Document(s) 26 of 27

1. Introduction
2. Content of the fieldwork report

I. INTRODUCTION:

Elaborating a fieldwork report is an entry point to HSR training on data analysis and research report writing. The research team, research assistants, if there were any, and facilitators should participate in this activity (see Module 15). Why should you prepare a fieldwork report that summarises your fieldwork experiences, observations, and preliminary conclusions? This will help you to:

• get a clear overview of the data collected (both qualitative and quantitative), your field observations and impressions, and consider how different sets of data work together to answer the research questions implied in your objectives;
• assess how well your research project was designed and thus the extent to which you can provide valid information to help solve the problem you investigated;
• develop the general approach you will use in reporting your findings and drawing conclusions;
• allow the facilitators and the other groups to provide you with feedback which will help you to identify what further analyses to make and how to organise the final report; and
• assess what you have gained from the data analysis workshop by comparing your preliminary and your final report.

II. CONTENT OF THE FIELDWORK REPORT

Your fieldwork report should include:

• A review of your field work experience, and
• A summary of preliminary findings.

1. Fieldwork experience

Review your fieldwork experience and evaluate how well you were prepared technically (in terms of the methodology developed in your research proposal), and organisationally (work plan, budget and administrative procedures). Summarise your experience and your evaluation of it in at most two pages. Address questions such as those posed below:

• General

  — How did you function as a group? Were all group members active?

  — Did you lose any members? Did you recruit any new members?

  — What procedures did you follow to obtain permission for the research?

  — Did you manage to obtain the research assistants, equipment, transport, and financial support needed?

  — Were the resources you budgeted sufficient?

• Technical preparations

  — What did you do to train your research assistants? Where and how did you do your pre-test or pilot study? How long did it take? Were any major revisions of the data collection tools and/or the research procedures necessary?

• Fieldwork

  — Did you do your sampling the way you had originally planned? Did you obtain the information and co-operation you wanted? How many interviews did you conduct? How does your planned sample size compare with the actual sample collected? (NB: If you have different categories of informants, specify for each group.) How many records were analysed?

  — Were your data collection tools adequate? Did they provide you with the information you wanted?

  — Were you able to follow your work plan? Did you correctly estimate the manpower and time needed to collect the data?

• Technical support

  — Did you receive support from your facilitator/resource person? In what phases of the fieldwork? Was the support timely? Was it sufficient or would more support have been helpful?

2. Preliminary research findings

When presenting research findings:

• First of all, get an overview of all the data you collected and processed.

  — Review any record forms or checklists you’ve completed. Has all the data you wanted to obtain been collected?

  — Review your master sheets or any computer printouts available. Are they complete?

  — Do the total number of responses for each question agree with the number of informants?

  — Have answers to open-ended questions been listed and categorised?

  — Have results from Focus Group Discussions if conducted), interviews with key informants, and/or field observations been transcribed in full, discussed and coded?

• Reread the plan for data analysis in your research proposal. Review the preliminary analysis of data you conducted during the pre-test (see Module 14) in the field. You may have done some useful ground work for data analysis which can be used now as your prepare your preliminary findings.
• Reread your statement of the problem and the objectives.

  Take the SPECIFIC OBJECTIVES as a starting point. Brainstorm as a group on the data you have collected and to what extent they appear to answer the research questions implied in your objectives.

  Consider not only the quantitative data from record forms and relevant sections of your questionnaires but also qualitative data and relevant observations you made or impressions you gained during the fieldwork.

  Discuss whether (and how) the data from various sources complement or contradict each other.

• Record the details of these discussions. This will help you structure the report you are going to write, keeping focused on major issues and yet not forgetting other relevant information.
• Analyse the VARIABLES that further describe the nature, size and distribution of your problem and make a brief summary.
• If you did an analytical study on a practical problem, prepare (at least) two tables for each objective, showing how crucial independent variables relate to dependent variables. (Review the dummy tables you prepared when developing your research proposal and determine which of them you can use).

  If you have mainly untabulated qualitative data, just summarise how crucial parts of the data you collected will answer the questions implied in your specific objectives.

Trainer’s Notes

Module 20: FIELDWORK REPORT

It is necessary to present this module during the workshop. Facilitators should stress that participants should consult the module when they have filled in their master sheets or have received the first printouts from the computer. It will guide them in beginning data analysis and preparing the preliminary report that the team leader will present on the first day of the data analysis workshop.

If a facilitator can pay two visits to the field, the second visit should preferably take place at the onset of data processing. He or she can then work with the group on this task, using Modules 13 and 20 as reference material.

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ANNEX to the modules: GUIDELINES FOR ORGANISING SHORT HSR COURSES; Part I: PROPOSAL DEVELOPMENT AND FIELDWORK*

I. Planning for the workshop

II. Management during the workshop

III. Training methodology

IV. Implementation of projects (the fieldwork period)

Annex 1: Example of a workshop schedule

Annex 2: Guidelines for budgeting an HSR training course

Annex 3: Example of information circular for course participants (used in Malaysia)

Annex 4: Reply format for participants (used in Malaysia)

Annex 5: Example of a course evaluation form

* See also: The Population Council (1970) A manual for Surveys of Fertility and Family Planning: Knowledge, Attitude and Practice. New York and Institute Kesihatan Umum (1986) National Health and Morbidity Survey, Supervisor Manual Kuala Lumpur, Malaysia. (Monograph document)

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I. PLANNING FOR THE WORKSHOP

1. Selection of course facilitators

The course co-ordinator will be the chief organiser of the course. A course co-ordinator will usually be supported by at least four facilitators, depending on the number of research teams. Together, they will be responsible for planning the course content, preparing instructional objectives and guiding the learning process throughout the course. They will give lectures, facilitate group sessions and guide research projects. The course co-ordinator is usually attached to the HSR Unit of the Ministry of Health.

Course facilitators may be selected according to the following criteria:

• Experience in health systems research.
• Experience with participatory teaching.
• Availability for the full duration of the workshop and for providing supervision and support through field visits during the 5-6 months when research projects will be implemented.
• Experience in previous HSR workshops as a participant or facilitator, and/or in a Training of Trainers course for HSR facilitators (the majority should have both!).
• Ideally, the team should comprise a variety of disciplines, such as medical sociology, health management/public health, and epidemiology. At least one facilitator should have knowledge of experience with statistics, and one with collecting and analysing qualitative data.
• An equitable mix of male and female facilitators is recommended.

2. Course administrator

Although the course co-ordinator is responsible for the overall functioning of the course, it is highly recommended that he delegate administrative tasks to a course administrator. The course administrator will, for example, make administrative arrangements, supervise support staff, (typists, drivers), ensure that participants and facilitators receive the necessary support to travel to and from the course site, and make sure that necessary payments are made and various other support tasks during and after the workshop are carried out promptly. The course administrator should attend all meetings of facilitators so that logistic support for the participants can be arranged for appropriate times.

3. Requesting consent for conducting the workshop

To obtain approval and funding to conduct the workshop, a proposal may have to be submitted to the relevant authorities for approval and funding approximately 12–18 months prior to the workshop. The proposal should include:

• The title, a brief background statement, and summary of the rationale for the workshop;
• Objectives of the workshop;
• Number and types of participants;
• Tentative date, duration and venue;
• Budget requirements (see guidelines on budgeting in Annex 1); and
• Any assistance required in the form of consultancies from within and outside the country.

As workshops in general take place at the initiative of the HSR Unit of the MOH, a training institution or NGOs active in health, approval is usually a matter of rubber-stamping, if needed at all. However, sometimes (additional) funding has to be identified for the workshops or for implementation of the research proposals developed, which requires time and energy.

4. Request for consultants (if needed)

Requests for consultants should be based on specific terms of reference and made through the Ministry of Health or other initiating organisation to the relevant donor agency. The workshop proposal should be included with the request.

5. Pre-workshop preparatory activities

A course management team consisting of the course manager, a core group of facilitators, and a course administrator should be set up at least 5 months prior to the workshop, to:

• Determine who the participants will be (depending on the priorities of the organisation that takes the initiative);
• Identify content areas, methodology and the course schedule (see Annex 1 of these Guidelines for sample schedules);
• Identify and arrange for the venue;
• Identify and make plans for procuring the required materials (e.g., stationery and other supplies and transport); and
• Identify resource persons who may be required to give special technical or logistical input (e.g., permission from administrative authorities for transport, if it is intended that workshop participants should do field work for pre-testing of data collection tools.)

(1) Selection of participants and research topics (about 4 months before the workshop)

The selection of participants is usually delegated by the HSR Unit or organising NGOs to the provincial levels, hence the need to give clear guidelines.

Number of participants: 20–25 (5–6 per team)

Criteria for selection:

The criteria for selection of the participants should be clearly defined, taking into consideration the types of participants who are available, their educational background, the feasibility of their incorporating research into their functions and their interest in research. The following factors have been found to be useful in selecting participants for the basic course described in this volume:

• Select small groups of participants from the same geographic or institutional locations, so that each group can develop and implement a research proposal as a team and support each other in the development of subsequent research projects.
• If HSR is in an early stage of development, give priority to the following types of participants:

  —Staff of relevant training institutions (e.g., public health or nursing schools) so as to rapidly create a pool of persons who can both do research and help others;

  —Staff who have had previous exposure to basic epidemiological or sociological research;

  — Participants with leadership qualities;

  — Participants from districts, institutions, or regions where the director or manager is strongly committed to HSR and is likely to provide leadership and support;

  — It is advantageous to have participants from different disciplines and with leading functions in the major health programs (i.e., maternal and child health, sanitation, nursing, rural development). Some junior social scientists may be included.

• In subsequent workshops a good mix of district- or provincial-level participants may be invited.

Communications with national and regional or provincial health managers or institutes that are invited to provide participants should be made 3-5 months before the workshop.

First, informal contact should be made with these authorities to inform them of the possibility of authorising staff to participate in an HSR training course, to enlist their interest and support in selecting problems for the research projects. The criteria for selection of participants and topics should be discussed, and the managers should be requested to explore potential topics with staff members whom they plan to select as participants. These should in turn consult other parties concerned (field staff, community members).

• Then official letters should be sent to the same authorities stating:
• The objectives of the training course;
• The structure and schedule (e.g., two workshops with a fieldwork period of 5-6 months (part time) for implementation of an HSR project in between);
• The venue of the workshop;
• The selection criteria for participants;
• The preparations the participants need to complete before attending the workshop;
• The deadline for the confirming participation in the workshop; and
• A request that the supervisors identify specific topics for HSR projects which the participants can consider/select during their workshop. A copy of Module 1 and the relevant sections of Module 3 could be sent to the authorities (and participants) to guide them through the process of selecting appropriate topics. It would be highly recommended to arrange for a facilitator to assist in the selection of research topics (see Module 1).

(2) Communication with selected participants

An information circular should be sent to all the participants selected, providing them with preliminary information on the workshop (similar to the one sent to their superiors). It should emphasise that they will be expected to do a research project themselves. The relevant sections of Module 3 can also be sent, providing there will be guidance for the selection of topics. (See a sample of an information circular in Annex 3).

On receiving confirmation of their participation, the prospective participants can be sent background-reading materials on HSR.

(3) Discussions on training methodology and training procedures

It is extremely important that the course management team as a whole takes time to discuss the course content and methodology. All facilitators should be very familiar with the training materials. Consensus will have to be reached concerning who will introduce the different modules and the role of facilitators during group work and plenaries. The capabilities of each facilitator will have to be discussed in relation to the training requirements.

(4) Ordering or duplicating sufficient copies of the training modules

This can be done through WHO Geneva, AFRO or other regional offices, or IDRC Ottawa.

(5) Selection of additional local resource persons

Additional local expertise in disciplines such as epidemiology, statistics, qualitative data collection and analysis, may be required if these specialisations are not sufficiently represented in the course management team. A local librarian or a researcher who is presently involved in an interesting HSR project may also provide ad hoc assistance.

Outside resource persons should generally not be asked to present modules, unless they are very familiar with the course and its training methodology. However, it is useful to invite them to one or more of the course sessions to familiarise them with the course; to introduce them to the participants as valuable resource persons (both during the course and afterwards); to make their expertise available during group work; and, finally, to enlist their support for the implementation of the proposals being developed.

(6) Invitation of authorities to open or close the course

Usually a high official from the Ministry of Health, or, if appropriate, a representative from another agency supporting the course, should be invited to open the course. This is a useful strategy for making high-level officials aware of HSR and motivating them to support it.

Usually, the official opening of courses takes place on the first morning. It might be worthwhile, however, to officially open the course the evening of the day previous to the first day of the workshop. This will save time. Alternatively, the opening may take place in the later afternoon of the first day or, better, the morning of the second day, when participants can present the final selection of their research topics.

(7) Invitation of donors

If you are considering inviting donors to explain what types of research projects they presently support and to provide details on research priorities and funding procedures, it is advisable to invite them for a panel session all together one evening. Time could be scheduled after the panel for teams to talk with the donors individually.

(8) Invitation of panel members for the presentations of proposals and research results

The plenary sessions at the end of the first and of the second workshop are extremely important. At the end of Workshop I each group presents its research proposal while at the end of Workshop II each group presents its research report, including a first draft of major findings, conclusions and recommendations. Each of these gives the participants a chance to gain experience in presenting research proposals or research papers. It also provides the opportunity to invite senior managers, researchers, academicians, etc., as panel members so that they gain a better understanding of health systems research and can have an input in the formulation of conclusions and recommendations. This will likely enhance their support for implementing them. Selection of appropriate panel members is important. Health managers of different levels and interested researches should be invited. If possible (distant-wise), it is highly recommended to include the direct superior(s) of the research team will utilise the research findings in the panel.

(9) Selection of support staff

Support staff for the workshop should include two secretaries and one driver/messenger. For the last 3 days of the workshop, four full time secretaries would be desirable, unless participants themselves do the word processing of part of the protocol. Secretaries may have to work overtime to finish typing the research tools before the pre-test and to finalise research proposals. For the data analysis workshop, one secretary may be sufficient during the first week, but when the groups start writing their reports four secretaries should preferably by available, unless participants are (partly) self-reliant. Ensure that there is a computer available for each research team, and two diskettes per group.

(10) Site preparation

Space required:

• Plenary space for 30–35 persons plus two small meeting rooms for group work.
• Office facilities for 2–4 secretaries, computers and space for a photocopy- or duplicating machine.

Materials required:

• Access to a vehicle for the whole workshop period. During the pre-test, extra transport may be needed.
• See Annex 2 for details concerning the materials needed.

II. COURSE MANAGEMENT DURING THE WORKSHOP

1. Course co-ordinator

The course co-ordinator will have overall responsibility for the workshop. Some of the essential functions include:

• Conducting opening and closing sessions;
• Making general announcements (concerning reading materials for the next day, work on weekends, deadlines for submission of materials for typing, etc.);
• Presenting the session on orientation to the course and doing a review of progress at the start of each day to enable participants to keep track of the workshop process;
• Introducing resource persons;
• Resolving specific problems that may arise; and
• •Maintaining a chart of the progress of each group on submitting its drafts of the proposal/report for typing. (This chart should be on display throughout the course.)

2. Chairpersonship of plenary sessions

It may be useful to rotate the chairpersonship, depending on the subject being discussed. For instance, the facilitator presenting a specific module and guiding the following discussion could be the chairperson of that session.

3. Allocating facilitators to working groups

When the participants have selected their research topics, a final decision will have to be made as to which facilitators, considering their interest and expertise, would best be in charge of particular groups. Facilitators will, in principle, stay with the same groups throughout the course, in order to ensure continuity and the quality of the end product.

In addition, each facilitator may have overall responsibility for certain technical aspects of the research process in which he or she is specialised, and assist other groups as well. Also local resource persons may assist on an ad hoc basis (e.g., on sampling).

4. Facilitators’ meetings

It is desirable to have a daily meeting of facilitators to monitor course progress and give an opportunity to the facilitators to discuss possible problems This meeting is best held in the evening and will usually last between half an hour and an hour. The course co-ordinator should be responsible for convening this meeting. It is probably helpful to have a secretary record at least the action points for each meeting.

5. Approval of projects

The national agencies that will need to endorse the research proposals (the National Research Council, for example) will also have to be mobilised before as well as after the workshop, to speed up procedures.

6. Workshop report

The official report of the workshop should be as brief as possible. After a one page introduction (when, where, why, organisers, sponsors, management team (functions), type of participants in the course), a summary report of 2-4 pages could follow, describing the training process, starting with the topics chosen and ending with evaluation results. A list of participants and course facilitators and their addresses (by research group) could be annexed to the report, as well as (summaries of) opening speeches.

The report should contain the final drafts of the groups’ research proposals. It is highly recommended that the course facilitators as a group screen the proposals immediately after the workshop, because some items may have been dropped out or added to the proposal that would need some clarification. The final polishing up of the proposals can be completed in the month following the workshop. Usually procedures to obtain consent for implementing the proposals take up the first month, so there is some time to do any final editing needed.

7. Meeting the participants’ needs for technical support during research implementation

The facilitators that have assisted in the development of the proposals will also assist the groups in the implementation of the proposals. However, sometimes additional support may be required, (e.g., the assistance of an experienced sociologist or statistician for data collection and data processing).

The participants will need to state this in their proposals and include it in the projects’ budgets.

All groups will need assistance when they start sorting and processing their research data.

III. TRAINING METHODOLOGY

Sessions in this training course on health systems research contain the following components:

• Introduction and discussion;
• Group work;
• Exercises; and
• Plenary.

1. Introduction and discussion

The introduction and discussion period is used to briefly explain new concepts and their application. Inviting responses and suggestions from participants and listing these on a flipchart or using them as a starting point for discussion is an essential element of the training method. This increases the interest of participants and may bring up valuable points of view that would be missed in classical (pure lecture-type) classroom teaching. Encourage all to participate in the discussion.

Depending on the level of the participants, the facilitator can delete or add details in the introduction, preferably using the research proposals that are being developed as examples, in interaction with the respective teams.

2. Group work

The purpose of the group work is to develop four to five research proposals (one per working group) that should be ready for implementation by the end of Part I of the training course. Thus the facilitators need to always keep in mind that the proposals being developed need to be feasible and of good quality.

To increase the efficiency of the group work, a chairperson and rapporteur should be appointed for each group. The chairperson is not only responsible for leading the discussion, but also for dividing the work among group members. It is recommended that, after discussion within the work group, the group should split up into groups of two or three persons to work on separate parts of the task to be completed. The work of each sub-group can then be discussed and amended before presentation in plenary.

Each facilitator should be responsible for one group throughout the course, in order to ensure continuity. Facilitators should only change groups if they have major problems in assisting their own groups. Other facilitators and resource persons, of course, can be consulted at any time on technical issues. The amount of time the facilitator spends with his/her group will depend on the needs and demands of that group. In the beginning of the course the needs may be greater than towards the end. In principle facilitation is a full-time activity. Even if a facilitator is not permanently participating in the group work, (s)he should be available at all times for consultation.

The facilitator’s role in discussion is primarily to stimulate the group to find its own solutions. However, if the group is clearly going in the wrong direction the facilitator should provide more direct guidance. In the beginning a facilitator may have to keep the group from wasting time on less relevant issues, or prevent relevant issues brought up by group members from being dropped because not everyone sees their importance.

3. Exercises

There are two types of exercises. In some exercises groups practice the use of new concepts by working with case studies prepared in advance. For these, it is probably a good idea to organise groups of a different composition than for the group work, so that all participants get to know each other well. In the second type of exercise, each group will examine a component of the proposal that is being developed by another group and provide constructive criticism. Groups should be encouraged to put the summaries of their comments on flipcharts or transparencies for presentation in plenary and for reference by the group developing the proposal. Not all modules contain exercises. Exercises can be omitted or added, depending on the needs of the participants and the time available.

4. Plenary

Presentations of the results of group work or exercises in plenary require special skills. Before the first plenary (in which the research topics considered for the development of research proposals are presented) the importance of presenting the group reports clearly and audibly, and of using readable visual aids, should be discussed with the participants. The working groups can use either flipcharts or transparencies for the presentations. Flipcharts have the advantage that they can be easily referred to or elaborated on later in the working groups. However, if the plenary exceeds 25 persons, it may become difficult for all to read the flipcharts. The use of transparencies and an overhead projector, in that case, may be indicated.

It should be stressed that there are limitations to what one can put on a transparency or a flipchart. Prepare two examples, one of a readable and one of an unreadable transparency, and let the participants give suggestions concerning how much information a transparency should contain (12-14 lines is the limit).

Stress also that one should never turn one’s back to the audience when presenting. (A pointer can be used to indicate various points on the transparency, rather than on the screen.)

In general, the presentation of one working group should not exceed 15 minutes, discussion included. Sometimes even less time is required. If necessary, the facilitator chairing the session should let presenters know when they have just a minute or so left.

IV. SUPERVISION OF RESEARCH PROJECTS: INTER-WORKSHOP ACTIVITIES

The activities during the inter-workshop period consist of preparing and implementing the studies and (preliminary) processing of data. The facilitator or resource person for the project should visit at least once, preferably during the pre-test, and if possible also during the preparations for data processing.

1. Activities that should be carried out by participants

During this period, the participants should:

1. Brief managers, health service staff and concerned community members regarding the project;
2. Obtain the necessary permission to collect data;
3. Identify and obtain the resources (manpower, materials, etc.) needed to collect data;
4. Review the availability of subjects or respondents, information, ethical aspects of the study and adjust the methodology if necessary;
5. Train research assistants, if required. Refine, pre-test and revise the research instruments and procedures for data collection and data analysis with the entire research team, preferably together with the facilitator;
6. Collect data;
7. Prepare for processing of data and do some of the processing by hand and by computer (if feasible and useful); and
8. Prepare a preliminary report.

2. Guidelines for participants

Modules 19 and 2 0 should be presented to participants at the end of Workshop I for their use during the inter-workshop period. The content of the modules should be reviewed before they leave for the field, so participants will know what they contain and why they are important.

Module 19 will serve as a checklist as well as a guideline for field activities.

3. Visit by the facilitator/resource person

The purpose of the visit by the facilitator near the beginning of the fieldwork is to:

1. Check the progress of the project;
2. Observe the real life situation in which the project will be implemented and identify problems and anticipate pitfalls;
3. Review the proposed methodology of data-collection;
4. Advise on modifications/adaptation of the research design, sampling, data collection procedures, etc.;
5. Assist in training team and possible research assistants in research- and interview techniques; and
6. If necessary, assist in obtaining managerial support.

The trainer’s notes at the end of Module 19 provide a useful checklist for facilitators to use during their site visits.

Annex 1: Example of a course schedule (used in southern Africa)

WORKSHOP I: PROPOSAL DEVELOPMENT AND FIELDWORK

Annex 2: Guidelines for budgeting an HSR training course

The following items will probably have to be budgeted. Indicate for each item who will cover the cost (Ministry of Health or donor, for example). Salaries of local participants and transport are usually provided by the Ministry of Health, whereas accommodations and meals are usually covered by the donor.

(1) Accommodation and meals

Board and lodging or lodging and an allowance for meals for:

24 participants
5 facilitators
2 secretaries (perhaps 4 at the end of the workshop)

Make sure the workshop site has available:

• a large conference room
• two small meeting rooms
• a room for the secretaries/photocopying machine

Also include:

• Coffee/Tea for 13 days, twice a day, for 30-35 people

Consider the inclusion of a:

• Reception for 50 people, after the official opening

(2) Salaries and allowances

Facilitators	salary at	US$ . . . . . . ./day x 14-16 days
	allowance at	US$ . . . . . . ./day x 14-16 days
Participants	salary at	US$ . . . . . . ./day x 14-16 days (MOH)
	allowance, if applicable	at US$ . . . . . . ./day x 14-16 days (according to MOH rules)

(3) Transport

• For facilitators and participants to come to the workshop and return home;
• For participants to get to the workshop site each day if they are lodging somewhere else than the workshop site (not recommended, but it may sometimes be necessary);
• For pre-testing of the methodology, including field visits for four working groups of participants

(4) Supplies

If photocopying is used during the workshop for duplication of the research protocol, questionnaires/tools, final report; and other documents:

• 34 reams of photocopy paper
• 2 reams of typing paper
• toner for photocopying

If all duplicating is done using stencils:

• 500 stencils for use during workshop
• 200 stencils for the final report
• 34 reams of duplicating paper (500 sheets each)
• 1 ream of typing paper
• ink for stencilling

40 note pads, 40 pens, 40 pencils, 40 rubbers, 40 file holders

35 name tags

paper clips, staplers, staples, paper hole punchers, scissors, chalk

200 overhead sheets, markers

5 flip charts, markers

35 copies of the modules, to be ordered through KIT, Amsterdam, AFRO or IDRC Ottawa, at least three months before the beginning of the workshop

Annex 3: Example of information circular for course participants (used in Malaysia)

Background

Health systems research (HSR) has been identified as an important tool to provide managers with information they can use in decision-making processes aimed at improving health care. In this context ‘managers’ could be those responsible for planning or implementing health programmes at district, state or national level or those responsible for managing hospitals, clinical units within hospitals or clinical outpatient services in hospitals, clinics etc.

Objective

The aim of the course is to enable you to develop and implement health systems research projects assisting managers, including yourselves, to improve the effectiveness and efficiency of health services.

Expected outcome and future functions

Once you have successfully completed the course, you will be expected to incorporate the conduct of HSR into your regular duties. As staff members who have had training in research, you will design and supervise projects and train your staff to collect data, analyse it, etc. You will also serve as ‘resource persons’ for your programmes, hospitals, etc., and provide assistance with the analysis of problems, design of studies, preparation of study reports.

Research skills can be acquired only through real life practice. Therefore this training programme is designed to give both theory as well as practical experience in conducting research. The practical experience will be in the form of a project that you will carry out in your place of work as a supervised training exercise. The course will be conducted in two sequential ‘parts’ with an ‘inter-workshop period’ during which you will actually carry out your study.

The structure of workshop will be:

1 . Pre-workshop assignment:

• Background reading
• (Tentative) selection of a suitable problem for the research training project

2. Part 1: Protocol development workshop (12-14 days)

• Design of the research proposal
• Design of research instruments

3. Inter-workshop period (5-6 months)

• Collection of data. (This will be done at the place of work of each participant and will be done in conjunction with her/his other duties.)

4. Part 2: Data analysis/report writing workshop (14 days)

• Analysis of data
• Preparation of report
• Presentation and discussion of findings

(The respective state/programme directors will attend these presentations and participate in the discussions.)

5. Time and research will have to be reserved for implementation the recommendations

Background reading

This workshop will be very intensive and you will need to do a considerable amount of background reading both before and during the workshop. Pre-workshop reading consists of: (List a number of relevant short papers on the concept and purpose HSR).

Selection of projects for the training exercise

Development and implementation of a research project will be the most important part of this training programme. The first step in doing research is to select a problem that is an appropriate topic for research. You will have to do this before you come to the workshop.

One of the basic principles of HSR is that research should focus on priority problems. Although the project that you will do during the workshop will be designated as a training exercise, the only difference from any other research project will be that the scope might have to be limited to enable you to complete the project before the Data Analysis/Report Writing Workshop. Therefore, the problems that are selected should conform to all the criteria that would be used in selecting projects for research, and the process of selection should be the same as in actual practice.

We suggest that you should meet with your state or regional/provincial and district medical officer, in order to identify one or two priority problems that need additional information that can be provided through research. (N.B. If sufficient information is already available either through routine data or from other studies, it is not suitable for a research project, even if the problem is a priority.)

Criteria for selecting a problem for research include:

• Is the problem a priority?
• Is the problem specific and can it be clearly stated?
• Is necessary data missing to help solve the problem?
• Can the research be carried out with the available resources? (4-8,000 US$ ) and in the available time (5-6 months) with a team of 5-6 persons?
• Will the research findings contribute important information that can be used to solve the problem?
• Is it likely that the recommendations of the study will be applied?
• How urgently are the results needed for making a decision?

If two or three problems emerge as suitable, a final decision concerning which to choose as the focus of the research can be made during the Protocol Development Workshop.

Preparation for the project

Before coming for the workshop, you should be able to answer the following questions regarding the problem that you will focus on in your research:

• What type of information will assist managers in making decisions regarding the problem? For example:

  — The causes of the problem?

  — The factors contributing to the problem?

  — The relative importance of various factors?

  — The comparative effectiveness of various solutions?

• Can existing information be analysed to provide part or all of the data needed? Does new data need to be gathered as well?
• How will managers use the information when they receive it? (i.e., What actions will the manager be able to take based on the results?)
• Can the research provide the type of information the managers needs?

Available data on the problem

• Collect and bring to the workshop all available data, copies of district or national annual reports, or circulars and guidelines, etc., on the problem that you will be investigating. This will help you prepare your research protocol.
• Also visit the health centres, hospitals and/or other sites where you may eventually collect data for this project and familiarise yourself with their systems of keeping registers, cards, appointment books, etc., so that you will know how to select the sample for your research project.

Manpower for data collection

Identify members of your staff such as nurses, medical assistants, health inspectors and others who can assist you in collecting data for your research project during the implementation period. You will need this information to help you determine how much data you can collect within the given time period.

Annex 4: WORKSHOP: DESIGNING AND CONDUCTING HEALTH SYSTEMS RESEARCH PROJECTS: Reply format for participant

Annex 5: Evaluation form

Evaluation questions: HSR Proposal Development Workshop in . . . . . . . . . . . . . . . . . .

1. Have the objectives of the workshop been achieved?

   1.1 Have you gained the expertise to develop a research proposal? (explain)
   

   1.2 Have you developed a proposal that you think can be carried out by your group within the coming 5 months? (explain)
   

   1.3 Do you feel (1) motivated and (2) confident enough to start other small research projects in the future in your own working situation? (explain) ? Yes ? No
   
   

2. Do you have any comments on the course content?

   Would certain parts need extension?

   Should certain parts be slimmed down?

   How clear were the presentations?

3. What is your opinion of the training methods used in the workshop (compared, for example, to the ‘lecture’ type of teaching)?
4. Did you find the division of time between lectures, group work and plenary satisfactory or would you propose more or less time for any of these three components of the course?
   
   
5. Were you satisfied with the type of assistance provided by the facilitators?

   ? Yes ? Partly ? No

   Would you have any suggestions for improving the work of facilitators for similar courses in the future?
   

6. How did you function as a group?

   Do you feel that every group member had an equal chance to gain from and contribute to the course?

   ? Yes ? Partly ? No

   (Explain)
   

   Would you have any suggestions for improving the opportunities for group members to gain from or contribute to similar courses in the future?
   

7. Acknowledging that you are all busy people, but that the course was quite compact: Would you have liked the duration of the course longer, shorter or was it the right length as it was?
   
8. What is your opinion on the organisation/accommodation/working conditions of the course?
   
   
   

   Do you have any suggestions for the next workshop in this respect?
   
   

9. ANY OTHER COMMENTS

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