Phases 1 and 2 have been completed (2014–2017) and a summary of this work is presented. London: Sage Publications Limited; 1997. Frehywot S, Mullan F, Payne P, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? 2014;29(3):323–7. An incremental cost-effectiveness analysis will be undertaken (cost per additional skilled delivery and associated care). The aim of the ITS analysis is to identify discontinuities in the time series associated with, and potentially caused by, the introduction of the SURE-P programme to health facilities. Although we do not anticipate any further data collection for this stage, we do not see a linear progression between the steps: i.e. This paper should be of interest to researchers who are adapting and applying robust methodologies for assessing complex health systems interventions and policymakers and practitioners who are interested in commissioning, and engaging in, similar evaluations. The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. The study will draw upon health economics, social sciences and statistics. Google Scholar. The data will be collected using three methods. Fiona Keogh, Maria Pierce, Karen Neylon, Padraic Fleming, Intensive home care packages for people with dementia: a realist evaluation protocol, BMC Health Services Research, 10.1186/s12913-018-3630-8, 18, 1, (2018). These costs will be apportioned between the key SURE-P indicators: change in antenatal attendances, skilled deliveries and postnatal attendances. London: Medical Research Council; 2008. This technique assumes that knowledge is a social and historical product, thus the social and political context as well as theoretical mechanisms, need consideration in analysis of programme or policy effectiveness. First, the initial Logic Model (LM) (see Additional file 5) was developed for the SURE-P/MCH. Therefore, instead of attributing changes in health outcomes to the SURE-P/MCH only, we will explore the contribution of the interventions to achievement of desired effects within the real context. It describes five key ideas which frame realism and their implications for impact evaluation. assessment of context will inform best practices in PHC staff performance management; assessment of the added value of CCTs will inform further demand-side financing schemes. Analyzing Qualitative Data. Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Article  Phase 2 of the SURE-P/MCH was launched in late-2013 and aimed for an incremental expansion to a further 12 to 21 facilities in the selected states. Subsidy Reinvestment and Empowerment Programme (SURE-P): 2012 Annual Report. 2007;7(1):84. 2017 Dec 22;17(1):843. doi: 10.1186/s12913-017-2795-x. doi: 10.1136/bmjopen-2012-000882. This quantitative analysis interrelates with the qualitative IDIs mentioned earlier. The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. The two interventions (i.e. Pommier J, Guevel M-R, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. (ZIP 1568 kb), Pre-implementation Logic Map for SURE-P/MCH. Abuja: Federal Ministry of Health; Save the Children, Jhpiego; 2011. In addition to assessing whether the target indicators are achieved, we will identify how they are achieved (i.e. Realist evaluation reports need to be developed in line with the realist nature of the evaluation. The impact of the programme on a range of key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly (the unit of analysis) quantitative data from HMIS and SURE-P M&E monthly programme reports. The impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. 2007;21:554–72. We will use the understanding of the context in which interventions are operating to identify these consequences. Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority for achieving the health-related Sustainable Development Goals (SDGs), particularly for sub-Saharan African countries [1]. 2003;19(4):613–23. 2004;10(1):58–76. neonatal and perinatal deaths); T [35,36,37,38,39]), there have been very few protocols of realist process evaluations embedded within RCTs published to date. Specific methods of communicating research will include combinations of: Developing short and practical policy briefs to national and international policymakers and practitioners. is an error term. exploring the intervention mechanisms); identify the key contextual facilitators and constraints and analyse in what ways these contextual influences affected the achievement of outcomes. The protocol is largely very clear and well described but there are some areas that require further elaboration: While the aims and objectives have a realist flavor to them, the research questions seem to … BMC Public Health. We will also track significant non-quantifiable effects and will include estimates in the incremental cost-effectiveness analysis. Karki D, Mirzoev T, Green A, Newell J, Baral S. Costs of a successful public-private partnership for TB control in an urban setting in Nepal. For example, at the output level, we might expect that facility delivery rates will increase: the quantitative analysis will quantify the rate of change; the reasons for the change at this rate will then be explored using qualitative methods. 2005;331(7525):1107. J Adv Nurs. From a wider social perspective, the impact of the interventions is likely to affect the costs of obtaining services. How does capacity building of health managers work? Whereas in realist review the primary data comes from documents (e.g. This will give us greater understanding of the health system context, including the links with relevant policies, practices and programmes (e.g. 2010;88:364–70. [1] It is based on the epistemological foundations of critical realism. A detailed list of respondents will be developed within step 1, and snowballing will be used to identify any further informants. Implementation Sci 11, 83 (2015). In addition to changes in exogenous variables such as pay scales and size of the programme, we will include key contextual changes that can impact on the cost-effectiveness of the programme. Qualitative methods will include (a) IDIs with key actors, including service users, (b) reviews of key documents and (c) exit IDIs and focus group discussions (FGDs) with service users and their family members. Onwujekwe O, Uzochukwu B, Ojukwu J, Dike N, Shu E. Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: An analysis of activities, costs and outcomes. The demand component of the SURE-P/MCH programme aimed to increase utilisation of health services during pregnancy and at birth through the use of CCTs, i.e. Ethical approvals for this study were obtained from the University of Leeds (ref: SoMREC/14/097) and the University of Nigeria (ref: NHREC/05/02/2008B-FWA00002458-1RB00002323). Terms and Conditions, is time after the intervention; X Excerpt "A realist approach assumes that programs are “theories incarnate”. Only members of teams identified by the PIs in each institution will have access to the data. Realist methodology is increasingly used in the evaluation of complex health care interventions, to facilitate a deeper understanding of ‘what works, how, for whom, in what circumstances and to what extent’ [1,2,3,4].The initial step of realist studies aims to identify programme theories underlying the intervention . Malar J. © 2020 BioMed Central Ltd unless otherwise stated. The specific objectives of the study are to: Develop an in-depth understanding of the context and the process of implementation of the interventions, including relationships between health workforce and infrastructure and supplies, Identify, assess and compare the intervention outputs (e.g. This realist evaluation protocol will contribute to this knowledge in Zambia where there is increased attention towards promoting maternal, neonatal and child health as a means of addressing the current high early pregnancy and marriage rates. FMoH. The specific hypotheses will draw upon two data collection methods: (a) review of key documents (SURE-P implementation manual, relevant federal and state-level policies, e.g. This means, among other things, describing theories in terms of context -mechanism outcome (CMO) … However, if we reach data saturation earlier, these numbers may decrease. Other services might also be affected by resources (or their lack) such as drugs and theatre time that are channelled into the new programme. Realist impact evaluation draws on the realism school of philosophy. Knowlton LW, Phillips CC. Delivering presentations at local, state and federal meetings in Nigeria and relevant international meetings; Regular project review meetings and continuous engagement with key decision-makers, Developing newsletters, press-releases and interviews in the media aimed at communicating the key project findings to the public in Nigeria and more widely, Developing a dedicated website where the project results will be publicly accessible by national and international decision-makers, practitioners and academics, Delivering presentations at national and international conferences and publication of articles in peer-reviewed academic journals with emphasis on open access, Developing a project research report for the funder, with a publishable executive summary. statement and PubMed  The study comprises three steps: (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. J Health Serv Res Policy. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Ethical approvals for this study were obtained from the School of Medicine Research Ethics Committee at the Faculty of Medicine and Health at the University of Leeds (ref: SoMREC/14/097) and the Health Research Ethics Committee at the University of Nigeria Teaching Hospital, Enugu (ref: NHREC/05/02/2008B-FWA00002458-1RB00002323). We recognise context as a key influence in achieving the intended results. PubMed Central  it However, to guide further development and implementation of CHW programmes in different contexts, it is necessary to better understand what makes CHW programmes successful in achieving desired outcomes and under what circumstances they succeed [11, 12]. The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. The quality of government and programme indicators will first be assessed by comparing the data with relevant indicators from the demographic surveillance system, and we will adjust the HMIS/M&E variables accordingly in the case of major discrepancies. Research-policy partnerships - experiences of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. organisations and their roles) and micro level (e.g. Preliminary evidence indicates that paying CCTs to pregnant mothers is linked to increase antenatal care visits and facility deliveries [2]. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. A coherent LM is a thread of evidence-based logic that connects design, planning, implementation and evaluation of programmes [47]. The commitment by key health decision-makers at Anambra state to engage with this research is particularly encouraging. Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). In October 2015, 6 months after being elected, the new President of Nigeria announced his decision to reverse fuel subsidy reduction in order to catalyse the economic growth, effectively withdrawing government funding to SURE-P. with and without CCTs) of a Nigerian CHW programme to understand what contextual factors promote equitable access to quality services and examining the conditions under which these changes can be sustained following withdrawal of funding. We will also assess the relationships within each stage: whether and how the different inputs complement each other; any catalysing or mutually negating effects between the processes (e.g. This realist evaluation protocol sets out the approach that will be used to identify and explain which aspects of the programme are working, for whom and in what circumstances to produce the outcomes intended. actors’ behaviours in implementing intervention) to produce intended and unintended Outcomes. The-Presidency.

realist evaluation protocol

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