1. CMT06101: Entrepreneurship And Life Skills  
  2. CMT06102: Leadership And Management  
  3. CMT06103: Operational Research
  4. CMT06104: Basics Of Forensic Medicine  
  5. CMT06105: Surgical Specialties



  1. CMT06206: Apprenticeship In Obstetrics And Gynaecology
  2. CMT06207: Apprenticeship In Surgery
  3. CMT06208: Apprenticeship In Internal Medicine
  4. CMT06209: Apprenticeship In Paediatrics And Child Health


Below are Example of notes za wizara from Operational research

Definition of Terms 

      Operational research: Research encompassing a wide range of problem-solving techniques and methods applied in the pursuit of improved decision-making and efficiency.

      Health information: Analyzed health data ready for use in decision making.

      Burden of disease: Refers to the magnitude and distribution of diseases within a population. It is a measure indicating loss of years of healthy life through disabling diseases in a specified population.

      Prioritization: Process of ranking the health problems/needs in a given community according to relevancy, urgency of required solution, political acceptability, feasibility of intervention, ethical acceptability, and if there is no duplication of efforts.


Identification of Health Care Problems in a Given Environment:

Dispensary Setting, Health Centre and District Level 


Purposes for Identifying and Prioritizing Health Problems/Needs

      Description of health problems required for planning interventions. Planners need to know the magnitude and distribution of health needs in a population as well as of health resources, in order to formulate adequate policies and plan interventions.

      Acquire Information required  to evaluate ongoing interventions with respect to:

o   Coverage of health needs o Coverage of target group(s) o Acceptability and quality

o   Costs

o   Effects/impact, to assess progress and the need for adjustment on a routine basis

      Acquire Information required to define problem situations in interventions in any of the fields mentioned above and to analyse possible causes of health problems in order to find solutions.

o   Causes of health problems may include lack of or inequitable distribution of resources, vague policies, and any environmental factors affecting needs, health services, and others.




Sources for Obtaining Information/Data on Health Problems at District Level

      Health Management Information System (HMIS) and Health Statistics Abstracts or Records from the health facilities

      Survey and research reports

      Project and programme plans and reports

      Vital statistics records


      District annual reports and financial reports

      Community felt needs (these are either expressed by people or their leaders on their own feelings, needs and priorities)

      Personal experience of health workers o An assessment of the operationality of your district health system (district health indicators) 

      Any other relevant and available source of health  information


Prioritization of Health Problems for Research

      Operational research is intended to provide information for decision-making to improve health care.

      The selection and analysis of the problem for research should involve those who are responsible for the health status of the community. This would include managers in the health- and health-related services, health care workers and community leaders, as well as researchers.

      Each problem that is proposed for research has to be judged according to certain guidelines or criteria. 

      Before deciding on a research topic, each proposed topic must be compared with all other options. 

Guidelines/Criteria for Prioritizing Problems for Research


      Avoidance of duplication

      Urgency of data needed (timeliness)

      Political acceptability of study

      Feasibility of study

      Applicability of results

      Ethical acceptability


Identification of Resource Requirements Using District Health Indicators 


Some Examples of District Health Indicators

      Top ten causes of morbidity and mortality (Malaria, HIV and AIDS and others)

      Crude birth rate

      Infant mortality rate

      Under-five mortality rate

      Maternal mortality rate

      Population growth rate and district population

      Health facilities including private 

      Patient bed ratio and bed occupancy

      Communication facilities (transport, telephone and roads)


District Health Indicators for Resource Allocation

      Geographical features

      Economic activities, including food production

      Literacy rates

      Demographic data (total population, women of child bearing age, children under one and under-five, population growth rate, crude birth rate, crude death rate, infant mortality rate, under-five mortality rate, maternal mortality rate)

      Epidemiological data (top 10 causes of morbidity and mortality) for inpatients and outpatients

      Health services provision and use (patient bed ratio, bed occupancy) 

      Access to water and sanitation facilities

      Health resource data (human, material, financial) including distribution and gaps

      Physical health infrastructure e.g. status of buildings

      Major health status and health service problems by priority

      Membership of district health board and facility committees

      Communication facilities (transport, telephone, radio, roads)

      A district map with the necessary details, including divisions, wards, roads, health facilities

      Major key partners in health in the district, e.g. NGOs, private (for profit and non-profit) community

      Medical equipment

      Existing training institutions and training resources

      Available/functional health committees


Resource Requirements for the Local Area You Are Serving or Dealing With

      District/local health problems priorities

      HIV and AIDS control in the area 

      Malaria, TB and Leprosy control

      Lowering Maternal mortality rate

      Lowering Infant, under-five mortality rates

      Reduction and control of top ten morbidity and mortality causes (district disease burden)

      Family planning 

      Reduction of malnutrition

      Essential health service provision


Analysis of Clinical Information Derived from HMIS Data/Service Data 

• A systematic process to analyze the problems in HMIS data should be completed jointly by the researcher, health workers, managers and community representatives. This is a very crucial step in designing the research because: 

o It enables those concern to pool their knowledge of the problem o It clarifies the problem and possible factors that may be contributing to it o It facilitates decisions concerning the focus and scope of the research


Systematic Process Step 1  

• Clarify the view points of managers, health care workers and relevant key people and researchers in relation to the problem. 

o List all the problems in the area of concern and clarify with stakeholders on how they perceive the problem.


Systematic Process Step 2 

      Further specify and describe the core problem and quantify it. Elaborate on the nature of the problem, the discrepancy between ‘what is’ and ‘what you prefer the situation to be’

      The distribution of the problem – who is affected, when and where

      The size and intensity of the problem – is it widespread? How severe is it? What are its consequences (such as disability, death, waste of resources)?


Systematic Process Step 3

After identifying the core problem you should:

      Identify factors that may have contributed to the problem

      Clarify the relationship between the problem and contributing factors

      It is helpful to visualize these interrelationships in the form of a DIAGRAM. The basic principles of constructing such a diagram are illustrated below (Figure 1)

      Figure 1 shows that relationships between contributing factors and the problem can be indicated by arrows, either one- way (for cause – effect relationships) or two- way. The arrows (for mutual relationships). The core problem can be identified by drawing a double line around it.

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