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Program Evaluation: a potential platform for cross site analyses

This article discusses the importance of program evaluation in global health initiatives, specifically the evaluation of the impact on local health systems and the effectiveness of the program. The article outlines the methodology used, including quantitative data analysis, qualitative surveys, and focus groups. The outcomes examined are patient-focused, including quality of services, diversity of services, and health literacy. The article also presents case studies from Lascahobas, Haiti, and Rusumo, Rwanda, to illustrate the evaluation process and challenges faced.

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Program Evaluation: a potential platform for cross site analyses

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  1. Program Evaluation: a potential platform for cross site analyses Louise C. Ivers, MD, MPH and Joia S. Mukherjee, MD, MPH Partners In Health, Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School

  2. Context: Reason for Program Evaluation GHI spending may not be distributed evenly throughout countries Sub-recipients / partners at district, local or grassroots level are involved Program-level evaluation gives opportunity to examine variability in impact that may not otherwise be seen at a macro level

  3. Program Evaluation: Aims Evaluate performance of local health system impact of GHI on HS Impact of HS on GHI Facility level evaluation Community level evaluation

  4. Methods Quantitative data at program level Comparative analysis Historical control Projected targets Qualitative data via ethnographic surveys and focus groups with patients and providers

  5. Performance of Health System Scale Scope Distribution Quality/safety of services System capabilities (response to emerging and changing challenges)

  6. Process: Human Resources Number Distribution / per population served Skill level Skill mix Accreditation

  7. Outcomes Targeted disease/health outcomes GHI specific Non-targeted health outcomes Child Health DTP3 Diarrheal illness (2 weeks) Under 5 malnutrition (diagnosis and treatment) Maternal Health Births assisted by skilled worker Family planning uptake

  8. Outcomes: Patient-focused lens Quality of services Diversity of services Health literacy Fairness

  9. Delivery / access / linkages Attendance at antenatal clinic Attendance at primary care clinics Number of children weighed Existence of functional referral systems Community  health clinic  secondary/tertiary  community

  10. Lascahobas, Haiti: Attribution of Financing

  11. Lascahobas, Haiti:Work force, 2002 vs. 2007

  12. Lascahobas, Haiti:Health Service Utilization, 2002 vs. 2007

  13. Care Targets • MOH targets for primary health care utilization: 10% of population per month, 1.2 visits per capita per annum • WHO targets for ANC: 4% of total population is pregnant in a given year • Global TB report TB incident and prevalence • UNAIDS and country reports for HIV prevalence

  14. Lascahobas, Haiti:Is it stronger?

  15. Using the Yard Stick • Disease specific: HIV detection, ART enrollment, TB case detection and treatment, pMTCT • Total number : general visits, ANC, family planning uptake, immunization • Health personnel: numbers and cadres • Drugs: % of full “essential drug package” • Diagnostics: number of diseases “diagnosable”

  16. Rusumo, Rwanda: 2006 vs. 2007

  17. Rusumo, Rwanda:Is it stronger?

  18. Further Challenges • Outcomes • Temporal changes—strengthening, integraton • Evaluating quality of services • Evaluating counterfactual—clinics that have not had the benefits of GHI monies OR the GHI monies were used only vertically

  19. Next steps: • Developing a data abstraction tool Aug 28, 2009 • Evaluation of 2-3 PIH supported MOH clinics in Haiti, Rwanda, Malawi, Lesotho and one counterfactual in each Jan 1, 2009 • Visits to 4-5 other countries to analyze a clinics with tool Mar 1, 2009 • Analyze and interpret and write May 1, 2009

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