Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program (2020) / Chapter Skim
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2 Evaluation Design, Methods, and Limitations
2 Evaluation Design, Methods, and Limitations
Pages 37-54
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Ethical approvals for this evaluation were also provided by the Rwanda National Ethics Committee (April 3, 2019)
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The document review drew on policy and program documents, reports, and published literature. It situated the HRH Program within the broader HRH and HIV context in Rwanda and across the globe to understand the context 2018 2019 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Literature and Document Review Qualitative Interviews In-depth Examinations Secondary Quantitative Data Collection Integrated Analysis and Interpretation FIGURE 2-1 Evaluation process.
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Evaluation Team A team of expert evaluators from EnCompass LLC collaborated with the committee and study staff in the design phase, carried out the primary qualitative and secondary quantitative data collection and initial analysis, and provided synthesized findings and initial interpretations to the committee. See Appendix A for more information about the EnCompass evaluators.
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In-Depth Examination -- University of Rwanda The University of Rwanda, as the primary institution responsible for educating health professionals, was purposively selected to understand the institutional capacity for health professional education. The evaluation team identified and invited key respondents to participate in interviews.
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The final sample of interview respondents across the three evaluation components (facility microsystem in-depth examination, University of Rwanda in-depth examination, and qualitative interviews) included 87 interviews (see Table 2-2)
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Data Collection The evaluation team conducted a literature and document review and collected publicly available quantitative data between October 2018 and October 2019. Primary qualitative and requested secondary quantitative data were collected between May and September 2019.
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These approaches enabled the evaluation team to 3 Rwanda-based staff reviewed the interview guides for translation errors in Kinyarwanda and English and to ensure a clear understanding by all those interviewed. The semistructured interview guides were adjusted for relevance to respondent type.
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Data collection and analysis was iterative; data were coded and initial analyses were performed during the data collection phase to inform subsequent data collection. During regularly scheduled meetings, the evaluation team collectively determined new insights to examine more thoroughly and how to gather this information.
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Perception of the HRH Program's impact on the quality of HIV and other health services Qualitative Interviews Qualitative interview guides were developed according to initially identified relevant topics and then adapted iteratively, based on respondent type and what had been learned in previous data collection activities, following the approach described above. Table 2-3 lists the detailed interview topics by respondent type.
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The Ministry's agreement to this proposal was received on August 20, 2019, at which point the evaluation team began working directly with key individuals in the MOH to obtain these data. The following data were requested:
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Per communication with the MOH, there was not a readily available database of HRH Program trainees and their current places of employment; thus, it was not possible to understand which facilities had been exposed to the HRH Program. The MOH and the University of Rwanda did provide elements of the data on trainees alongside data from
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Because of the timing of receipt of the data, the committee was not able to reconcile these variations across sources. Data Analysis Literature and Document Review The evaluation team conducted text analysis of literature and documents using a Microsoft Excel spreadsheet set up to capture and organize data according to topics represented in the evaluation objectives and questions and reflecting the theoretical causal pathway discussed in Chapter 1.
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Direct quotations from respondents included in this report have been edited for clarity. Quantitative Data The evaluation team used a time series approach to examine publicly available HRH and population-level data for trends over time.
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The evaluation team then supported a process of further analysis and interpretation by the committee in September 2019. After providing committee members with draft findings and interpretations, backed by the thematic matrices, the evaluation team facilitated a participatory, appreciative session with the committee to further examine, interpret, and validate findings and to arrive at consensus on conclusions and recommendations.
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LIMITATIONS In an effort to address the first two objectives, which focused on describing the HRH Program and the context in which it was implemented, the evaluation team conducted qualitative interviews with individuals who were involved in the administration of the Program. These included respondents from the Government of Rwanda and other organizations involved in the design and early implementation.
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Finally, the request for data on where HRH trainees were placed following graduation had to be extracted from multiple sources, as Rwanda's Human Resources Information System did not include information on health worker training. This placed a significant burden on the MOH for extracting and generating the information.
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Documents and other information provided for the committee's consideration are available upon request from the National Academies' Public Access Records Office (paro@nas.edu)
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