>> 90,9773 777737F7F77P77 7 FF FPPFFIFIFIIIAI III II IID MBA Hospital and Health Management 2020 - 2022 First Year Research Methods March 15 ~ 26, 2021 Dr. Neetu Purohit / Dr. Anoop Khanna LITHMR& Institute of Health Management Research 1, Prabhu Dayal Marg, Sanganer, Jeipur, india Phone. 91-141-3924700, Fax: 91. 141-2792138, emaii: iinmir@iihmr.edu.in, URL: www.iihmr.org,7993939393933 3333333 8939793999399 990930939399>ra DvD PFD.DD »>rx, vDIB > 1. Research Methods 2. Course Code: cc 613, 3, Contact hours: 60 4, Self-Study and Assignments: 30 Credits: 03 5. INTRODUCTION The purpose of research s to provide evidence for taking informed action. Since management follows evidence-based approach, importance of research cannot be overestimated. The impact of research studies in management depends upon the appropriateness and rigor of the research methods chosen. The course aims at introducing the students ta the research ‘methods used in various functional areas of Health and Hospital management. It guides the students to the nature and process of scientific inquiry in the field of health and hospital services. The course will help the students understand the basic principles of research and methods applied to draw inferences from the research findings. This course teaches the Purposes, approaches, and methods of Quantitative and qualitative research methods used in heaith and hospital services. 6. COURSE OBJECTIVES The broad objective of the course on research methods is to develop skills to perform as cffective health and hospital manager. The syllabus and course content are generic, yet have been designed Keeping in mind the current requirements of the healthcare industry. The objectives are as under: * To discuss research and its reievance in management of health systems and healtn industry + To identify and recognize research-related management issues related (o health care Industry + Toexplain research process and its various steps + Toexamine quantitative and qualitative approach end methods + Todevelop research proposals 7. COURSE OUTCOMES By the end of the course, students will be able to: Recall and recognize researchable issues in management Apply the gained knowledge in imiting reseerch questions and objectives Compare various research desions and methods in view of the research problem Develcp research proposal for specific research issues. 8. MODE OF DELIVERY The course pedagogy will be a combination cf classroom teaching, group work and written examination and oral presentations. The course is an interactive one, providing a blend of participatory exercises, individual and qroup presentations, and group discussion focusing especially on the issuesiproblems reiated to health systems. Hands-on practice in class room and heme assignments will b¢ given to the students. Class room exercises and homeassignments will be based on the various aspects of research. Tutorials will be conducted to help students solve their problems. 9, COURSE CONTENTS [Week | Hours Units Contents 1 3 1 Introduction to Health Systems Research Introduction to systems and Health systems Research and its relevance in the health systems Relevance and scope of research in management ‘Types of research Identifying Research Problem The context of research Identification and synthesis of issues Formulation of research questions Research Process Introduction to proposal writing Finding a research question Writing objectives of a problem Reviewing relevant literature reviewing of literature, references and referencing systems. Writing rationalemeed for the study Research Design ‘Types of research designs Non-intervention Studies Descriptive Analytical Surveys Cohort Case control studies Intervention Studies (operational research designs) Pre-experimental studies Experimental studies Quasi Experimental Studies Sampling Methods. Need for sample Choosing a sample Number of units of a sample needed to draw inferences Need for oversampling Bias and Confoun: | Introduction to bias | introduction to confounding Importance of bias and confounding Ways to minimize bias and confounding ea .. eon! Research Approaches ‘Quantitative approach Qualitative approach Reliability and Validity ee Importance of reliability —_>rnav>F OP DDODRDDRDD > > rv vv DDD >rvo vo voxF FRR D ‘Types of reliability Importance of validity Types of validity Data Collection Methods and Material (Tools and 2 3 a ‘ Techniques) Choosing the right tool for the survey How to develop survey instruments Do's and don'ts of tool development Steps involved in tool development Finalizing the tools | Methods of data collection | 2 3 410 | Ethical Issues in Research | Need for ethics in research Its importance Historical perspective of ethics in health and hospital research Nuremberg code Helsinki declaration Online ethics course 2 6 14__| Data Management and Analysis Importance of data management | Steps involved in data management | Preparing data analysis plan Why and how to analyze How to read the information Proposal Development ‘Choosing the right design for research Choosing the tools for research Data management and analysis plan | Writing a winning proposal | Prepare work plan and budget 2 3 43 | ReportWriting Basics of report writing Steps involved in report writing Importance of a good report Uslization of research findings 10. LIST OF STUDENT ACTIVITIES Research Proposal Development with all intermediary steps of research process 11. ASSIGNMENTICASE STUDIES Individual exercise Group exercise 12. ASSESSMENT Tne students will be assessed by a wnitten examination end assignments. The distribution of marks witi be as follows: Mid-term Examination: 39%Term Examination: 70% - 13, READINGS - » The standard text books published by the Werld Health Organization, Centers for Disease e Control and others will be used as text books besides a series uf reference books. Some selected ones are cited below: . * Designing and Conducting Health Surveys: Jossey Bass Publishers , San Franscisco © * Gummersson, E (1991) Qualitative Methods in Management Research, New Delhi, Sage Publications ~ * Kothari, C. R. Research Methodology, New Age Intemational Publishers, Second e edition, 2004 + Karishna Swami, Shiva Kumar &Mathirajan, Management Research Methodology. . Integration of Principles, Methods and Techniques, Pearson Education, 2006 + Kumar, R. Research Methodology: a step by step guide for the beginners, Sage = Publication, New Delhi, Third edition, 2071 e + Leedy, Paul D. Practical Research: Planning and Design, Macmillan Publishing Company, 1989 ~ * Vaughan, JP and Morrow, RH () Manual of Epidemiology for District Health Management, Geneva, WHO, 1989 e + Verkevieser et al., (1991) Designing and Conducting Health Systems Research Projects WHO and IDRC ~ * Zikmund, William G. Business Researcl methods, The Dryden Press, New York, e Second edition, 1988 * Debus, M: methodological Review: A Handbook for Excellence in Focus Groups AED ~ Washtington, DC. List of Web sites hitos:/Aww researchgate net s http:/iwww.uniteforsight org/research-methodologyimodules https //wrew clobalhealthiearning ora! ~ https. //eeww woribank.ora! e hito:/iwww authoraid info/eny»>va va DID >rvod,,7 7 PF PFPFOFIFPFOPODIPOPRIO PPP PFIFADDD Session Plan 1. Research: An Overview Learning Objectives. 1. Defining Research... 2. Objectives of Research. 3. Motivation in Research, 4. Significance of Research 5. 6 7. 8. Research Methods versus etiology Research and Scientific Method... Criteria of Good Research... Problems Encountered by Researchers 2, Health Systems Research .. 12 Learning objectives 2 12 1 Why did HSR develop?.. 0 2 Whats Health Systems RES€aFCh? wer annnrnnsnnsnennninonnnnnnrn 3. Guidelines for H5R... 20 3. ‘Types & Appreaches of Research 22 1. Types of Research 2 2. Time in Research. i 25 3. Research Approachesin. 25 4. Process of Research aicbeitwelin ccs cee 27 1. Introduction. 2. Research Process Step-by-step. 3A brief description of the steps Involved in research process. 5, Research problem, Objectives and Hypothesis. 45 1. Defining Problem 2. Types of Relationships ...... 3. Formulating Research Objective 4 4 Defining Varixbles, Founuvlating Hypothesis Tips for Writing Objectives and Hypotheses vs 69 6 Research Designs 70. 1. Introduction to Research Designs 0 2. Overview study types. ™ 2 Non intervention studies ...... 74 1 2.2 intervention (Operational) stuc'y designs° 22.1 Nonexperimental Designs 2.22 Experimental Designs... e 2.2.3 Quasi-Experimental Oesions 3. Selecting a Study Design .. i 4. A"Good" Research Design « 1. Sampling and Sample Size... . e 1. Introduction to Sampling... 2. Errorsin Sampling = 3. Probability Semple e 4. Non-probability Sample 5. Sample Size Determination. e & Plan for data collection... lives 08 e 1. Why should you develop a plan for date collection’ 106 « 2. Logistics of data collection 106 8, Designing a questionnaire sas 110 = 1. Introduction to designing questionnaires M10 se 2. Deciding what to ask... uo 3. Wording of individual question um = 4. Format of responses... simran 113 e 5. Administering the questionnaires 7 us 6. Pretesting and evaluation of questionnaires. 7 see US e 10. Daia Collection 417 e 4. Introduction set Socal 7 2. Quantitative Data Collection some ATF = 3. Qualitative Data Collection . wa e 4. Data Quality Checks at v7 1, Ethics in Research... 128 = 1. Introdvetion to Ethies 28 . 2. Fundamental research ethics principles. woatyated 3. Informed consent. 129 . 4. Confidestiality.. nL e 1 Validity and Reliability of Res: 132 e 4. Two Research Fallacies 122 2. Validity 232 e 3, Reliability. c See 133 e 4. Biasin Research Studies iain 16 5. Threats to Validity and Prevention Measures 138 © 6. Strategies to deal with threats to validity oA e>r>7>>>7OdvO>xa xP >F DOF OOPOO OO ODO OPO DOP TIDAP PDD Analyzing and Presenting Data. Introduction sw Preparing Data for Anais. ‘Types of Variables. Epidemiological thinking for Analysis Analysis of Quantitative Dat swrnn The Basic Measures Analysis of Qualitative Data... Presenting Data... ‘Work plan and Budget... ‘Work Pian, Budget = ‘Major components and outline of the different ghases in a research process. summary of the major components of a research proposal. ‘Summary of the major activities of the fieldwork phase ...« ‘Writing a research report. “A7FFF7FTFTFTTDVAVDVPA9XADX9VADVAVIVXV DIV ®PVOVDOVDVDX9D VDDD VDIDD>>, ,7d77 FPF FPF FPVOPOOPARAPPPOPFIPAPRDRAPDDD 1. Research: An Overview Learning Objectives ‘After completing this chapter, the student should be able to: + Enumerate the characteristics of research © Explain the roles of research in development + Explain significance of research 1, Defining Research Research in common parlance refers to a search for knowledge. Once can also define research as a scientific and systematie search for pertinent information on. a specific topic. In fact, research is an art of scientific investigation. The Advanced Learner's Dictionary of Current English lays down the meaning of research as “a careful investigation or inquity especially through search for new facts in any branch of knowledge.” Redman and Mory define research as a “systematized effort to gain new knowledge.” Some people consider research as a movement, a movement from the known to the unknown. It is actually a voyage of discovery. We all possess the vital instinct of inquisitiveness for, when the unknown confronts us, we wonder and our inquisitiveness makes "s probe and attain full and fuller understanding of the unkno:n. This inquisitiveness is the mother ofall knowledge and the method, which man employs for obtaining the knowledge of whatever the unknowa, can be termed as research Research is an academic activity and as such the term should be used in a technical sense. According to Clifford Woody research comprises defining and redefining problems, formulating hypothesis or suggested solutions; collecting, organising and evaluating data; making dedvetions and reaching conclusions; and at last carefully testing the conclusions to determine whether they fit the formulating hypothesis. D. Slesinger and Mi. Stephenson in the Encyclopaedia of Social Scicnces define research as “the manipulation of things, concepts or symbols for the purpose of generalising to extend, correct or verify knowledge, whether that knowledge aids in construction of theory or in the practice of an art.” Research is, thus, an original contritytion to the existing stock of Knowledge making for its advancement. It's the pursuit of truth with the help of study, observation, comparison and experiment. In short, the search for Knowledge through objective and systematic method of finding solution to a problein is research. The systematic approach concerning, generalisation and the formulation of a theory is also research. As such the term ‘research’ refers to the systematic method consisting of enunciating the problem, formulating a hypothesis, collecting the facts or data, analysing the facts and reaching certain conclusions either in the form of solutions(s) towards the concerned problem or in certain generalisations for some theoretical formulatio2, Objectives of Research ‘The purpose of research is to discover answers to questions through the application of scientific procedures. The main aim of research is to find out the uth which is hidden and which has not been discovered as yet. Though each research study has its own specific purpose, we may think of research objectives as falling into a number of following broad groupings: 1, To gain familiarity with a phenomenon or to achieve new insights into it (studies with this object in view are termed as exploratory or formulative research studies); 2, To portray accurately the characteristics of a particular individual, situation or a group (studies with this object in view are known as descriptive research studies); 3. To determine the frequency with which something occurs or with which it is associated with something else (studies with this object in view are known as diagnostic research studies); 4. To test a hypothesis of a causal relationship between variables (such studies are known as hypothesis-testing research studies). 3- Motivation in Research What makes people to undertake research? This is a question of fundamental importance. The possible motives for doing research may be either one or more of the following: 1. Desire to get a research degree along with its consequential benefits; 2. Desire to face the challenge in solving the unsolved problems, ie, consern over practical problems initiates research; Desire to get intellectual joy of doing some creative work; 4. Desire to be of service to society; 5. Desire to get respectability However, this is not an exhaustive list of factors motivating people to undertake research studies. Many more factors such as directives of goverament, employment conditions, curiosity about new things, desire to understand causal relationships, social thinking and awakening, and the like may as well motivate (or at times compel) people te perform research operation>rv,,77777PRF7 POOF DOPOP PIO ORD OOO PAO PODOIAI AIA DIDD 4. Significance of Research “All progress is born of inquiry. Doubt is often better than overeonfidence, for it leads to inquiry, and inquiry leads to invention” is a famous Hudson Maxim in context of which the significance of research can well be understood. Increased. amounts of research make progress possible. Research inculeates seientific and inductive thinking and it promotes the development of logical habits of thinking and organisation. ‘The role of research in several fields of applied economics, whether related to business or to the economy as a whole, has greaily increased in modern times. ‘The increasingly complex nature of business and government has focused attention on the use of research in solving operational problems, Rescarch, as an aid to economic policy, has gained added importance, both for government and business. Research provides the basis for nearly all government policies in our economic ‘system. For instance, government's budgets rest in part on an analysis of the needs and desires of the people and on the availability of revenues to meet these needs. The cost of needs has to be equated to probable revenues and this is a field where research is most needed. Through research we can devise alternative policies and can as well examine the consequences of each of these alternatives. Decision-making may not be a part of research, but research certainly facilitates the decisions of thee policy maker. Government has also to chalk out programmes tor dealing with all facets of the country’s existence and most of these will be related dircetly or indirectly to economic conditions. The plight of cultivators, the problems of big and small business and industry, working conditions, trade union activities, the problems of distribution, even the size and nature of defence Services are matters requiring research, Thus, research is considered necessary with regard to the allocation of nation’s resources. Anothe: area in government, where research is necessary, is collecting information on the economic and social structure of the nation. Such information indicaies what is happening, in the economy and what changes ate taking place. Collecting such statistical information is by no means 2 routine task, but it involves a variety of research problems. These day nearly all governments maintain large staif of technicians or experts to carry on this work. Thus, in the context of gover research as a toul to economic policy has three distinct phases of operation @ investigation of economic structure through continual compilation of facts; (ii) diagnosis of events that are taking place und the analysis of tie torces underlying them; and (iii) the prognosis, i.e, the prediction of future developments, Research has its special significance in solving various operational and planning problems of business and industry. Operations research and market research, along with motivational research, ate considered crucial and their results assist, in more than one way, in taking business decisions. Market research is the investigation of the structure and development of a market for thepurpose of formulating efficient policies for purchasing, production and sales Operations research refers to the application of mathematical, logical and analytical techniques to the solution vf business problems of cost minimisation or of profit maximisation or what cen be termed as optimisation problems. Motivational research of determining why people behiave as they do is mainly concerned with market characteristics. In other words, it is concerned with the determination of motivations underlying the consumer (market) behaviour. All these are of great help to people in business and industry who are responsible for taking business decisions. Research with regard to demand and market factors has great utility in business. Given knowledge of future demand, it is generally not difficult for a firm, or for an industry to adjust its supply schedule within the limits of its projected’ capacity. Market analysis has become an integral too! of business policy these days. Business budgeting, which ultimately results in a projected profit and loss account, is based mainly on sales estimates which in turn depends on business research. Once sales forecasting is done, efficient production and investment programmes can be set up around which are grouped the purchasing and financing pians. Research, thus, replaces intuitive business decisions by more logicai and scientific decisions. Research is equally important for social scientists in studying social relationships aad in seeking answers to various social problems. It provides the intellectual satisfaction of knowing a few things just for the sake of knowledge and also has practical utility for the social scientist to know for the sake of being able to do something better or ina more efficient manner. Research in social sciences is concerned both with knowledge for its own sake and with knowledge for what it can contribute to practical concerns. “This double emphasis is perhaps especially appropriate in the case of social science. On the one hand, responsibility as a science is to develop a body of principles that make possible the understanding and prediction of the whole range of human interactions. On the other hand, because of its social orientation, it is increasingly being looked to for practical guidance in solving immediate problems of human relations.” In addition to what has been stated above, the significance of research can also be understood keeping in view the following points: (a) ‘To those students who are to write a master's or Ph.D. thesis, research may mean a careerism or a way to attain a high position in the social structure; (b) To professionals in research methodology, research may mean a source of livelihood; new ideas (c) To philosophers and thinkers, research may mean the outlet for and insighis; (@) To literary men and women, research may mean the development of new styles and ereative work;> 7>,97oP7v7P PPAF POPO OFF OOO OOOO TO PSP PRO DIDD (©) To analysts and intellectuals, research may mean the generalisations of new theories. ‘Thus, research is the fountain of knowledge for the sake of knowledge and an important souree of providing guidelines for solving different business, governmental and social problems. It is a sort of formal training which enables ‘one to understand the new developments in one's field in a better way. 5- Research Methods versus Methodology It seeins appropriate at this juncture to explain the difference between research meihods and research methodology. Research methods may be understood as all a ee Tego T Ubiy () Abuiysarbiereay = Revolng of ws Cet anal, Tope an Fl ineing ad Recah recs onal Aras of dcuneas Sel compilstin ad manipulations, elec an abet ier, content aan Find) Non parts eet ‘eration! behours seale, ws of sores 6 Reseuch "obaeration i) Pai oberon Interaction! ecrting possible se of pe records, hot gris sesigees {i) Mas obsovation Recording mas tebe, interview wsngirdepadentobseren in pubic places () Mas eine {lenin oscil at economic backround respondents () Oplaionnace (63) Persoralintarview (08) Foeased inerview |i) Group interview (6 Telephone survey ed schedule wih pena elosed questions 258 stavey tenga for information aed fe cerning tpilon. nay ale bend a follow vp of urate {9 Case sty ai istry Cross sectional ellen of data or intensive analy, longitu collstion of dt of wens charac 3. Labowry’ Small group tus) of andom Use of aatio- visual reording devices, we of eserves et Rewnich __ehavour play anal amass those methods/techmiques that are used for conduction of research. Research ‘methods or techniques, thus, refer to the methods the researchers use in performing research operations. In other words, all those methods which are ‘ised by the researcher during the course of studying his research problem are termed as research methods. Since the object of research, particularly the applied esearch, it to artive at a solution for a given problem, the available data and the unknown aspects of the problem have to be related to each other to make a solution possible, Keeping this in view, research methods can be put into the following three groups: 1. In the first group we include those inethods which are cone collection of data. These methods will be used where the data already ava are not sufficient to arrive at the required solution:2. The second group consists of those statistical techniques which are used for establishing relationships between the data and the unknowns; 3. The third group consists of those methods which are used to evaluate the accuracy of the results obtained. Research methods falling in the above stated last two groups are generally taken as the analytical tools of research. Research methodology is a way to systematically solve the research problem. It may be understood as a science of studying how research is done scientifically. In it we study the various steps that are generally adopted by a researcher in studying his research problem along with the logic behiud them. It is necessary for the researcher to kaow not only the research methods/techniques but also the methodology. Researchers not only need to know how to develop certain indices or tests, how to calculate the mean, the mode, the median or the standard deviation or chi-square, how to apply particular’ research techniques, but they also need to know which of these methods or techniques, are relevant and which are not, and what would they mean and indicate and why. Researchers also need to understand the assumptions underlying various techniques and they need to know the criteria by which they can decide that certain techniques and procedures will be applicable to certain problems and others will not. All this means that it is necessary for the researcher to design his methodology’ for his problem as the same may differ from problem to problem. For example, an architect, who designs a building, has to consciously evaluate the basis of his decisions, ie., he has to evaluate why and on what basis he selects particular size, number and location of doors, windows and ventilators, uses particular materials and not others and the like. Similarly, in research the scientist has to expose the research decisions to evaluation before they are implemented. He has to specify very clearly and precisely what decisions he selects and why he selects them so that they can be evaluated by others also. From what has been stated above, we can say that research methodology has many dimensions and research methods do constitute a part of the research methodology. The scope of research methodology is wider than that of research methods. Thus, when we talk of research methodology we not only talk of the research methods but also consider the logic behind the methods we use in the context of our research study and explain why ive are using a particular method or technique and why we are not using others so that research vesuits are capable of being evaluated either by the researcher himself or by others. Why a research study has been undertaken, how the research problem has been defined, in what way and why the hypothesis has been formulated, what data have been collected and what particular method has been adopted, why particular technique of analysing data has been used and a host of similar other questions are usually ansivered when we talk of research methodology concerning a research problem or study>rodv>xF FD PF RPDIIDDD >rx>> v7 >a vO DOP >OPOTOPOOIADDDD 6. Research and Scientific Method For a clear perception of the term research, one should know the meaning of scientific method. The two terms, research and scientific method, are closely related. Research, as we have already stated, can be termed as “an inquiry into the nature of, the reasons for, and the consequences of any particular set of circumstances, whether these circumstances are experimentally controlled or recorded just as they occur. Further, research implies the researcher is interested in more than particular results; he is interested in the repeatability of the results and in their extension to more complicated and general situations.” On the other hand, the philosophy common to all research methods and techniques, although they may vary considerably from one science to another, is usually given the name of scientific method. In this context, Karl Pearson writes, “The scientific method is cne and same in the branches (of science) and that method is the method of all logically trained minds ... the unity of all sciences consists alone in its methods, not its material; the man who classifies facts of any kind whatever, ‘who sees their mutual relation and describes their sequences, is applying the Scientific Method and is a man of science.” Scientific method is the pursuit of truth as determined by logical considerations. The ideal of science is to achieve a systematic interrelation of facts. Scientific method attempts to achieve “this ideal ‘by experimentation, observation, logical arguments irom accepted postulates and a combination of these three in varying proportions.” In scientific method, logic aids in formulating propositions explicitly and accurately so that their possible alternatives become clear. Further, logic develops the consequences of such alternatives, and when these are compared with observable phenomena, it becomes possibie for the researcher or the scientist to state which alternative is most in harmony with the observed facts. All this is done through experimentation and survey investigations which constitute the integral parts of scientific method. Experimentation is done to test hypetheses and to discover new relationships, If any, among variables. But the conclusions drawn on the basis of experimental data are generally criticized for either faulty assumptions. poorly designed experiments, badly executed experiments or faulty interpretations. As such the researclier must pay all possible attention while developing the experimental design and must state only probable inferences. The purpose of survey investigations may also be to provide scientifically gathered information to work asa basis for the researchers for their conclusions. ‘The scientific method is, thus, based on. stated 9s under: ertain basic postulstes which ean be 1, Itrelies on empirical evidence; 2. Itutilizes relevant concepts; 43. Itis committed to only objective considerations;4. It presupposes ethii adequate and correct statements about population objects; 1 neutrality, ie, it aims at nothing but making only §. itresults into probabilistic predictions; 6. Its methodology is made known to all concerned for critical scruiiny are tox use in testing the conclusions through replication; 7. Itaims at formulating most general axioms or what ean be termed as scientific theories, Thus, “the scientific method encourages a rigorous, impersonal mode of procedure dictated by the demands of logic and’ objective procedure.” Accordingly, scientific method implies an objective, logical and’ systematic method, ie,,a method free from personal bias or prejudice, a method to ascertain demonstrable qualities of a phenomenon capable of being verified, a method wherein the researcher is guided by the rules of logical reasoning, a method wherein. the investigation proceeds in an orderly manner and 2 method that implies internal consistency. 7. Criteria of Good Research Whatever may be the types of research works and studies, one thing that is important is that they all meet on the common ground of scientifie meihod employed by them. One expects si esearch to satisfy the following criteria nti 1. The purpose of the research shiould be clearly defined and common concepts be used. 2. The research procedure used should be described in sufficient detail to permit another researcher to repeat the research for further advancement, keeping the continuity of what has already been attained, 3. The procedural design of the 2 esearch should be carefully planned to yield results that are as objective a possible. 4 The researcher should report with complete frankness, flaws in procedural design and estimate their effects upon the findings. d be sufficiently adequate to reveal its significance used should be appropriate. The validity and reliability of the data should be checked carefully. 6. Conclusions should be confined to those justified by the data of the research and limited to those for which the data provide an adequate basis.>r>>>7 vDOd,POP>FPF.TF POPPA DAIAIAADADIDID >>> 3039300 7. Greater confidence in: yvesearch is warranted if the researcher is experienced, has a good reputation in recearch and isa person of integrity. Inother words, wecan state the quelities of a good research asunder: 1. Good research is systematic: It means that research is structured with Specified step to be taken in a specified sequence in accordance with the well defined set of rules. Systematic characteristic of the research does not rule out sreative thinking but it certainly does reject the use of guessing and intuition in arriving at conclusions. 2. Good research is logical: This implies that research is guided by the reles of fogieal reasoning and the logical process of induction and deduction are of great value in carrying out research. Induction is the process of reasoning from, erpart to the whole wiereas deduction is the process of reasoning, from some premise to a conclusion which follows from that very premise. In fact, logical Feasoning makes research more meaningful in the context of decision making. 4. Good research is erapirical: It implies that research is related basically to one or more aspects of a real situation and deals with concrete data that provides a basis for external validity to research results. 4. Good research is replicable: This characteristic allows research results to be verified by replicating the study and thereby building a sound basis for decisions. 8, Problems Encountered by Researchers Researchers in India, particularly those engaged in empirical research, are facing several problems. Some of the important problems are as follows: 2. The lack of a scientific training in the methodology of research is a great impediment for researchers in our country. There is paucity of competent researchers, Many Tesearchers take a leap in the dark without knowing research methods. Most of the work, which goes in the name of research is not methcdologically sound. Research to many researchers and even to their aides, is mostly a scissor and paste job without any insight shed on the coilated materials. The consequence is obvious, VIZ., the research results, quite often, do not reflect the reality or realities. ‘Thus, 2 systematic study of research methodology is an urgent necessity. Before undertaking research projects, researchers should be well equipped with all the methodological aspects. As such, efforts should be made to provide short-duration intensive courses for meeting this requirement. 2, There is insufficient interaction between the university research departments, nts, government departments and on one side and business establishn 99 research institutions on the other side. A great deal of primary data of non- confidential nature remain untouched/untreated by the researchers for want of proper contacts. Efforts should be made to develop satisfactory liaison among all concerned for better and realistic researches. There is need for ‘developing some mechanisms of a university —industry interaction prograrnme 80 that academics can get ideas from practitioners on what needs to be researched and practitioners can apply the research done by the academies. 3. Most of the business units in our country do not have the confidence that the ‘material supplied by them to researchers will not be misused and as such they are often reluctant in supplying the needed information to researchers. The concept of secrecy seems to be sacrosanct to business organisations in the country so much so that it proves an impermeable barrier to researchers. Thus, there is the need for generating the confidence that the information/data obtained rom a business unit will not be misused. 4. Research studies overlapping one another are undertaken quite often for want of adequate information. This results in duplication and fitters aivay resources. This problem can be solved by proper compilation and revision, »¢ regular intervals, of a list of subjects on which and the piaces where the research is going on. Due attention should be given toward identification of research problems in various disciplines of applied science which are of immediate concern to the industries. There does not exist a code of conduct for researchers and inter-university and inter-departinenta! rivalries are also quite common. Hence, there is need for developing a code of conduct for researchers which, if adhered sineerely, can win over this problem. Many researchers in our country also face the difficulty of adequate and timely secretarial assistance, including compute assistance. This causes unnecessary delays in the completion of research studizs. All possible efforts be made in this direction so that efficient secretarial assistance is made available to researchers end that too well in time. University Grants Commission must play a dynamic role in solving this difficulty Library management and functioning is not satisfactory at many places and much of the time and energy of researchers are spent in tracing out the books, Journals, reports, ete., rather than in tracing out relevant material from them. There is also the problem that many of our libraries are not able to get copies of old and new Aets/Rules, reports and other government publications in time This problem is felt more in libraries which are away in places from Delhi and/or the state capitals. Thus, efforts should be made for the regulir and speedy supply of all governmental publications to reach our libraries,> ve v,rDD ee ee ie >r7>7FPF DODO DFOIOPOIPFPPF ODIIOIFIADRDIDD 10. There is also the difficulty of timely availability of published data from various government and olher agencies doing this job in our country, Researcher also faces the problem on account of the fact that the published data vary quite significantly because of differences in coverage by the ecncerning agencies. 11, There may, at timos, take place the problem of conceptualization and also problems relating to the process of data collection and related things. u>>” ’ >” » @>>>, POPP PF >FPF FPP FRFPITDIDADDD >veF>vFR ,DRTDD o. Health Systems Research Learning objectives * Describe various components of the health system as a basis for understanding HSR. «Describe types of information for decision-making in the health system and the + contribution various disciplines can make in providing such information. + Describe the purpose, scope and characteristics of HSR 1 Why did HSR develop? By adopting of the philosophy and strategies for Health For AI], politicians and health staff at all levels are committed to ensuring that all people will attain a level of health that enables them to participate actively in the social and economic life of the community in which they live. Although research has made major contributions to health by providing Inouvledge of the causes of diseases and by developing the technology to cure and prevent disease and promote health, Health For All is far fron: being achieved. Why is there still so much disease that could have been prevented or cured? Because heath services by themselves cannot control all of the factors that influence health. Poverty and political systems which either widen or narrow the gap between rich end poor and which promote oz neglect the education of girls, for example, influence the health of people. Drought and wars may bring malnutrition and disease with which the health services can hardly cope. While communicable diseases such as smallpox and, to some extent, leprosy may be gradually couqueved due to improved environmental conditions and extra eifort ‘on the part of the bealti services, new diseases such as HIV/AIDS may appear hich upset the whole health eare system and society at large. ‘This complex of environmental factors . Geographical, socio-economic, cultural, political, demographic, epidemiological. not only influences the health of people, it also affects the health services. Countries suffering from poor ane ‘wars and drought usually have poorly functioning health services 5 favourable environments, some services function better than others. 4 very important factor is the quality of information on which policy makers base their decisions. Very often this information is vague oF missing, Then decisions on interventions can be completcly off track, which ineans that money is wasted. Basic questions which health policy makers need answered include, for example: Still, even within I 2+ What are the health needs of (different groups of) people, not oniy according to health: professionals but also according to the people themselves? Can shared priorities be agreed upon? + To what extent do the present health interventions cover these priority needs? Are the interventions acceptable to the people in tems of culture and cost, especially to the poor? Are they provided as cost-effectively as possible? + Given the resourees we have, could we cover more needs, or more people, in a more cost effective way? Is it possible to introduce or expand cost- sharing through insurance, to reduce the risk of unexpected high costs, in particular for the economically vulnerable? Could cooperation with the private/NGO sector be improved? Could donor agencies help solve well- defined bottlenecks in the system? + Is it possible to better control the environmental factors which influence health and health care? Can other sectors help (education, agriculture, public works/roads, ete.)? (Figure 2.3) ‘These questions cannot be answered without collecting more information through research. That is why, since the end of the 1970.s, Health Systems Research (HSR) has been developed. Figure 2.1: Environmental and health system factors influencing attainment of Health For All>rPvovoe vPro DPFP OP DA PFFDRDD »>r> >, v0 OD »>r> vv F FR R”D Political “wR o Heath patsy & planning Ne Ss islont 2 + . a) Needs 1 Resources > Strengthening and changing exiting nteventions eV— featn needs: Hain resources: Gonmunty prev, Taos Protaesionaly determined + Useriees {insurance | * Contnaution from donor eles + Slat and equipment + Community labour 2 Other seaters sjydersower gosio-economic Tigger PRRAE ey (oven pty reeds?) 1 Corp? (A Fat pean > cee (Nporers chon demands an cutee /3 SR EER asda pee é and cients?) A amas s a Environmental Factors 2 Whatis Health Systems Research? ‘What is research? RESEARCH is the sin question orsolve 2 Health research serves two major purposes: First, basic research is necessary to generate new knowledge and technologies to deal with major unresolved health problems. Second, applied researeh is necessary to identify priority problems and to design and evaluate policies and uprogrammes that will deliver the greatest health benefits, making optimal use of ailable resources. During the past two (or even three) decades there has been a rapid evolution of concepts and research approaches to support managerial aspects of bealth development. Many of these have been described by specific terms such as operations/operational research, health services research, health management research, applied research and decision-linked research. Each of these has made crucial contributions to the development of HSR (WHO 1990). What is meant by a health system? ‘There are different interpretations of what a health system is. Some give a narrow definition and only consider the different levels of the public health care services. asa health system (see Figure 2.2.) Figure 22: Public health care system ional or proved hosritala. | Zan rand vainonremeh mosis | Dstict eouncts aa! devetopment canmttaes fnersecrort | SHEL ‘Davie Haalth weiningieseaich metus i = ‘The incl Gistriet council, district development committee and village cevelopment committee indicates, however, thal some 25 years after Alma Ata* it has been widely recognized that lucal administration and other sectors than the health sector alone carzy respousibility fer the health of the people in a village, district or region»>rv vo >>o>vo FF FORA FOPPF POF FPO POPPFPFPFFFIPADAHEDD Many HSR researchers have a wider peroeption of health systems. They also include the private sector. The private sector has many possible components: + Non-governmental organization (NGO) care, provided by churches, Red Cross, local NGOs, ete. «© Medical practice by private doctors, nurses, or by quacks who provide injections and drugs without medical training, ‘= The pharmaceutical sector (licensed pharmacies or unlicensed sellers). + The large .non-biomedical. professionalised healing systems (Ayurvedic, Chinese, Unani, homeopathic, chiropractic, etc.) ‘+ Traditional (or folk) medicine, with traditional birth attendants, herbalists and diviners, who may either identify natural or supernatural causes of disease (witchcraft, angry ancestors) or treat patients accordingly. ‘The Primary Health Care (PHC) approach has broadened the horizon of medical care providers considerably. PHC put individuals and communities in the centre of attention. Individuals providing self-care (what mothers and other relatives do to keep children and themselves healthy) and traditional/folk healers were accepted as important potential allies of health staff. So were personnel from cther sectors, which could support health, for example, through the construction of roads, the improvement of education, water, sanitation, and through Income Figure 2.3 presents the widest possible definition of a health system, including ail public and private sectors/institutions which directly influence and support the health of people, embedded in the wider environmental context that was described in Figure 2.1. This figure would take different shapes in different societies, but everywhere individuals form part of a network of family and community members who are concerned about their health. This network preseribes ot advises how to preveat illness and what to do in case of ill health. In mnany societies, mothers and grandmothers are key figures in carly childcare ‘They determine nutritional and hygiene practices, alert children to dangers, provide care in case of disease, and teach children the basies of self-care. ‘At the other end of the spectrum, a public autherity is responsible for the well being of all people inhabiting its territory Nowadays governinents of stat organise public health care and, to some extent, regulate private health care initiatives. Through other social services (e.¢., education, social welfare), through laws and taxes and police and army, governments are supposed to assure their citizens the resources to survive and live in peace. Since time immemorial this 1s been the duty of rulers, although each society has developed its own ways of ensuring health for al. 16Figure 2.3: A broadly defined health system Private sector Public sector>>707777737F7P77FFPFPPPPPPPFPOPAPOPRDIADAIAIAIAP DD ‘When in the 1980s many countries were struck by chronic economic rises, the World Bank advocated structural adjustment programmes to reorganise the economies, which relied on market mechanisms rather than on state control with subsidies and protection, The health and educational sectors were inevitably affected and weat through a series of reforms that hit the consumer hard. ‘The World Health Organization recognised the need for health reforms, but under the condition that these would leave the goal of HEALTH FOR ALL intact. It therefore focused attertion on fairness of the system, which should also be affordable to the poor, and at the same time stressed that the system should be responsive to the need of patients for human, respectful treatment (Figure 2.4). Figure 2.4: Objectives and functions of the health system Functions the health system performs Objectives of the sysiem [Responsiveness >|t0 people's need to human treatmens | ~, Essential cost ttective HEALTH Fair inanciat Stewartship leadership, version) (isvestment ard taining) i it ‘contribution | ‘Fnoncrg a = {eolecting, posting |—— and puch system, with fees according to capacity. The insurance revenues are then pooled ‘and costs of care paid from the pool, so that in fact the rich heip to cover the treatment of the poor. Unfortunately, such a system is hard to organise in theleast developed countries where rural areas harbour mainly poor, but WHO counts on international solidarity and donor agencies for contributions. The health system comprises both public and private health services but, for the ime being, no agricultural, educational or other sectors, however relevant. The first urgency is the performance of the health system, which should be as good as possible, given the available means. To reach that air, WHO set some criteria, Ministries of Health should weigh the public health importance of proposed health actions, set priorities, and thoroughly investigate the cost-effectiveness of different possible interventions to select the highest value for the money. In terms of resources, they should strive for « balance between investments, the use made of these investments and their maintenance. For example, if staff members are highly trained but their knowledge is underutilised, or if buildings, equipment and meaus of transport cannot be maintained, these investments are highly wasteful. Likewise the services don’t function well if there is no money left for consumables such as essential medicines. The patients then have to buy medicines on the private market, out of their pockets and at unnecessary high costs, which the poor cannot afford. Good oversight is required to achieve an optimal balance among the different expenses, and it is one of the aims of HSR to provide the policy makers with the relevant data. Good oversight and stewartship, is also required to develop a fair financing system. The Ministry of Health is usually the appropriate institution to collect money from taxes and dono agencies to finance the health care system. In the 1980.8 it became clear that even PHC services could never function adequately with the required coverage (health for ALL) without a contribution from the clients. User fees were introduced in countries that hitherto had provided care free of cost, but this appeared to hit the poor out of proportion despite exemption rules. Hence WHO proposes a more structural solution by introducing prepayment through insurance and pooling of resourees, which is beneficial for the poor. Although the MOH, in many developing countries, is stili the prineipal provider of health care, ifit is to achieve the most cost-effective care, it has to consider the use of the private sector and contract services out in cases where this would be cheaper. Consequenily, the MOH has to set standards of care and control for deviation in the private sector as well as the public. To have oversight and control is one of the major present day challenges for Ministries of Health. Specific questions for specific levels of service HSR is not only of use to poiicy makers; at cach level m questions that require further research, ay have Health policy makers may, for example, want to know: What are the prospects for voluntary community-based insuranze? Wiat vs acceptable contributions for different income groups? Should the pocling of resources take place on a community or national basis?>vodvovevF xO vOPOOOII OF FOF FOIA? »>rva >, DvD > vo vv DD How can userfees be used as an instrument to direct demands for care to the appropriate level? Pharmaceutical company ‘What is the scope of penetrating for brandecl generics in rural areas? What should be the strategy for penetrating for branded generics in rural areas ‘Managers at distriet/provincial level may raise questions such as Why is neonatal mortality in certain districts much higher than in other districts? What is the level of drug distribution among the government's free drug distribution scheme? ‘What is the perception of beneficiaties about the scheme? Hospital directors may ask: Why do we have such a high rate of complications during child birth? Are the fireyline services available and adequate? Are our own services adequate? Are mothers coming late for delivery and, ifso, why? Managers at village level (village health committees) may want to know: How ees we assist women with little or no education so that they can effectively recognize the symptoms of pneumonia and go in time to the health centre with their children? ‘How much community labour will be required to manage the new water system? Ris to provide health managers at call levels, as well. as rination they need to make decisions on gctive of. bers, iwith the relevant infor rhe are facing. 3. Guidelines for HSK Beating in mind that HSR is undertaken primarily to provide information to support decision-making that can improve the functioning of the health: system, we summarise by suggesting some essential gnidelines for success: 1. HSR should focus on priority problems in healtin care. 2. Itshould be action-oriented, iz, aimed at developing solutions, esearch ected by 3, An integrated multi-disciplinary approach is required, & approaches from many discipiines ove needed since health is a the broader coutext of socio-economic development. parties ‘4. The research should be participatory in nature, involving es of the concerned (from policymakers to community members) in all st projectStudies should be scheduled in such a way that results will be availal when needed for key decisions; research must be timely. Otherwise, il loses its purpose . Einphasis 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 toyield useful results when needed. - 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 ean be undertaken by management and service personnel in the course cf daily activities. (There is a need for larger studies as well, however, which may require outside funding and full-time research staff.) 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 research. 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, formulated with inputs from all parties concerned. ._ Evaluation of the research undertaken should concentrate on its ability to influence policy, improve services and ultimately lead to better health, rather than on the number of papers published.