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Evaluating large-scale health programmes at a district level in resource-limited countries.
Theodore Svoronos1, Kedar S Mate
1Institute for Healthcare Improvement, 20 University Road, Cambridge, MA 02138, United States of America. teddy.svoronos@gmail.com
Bulletin of the World Health Organization
|November 16, 2011
Summary
Evaluating global health programs requires understanding context. Driver diagrams offer a new tool to systematically monitor implementation dynamics and contextual variations across diverse sites for better intervention effectiveness insights.
Area of Science:
- Global Health Program Evaluation
- Implementation Science
- Health Services Research
Background:
- Large-scale global health programs require evaluation methods sensitive to contextual differences.
- Traditional randomized controlled trials (RCTs) are limited in explaining intervention mechanisms (how, when, why).
Purpose of the Study:
- To review evaluation designs that incorporate contextual factors.
- To propose principles for capturing contextual information in program evaluations.
- To introduce the driver diagram as a tool for monitoring implementation dynamics and contextual variation.
Main Methods:
- Review of existing evaluation designs.
- Proposal of principles for context-sensitive evaluation.
- Introduction and application of the driver diagram tool.
Main Results:
- Driver diagrams can systematically monitor implementation dynamics and identify contextual variations across sites.
- An example from South Africa demonstrates the tool's utility.
- Pooled driver diagrams can contribute to generalized theories of intervention effectiveness.
Conclusions:
- Existing evaluation methods need complementary tools to capture context.
- Driver diagrams offer a systematic approach to understanding how, when, and why interventions work in diverse settings.
- This approach is crucial for improving the effectiveness of large-scale global health initiatives.
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