CONT….
CONT….
In situations where the local resources necessary to carry out the project
are not sufficient, you might consider resources available at the national
level; for example, in research units, research councils, or local universities.
Finally, explore the possibility of obtaining technical and financial assistance
from external sources.
4. POLITICAL ACCEPTABILITY
In general it is advisable to research a topic that has the interest and
support of the authorities. This will increase the chance that the results of
the study will be implemented. Under certain circumstances, however, you
may feel that a study is required to show that the government’s policy needs
adjustment. If so, you should make an extra effort to involve the
policymakers concerned at an early stage, to limit the chances for
confrontation later.
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CONT…
CONT…
5. APPLICABILITY OF POSSIBLE RESULTS AND RECOMMENDATIONS
Is it likely that the recommendations from the study will be applied? This will
depend not only on the blessing of the authorities but also on the availability
of resources for implementing the recommendations. The opinion of the
potential clients and of responsible staff will influence the implementation of
recommendations as well.
6. URGENCY OF DATA NEEDED
How urgently are the results needed for making a decision? Which research
should be done first and which can be done later?
7. ETHICAL ACCEPTABILITY
We should always consider the possibility that we may inflict harm on others
while carrying out research. Therefore, review the study you are proposing
and consider important ethical issues such as:
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CONT….
CONT….
• How acceptable is the research to those who will be studied? (Cultural
sensitivity must be given careful consideration).
• Can informed consent be obtained from the research subjects?
• Will the condition of the subjects be taken into account? For example, if
individuals are identified during the study who require treatment, will this
treatment be given? What if such treatment interferes with your study
results?
These criteria can be measured by the following rating scales:
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SCALES FOR RATING RESEARCH TOPICS
SCALES FOR RATING RESEARCH TOPICS
Relevance
1. = Not relevant
2. = Relevant
3. = Very relevant
Avoidance of duplication
1. = Sufficient information already available
2. = Some information available but major issues not covered
3. = No sound information available on which to base problem-solving
Feasibility
1. = Study not feasible considering available resources
2. = Study feasible considering available resources
3. = Study very feasible considering available resources
Political acceptability
1. = Topic not acceptable to high level policymakers
2. = Topic more or less acceptable
3. = Topic fully acceptable
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CONT…
CONT…
Applicability of the results
1. = No chance of recommendations being implemented
2. = Some chance of recommendations being implemented
3. = Good chance of recommendations being implemented
Urgency
1. = Information not urgently needed
2. = Information could be used right away but a delay of some months would be
acceptable.
3. = Data very urgently needed for decision-making
Ethical acceptability
1. = Major ethical problems
2. = Minor ethical problems
3. = No ethical problems
