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10 Lessons from Large-Scale Program Evaluation on a Not-Quite-as-Large Scale
Pages 87-94

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From page 87...
... SAVING MOTHERS, GIVING LIFE STRATEGIC IMPLEMENTATION EVALUATION The Saving Mothers, Giving Life program is a global, public–private partnership in which a consortium of six institutions, including the U.S. government, is working to reduce maternal mortality by 50 percent in four 87
From page 88...
... Kruk noted that one confounding factor was that other programs were ongoing in the target districts that were involved in improving access to and delivery of health services, whether it was maternal health, HIV, or child health. "It's an incredibly crowded environment in which to work both from a logistics point of view and from an attribution point of view," said Kruk.
From page 89...
... However, comparison districts were not included in the original evaluation design, so the team conducted post-test exit surveys with women who delivered in health facilities along with satisfaction surveys and obstetric knowledge tests to providers in both program and noncontiguous comparison districts. The evaluation was not funded to conduct a population survey, so the evaluation team conducted 80 focus group discussions with women to help identify any remaining barriers that inhibited or prevented women from using the program's services.
From page 90...
... The implementation programs, said Chandrasekaran, were large and complex and included efforts to distribute treatments for sexually transmitted infections and community mobilization to get hidden populations into clinics. The evaluation effort consisted of separate design and implementation teams with oversight provided by an evaluation advisory group.
From page 91...
... "These are questions that could have had a short duration and provided cause-and-effect data," she said in closing. EQUIP -- EXPANDED QUALITY MANAGEMENT USING INFORMATION POWER The EQUIP program, explained Tanya Marchant, an epidemiologist at the London School of Hygiene and Tropical Medicine, is designed to implement and evaluate the effect of a quality improvement intervention implemented at district, facility, and community levels designed to get all of the actors at the district level to work together to improve maternal and child health.
From page 92...
... By relying on existing infrastructure organized within district-level health systems, EQUIP was able to engage with district health management teams, which in turn were able to support subdistrict, local quality improvement processes. The conceptual framework, Marchant explained, is built on the hypothesis that district-level health facilities are the best places to target quality improvement, but that communities are the best place to affect uptake of services.
From page 93...
... However, continuous surveys require continuous field work, so the team tried to avoid scheduling surveys during the rainy season or during the agricultural season. The use of personal digital assistants was incredibly important, Marchant said, because they boost data quality and control and because they enable automated data harvesting and analysis.
From page 94...
... Another participant noted that this is an expensive proposition given that Tanzania spends $30 per capita annually on health services. OTHER TOPICS RAISED IN DISCUSSION Kruk pointed out that every evaluation creates opportunity costs.


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