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THE OPERATIONS RESEARCH APPROACH |
Stig Andersen & M Piot: Proceed Natl TB &
Chest Dis Workers Conf, Bangalore, 1962, Souvenir 16-19. |
The National Sample Survey demonstrated that tuberculosis
is one of India's major public health problems, disease being equally
prevalent in both rural and urban areas. To bring about the reduction
of the tuberculosis problem in a limited time the programmes developed
at National Tuberculosis Institute (NTI) must have the following
characteristics: i) they must be firmly rooted in the general health
services and contribute to their development. ii) they must be applicable
to the large majority of the districts of India. The existing clinical
knowledge of tuberculosis should be brought to the realm of public
health application, for which NTI must accumulate a body of knowledge
on the efficiency of various control programmes under field conditions
and their operational feasibility.
Operations Research at NTI consists of following
elements (i) Data collection on (a) epidemiological factors
by conducting base line and longitudinal surveys (b)
operational factors by comparing Mass Campaign approaches
and Community Development Approaches (c) Sociological and
economic factors by studying the awareness of symptoms among
TB patients, economic consequences of TB and acceptability of long
term drug treatment (ii) construction of various epidemetric and
operational models to give information on the efficacy of various
tuberculosis programmes (iii) test run at the moment NTI is operating
a District TB Programme (DTP) in Anantapur and a city programme
in Bangalore. These programmes have been formulated to a large extent
on the basis of preliminary data not organised in model form. Some
provisional conclusions are beginning to emerge from the various
elements of the Operations Research Programme operating for a year.
The general health services are proving to be capable of playing
their essential role in the diagnosis and treatment of tuberculosis,
provided they are assisted, at district level, by a special tuberculosis
service for planning, partial supervision, evaluation and referral.
With existing chemotherapy the treatment organisation is the most
crucial part of the tuberculosis services, and the decisive role
is played by the field organization engaged in preventing and curing
treatment default. The most critical requirement of any control
programme is an ample provision of drugs, to be supplied free of
cost to the patients. Over half the X-ray active cases (including
more than three quarters of the sputum positive cases) are aware
of symptoms of the disease, and Case-finding can therefore, for
some time to come, be based on the self advertising attraction of
a free treatment service within a walking distance, associated with
a simple sputum diagnosis at Primary Health Centre level and referral
X-ray diagnosis at taluk or district level. NTI's task is formidable,
its resources limited. We believe that through its Operations Research
Approach, NTI utilises most effectively its limited facilities towards
the solution of India's tuberculosis problem.
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KEY WORDS: OPERATIONS RESEARCH, CONTROL PROGRAMME,
NTI, APPROACH. |
078 |
OPERATIONS RESEARCH IN PUBLIC HEALTH |
Stig Andersen: Indian J Public Health 1963, 7, 141-51. |
The research which is foremostly needed in the
poor countries of the world is not inventive and experimental research;
the demand of these societies is no longer for new techniques and
new inventions to improve their human material. Their demand is
for systems composed of largely known techniques which could improve
the human material to a level they can now afford and give the optimal
utilisation of scarce economic resources. Research that satisfies
this demand can be called application research or operations
research. The term Operations Research has been borrowed from
certain other fields i.e., military and industry. The techniques
have mainly been developed during the second world war military
field operations and later on applied in the field of industrial
management. The spectacular progress of public health in the developed
countries during the last century was a result of interaction mainly
between economic progress and the development of science and not
as a result of application of operations research. Over a period
of time a very large number of inventions and experiences in techniques
are available to apply in logical systems. This relative preponderance
of technical knowledge over economic capacity is the social fact
and many developing countries cannot choose the best and have to
depend upon the utilisation of operations research in public health.
The following are the major seven phases in Operations
Research applied to Public Health Services: i) formulation of the
problem, ii) collection of data, iii) analysis and hypothesis formulation,
iv) deriving solutions from the model, v) choosing the optimal solution
and forecasting results, vi) the test run and the control system,
vii) Recommending implementation. Operations Research can be a continuous
process or even one time effort. For a country like India it could
be a permanent feature of the national health services. The minimum
composition of the Operations Research team is probably a
public health administrator, an epidemiologist, a
mathematician, a statistical and social scientist.
The essence of Operations Research is that logical
thought combined with careful observation and methodological analysis,
which should form the basis of decision making. Operations Research
thus may be called as the science of common sense.
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KEY WORDS: OPERATIONS RESEARCH, PUBLIC HEALTH,
MANAGEMENT, METHODOLOGY. |
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