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Evaluation of complex health system interventions

Researchers in HESA are actively involved in evaluating a range of health systems interventions, from global and national level programmes to localised pilots, in a variety of low- and middle-income country settings. These interventions are often complex, and evaluations reflect the complexity of introducing change into health system settings. The methodological approaches employed and built on by the group include process evaluations, to understand the fidelity, reach and dose of interventions delivered and received, mechanism evaluations, to understand how change occurred and attribution to the intervention, impact evaluations, to assess the intended and unintended impacts of interventions, and economic evaluations, to assess the cost-effectiveness of interventions. These evaluations are undertaken using rigorous study designs, including randomised trials, quasi experimental designs and natural experiments. Our methodological toolkit incorporates quantitative and qualitative fieldwork, the use of theory driven data analysis techniques for both quantitative and qualitative data and the use of systematic reviews on the effectiveness of different health systems interventions.

List of projects:

IMPACT 2: Monitoring interventions to improve ACT access and targeting (ACT consortium) | Catherine Goodman (PI); Katia Bruxvoort; Rebecca Thomson | Ifakara Health Institute (IHI); US Centres for Disease Control & Prevention | Tanzania

IDEAS (Informed Decisions for Action) to improve Maternal and Newborn Health | Joanna Schellenberg (PI); Anne Mills; Neil Spicer; Lindsay Mangham; Kara Hanson | Last 10 Kilometers, Saving Newborn Lives, The Maternal and Newborn Health in Ethiopia partnership, Ethiopia; Society for Family Health, Nigeria; Better Birth, Manthan, Sure Start, India | Ethiopia, India, Nigeria

Independent Evaluation of the Affordable Medicines Facility – Malaria (AMFm) | Kara Hanson (PI); Catherine Goodman, Sarah Tougher, Ben Palafox | ICF International | Ghana; Niger; Madagascar; Nigeria; Uganda; Kenya; Tanzania

Evaluation of a pilot P4P initiative in Tanzania | Josephine Borghi (PI); Edith Patouillard; Giulia Greco | Ifakara Health Institute (IHI) | Tanzania

Evaluation of the impact of the NHIF MCH insurance, Tanzania | Josephine Borghi (PI); Edith Patouillard; Frida Kasteng | Ifakara Health Institute (IHI) | Tanzania

A cluster-randomised trial of health worker and community interventions to improve adherence to national guidelines for the use of ACTs in Tanzania | Hugh Reyburn (PI); Shunmay Yeung; Clare Chandler | National Malaria Control Programme; National Institute for Medical Research in Tanzania; Kilimanjaro Christian Medical Centre | Tanzania

Introducing malaria rapid diagnostic tests (RDTs) into the private health sector in Uganda: a randomised trial among drug shops to evaluate impact on antimalarial drug use | Sian Clarke (PI); Kristian Hansen (PI); Clare Chandler | Ministry of Health, Uganda; DBL Institute for Health Research and Development, University of Copenhagen | Uganda

ACT PRIME: Evaluating the impact of enhanced health facility-based care for malaria and febrile illnesses in children in Tororo, Uganda | Sarah Staedke (PI); Clare Chandler | Infectious Diseases Research Collaboration, Makerere University and University of California San Fancisco | Uganda

ACT PROCESS: Evaluating the process, context, and impact of interventions to enhance health facilities in Tororo, Uganda | Sarah Staedke (PI); Clare Chandler | Infectious Diseases Research Collaboration, Makerere University | Uganda

Perceptions of malaria and antimalarials amongst HIV positive individuals enrolled in an antimalarial drug trial in Tanzania | Clare Chandler (PI); Lasse Vestergaard (PI); Joanna Reynolds | National Institute of Medical Research, Tanzania; DBL Institute for Health Research and Development, University of Copenhagen | Tanzania
School-based Treatment with ACT to Reduce Transmission (START): Evaluation of the community impact of intermittent preventive treatment for malaria in Ugandan schoolchildren: a cluster randomised trial  | Sarah Staedke (PI); Clare Chandler  | Uganda

GUARD study: Good Use of ACTs and RDTs in Drug outlets. Mixed method study of the quality and use of RDTs and corresponding use of ACTs and artemisinin monotherapies in the private sector in Cambodia  | Shunmay Yeung (PI), Clare Chandler  | Cambodia

An evaluation of the Cambodian Village Malaria Worker programme | Shunmay Yeung (PI); Edith Patouillard | Ministry of Health, Cambodia | Cambodia

Millennium Village Evaluation, Ghana | Timothy Powell-Jackson (PI); Arnab Acharya | ITAD, Institute of Development Studies | Ghana

Integrated community case management of common diseases of childhood at scale | Betty Kirkwood (PI); Kara Hanson, Anna Vassall, Frida Kasteng | Malaria Consortium | Uganda, Mozambique

Maternal Evaluation Team | Catherine Goodman (PI); Timothy Powell-Jackson, Andreia Costa Santos; Shreya Pereira; Manon Haemmerli; Richard Iles, Sarah Tougher

Health systems strengthening in global health in China | Kara Hanson (PI), Melisa Martinez Alvarez; Dina Balabanova | China

Investigating the determinants of health worker performance | Mylene Lagarde (PI) | Senegal

Evaluation of the implementation, cost and long term impact of P4P of health services in Tanzania | Josephine Borghi (PI) | Tanzania

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