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Intracluster correlation coefficients from the 2005 WHO Global Survey on Maternal and Perinatal Health: Implications for implementation research.
Paediatric and Perinatal Epidemiology. 2008 Mar; 22(2):117-125.Cluster-based studies involving aggregate units such as hospitals or medical practices are increasingly being used in healthcare evaluation. An important characteristic of such studies is the presence of intracluster correlation, typically quantified by the intracluster correlation coefficient (ICC). Sample size calculations for cluster-based studies need to account for the ICC, or risk underestimating the sample size required to yield the desired levels of power and significance. In this article, we present values for ICCs that were obtained from data on 97 095 pregnancies and 98 072 births taking place in a representative sample of 120 hospitals in eight Latin American countries. We present ICCs for 86 variables measured on mothers and newborns from pregnancy to the time of hospital discharge, including 'process variables' representing actual medical care received for each mother and newborn. Process variables are of primary interest in the field of implementation research. We found that overall, ICCs ranged from a minimum of 0.0003 to a maximum of 0.563 (median 0.067). For maternal and newborn outcome variables, the median ICCs were 0.011 (interquartile range 0.007-0.037) and 0.054 (interquartile range 0.013-0.075) respectively; however, for process variables, the median was 0.161 (interquartile range 0.072-0.328). Thus, we confirm previous findings that process variables tend to have higher ICCs than outcome variables. We demonstrate that ICCs generally tend to increase with higher prevalences (close to 0.5). These results can help researchers calculate the required sample size for future research studies in maternal and perinatal health. (author's)
Lancet. 2007 Feb 3; 369(9559):368.We fully agree with the Viewpoint by Kent Buse and colleagues about the need for agencies working in sexual and reproductive health policy to engage in applied political analysis as part of their core activities. We would like to draw your attention to the work of the United Nation Population Fund (UNFPA). UNFPA's country office in Guatemala used a form of interest-group analysis to plan and facilitate the adoption of that country's first social development and population law in 2001. UNFPA's Strategic Planning Office, with six country offices, has introduced interest-group analysis to scan the environment and engage with key players who influence the implementation of goals agreed at the International Conference on Population and Development (ICPD) in 1994. The approach has been applied to issues including early marriage and gender-based violence. In short, UNFPA, as the agency primarily responsible for sexual and reproductive health policy, is doing what Buse and colleagues recommend. (excerpt)
[Geneva, Switzerland], International Labour Organisation [ILO], Understanding Children's Work, 2003 Oct 1. 6 p.A good practice can be defined as anything that works in some way in combating child labour, whether fully or in part, and that may have implications for practice at any level elsewhere. The following are implicit in this definition: A good practice can represent any type of practice, small or large: It can represent a practice at any level. E.g. good practices can range from broad policy-level activities to practices at the grassroots level in the field. It need not represent an overall project or programme. Even if a project overall has not been successful, there still good be good practices that it developed or applied. It could be a very specific "nitty-gritty" process or activity, e.g. a strategy for incorporating questions related to child labour in other household surveys, a means of getting teachers in a rural setting to incorporate child labour considerations into the curriculum, a technique that was successful in getting an employer association on board, an effective communications strategy, an approach that led to the adoption of Convention 182, an innovative legal clause in implementing legislation … It could also represent something that only emerges after comparison across multiple settings, which may be more useful at the policy level than with nitty-gritty programme implementation considerations at the grassroots. (excerpt)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S15-S26.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development. (author's)
Health Promotion International. 2005 Jun; 20(2):177-186.Health-promoting schools (HPS)/healthy schools have existed internationally for about 15 years. Yet there are few comprehensive evaluation frameworks available which enable the outcomes of HPS initiatives to be assessed. This paper identifies an evaluation framework developed in Hong Kong. The framework uses a range of approaches to explore what schools actually do in their health promotion and health education initiatives. The framework, which is based on the WHO (Western Pacific Regional Office) Guidelines for HPS, is described in detail. The appropriate instruments for data collection are described and their origins identified. The evaluation plan and protocol, which underpinned the very comprehensive evaluation in Hong Kong, are explained. Finally, a case is argued for evaluation of HPS to be more in line with the educational dynamics of schools and the research literature on effective schooling, rather than focusing primarily on health-related measures. (author's)
Global HealthLink. 2000 Nov-Dec; (106):15, 22.The central problem in health research can be summarized as follows: global spending on health research by both the public and private sectors in the world amounts to about US$70 billion per year (1998 estimate). Of this amount, however, less than 10 percent is devoted to 90 percent of the world’s health problems as measured by the number of healthy life-years lost due to morbidity or premature death (often measured in terms of DALYs, or Disability-Adjusted Life Years). The economic and social costs to society as a whole of such misallocation of resources are enormous. The central objective of the Global Forum, an international foundation created in 1998, is to help correct the 10/90 gap and focus research efforts on diseases representing the heaviest burden on the world’s health, by improving the allocation of research funds and by facilitating the collaboration among partners from the public and private sectors in the priority areas of health research. (excerpt)
Untangling Gordian knots: improving tuberculosis control through the development of “programme theories.”
International Journal of Health Planning and Management. 2004; 19:217-226.We argue that if the lessons from tuberculosis control programmes are to be drawn effectively then a more nuanced understanding is needed that takes account of the complex health system environment within which they sit. We suggest that a conceptual framework that draws upon the World Health Organization’s DOTS strategy can be harnessed to assist the systematic analysis of programmes in a way that links this vertical, disease specific strategy to horizontal health system factors so that comparisons can be made. This multi-disciplinary, multimethod approach to the evaluation builds upon the work of others including Pawson and Tilley and their ‘programmes theories’. This work has informed the application of an evaluation toolkit which has been successfully applied in a number of settings and assisted in the sustainable implementation of a DOTS strategy in Russia. (author's)
Development in Practice. 2004 Jun; 14(4):569-573.Monitoring and evaluation (M&E) are needed by all development interventions in order to document their output and outcomes. Once a set of goals has been established in response to a development ‘problem’, a corresponding set of indicators (i.e. variables or information) will also be identified in order to review progress towards those goals. In Africa, the so-called ‘expert’ evaluators—those who see M&E as their professional calling—have dominated the process of selecting social indicators. Unfortunately, this domination has given rise to sporadic and unreliable social data for M&E purposes facing every agency involved in development work in Africa. Zimbabwe is no exception. This Practical Note tells the story of UNICEF Zimbabwe’s search for relevant and reliable indicators based on solid data. The guiding philosophy in this effort is the belief that local communities themselves are among the many agencies involved in implementing development programmes—in the sense that they always seek ways of tackling whatever problems they face. These communities must therefore be active participants in the process of selecting indicators. The paper will first discuss the difficulty in establishing relevant data and indicators in the context of Zimbabwe, a task which is now an urgent priority given the dual problems of HIV/ AIDS and a declining economy. It is generally believed that these two problems have been responsible for the reversal of social gains made immediately after independence—hence the need to know exactly what is going on. The paper will then highlight recent attempts by UNICEF Zimbabwe—together with its partners—to establish good and reliable information sources so that not only can it monitor and evaluate the various impacts of its programmes but also the social environment of children. In part, the pressure for community-generated indicators has also been driven by the shift in UNICEF’s approach to its work—an approach underpinned by human rights principles. The final part of the paper discusses the challenges that UNICEF and its partners have faced and continue to struggle with. It draws some lessons learned and points to what more could be done to improve the qualities of social indicators. (excerpt)
Contraception. 2004 May; 69(5):347-351.A recent review article by Smith et al. in The Lancet purports to find a causal relationship between long-term use of oral contraceptives (OCs) and cervical cancer. While we endorse the search for such a relationship, we felt it important to critically examine Smith et al.’s review process and, as a result, we have questions about the validity of their conclusions. In our view, the findings of published articles as presented by Smith et al. do not confirm a causal connection between long-term use of OCs and cervical cancer. Our goal is not to conduct another formal review of the evidence, but to evaluate whether Smith et al. have met the burden of proof for establishing a causal relationship. Given the importance of OCs to women the world over, we urge reproductive health professionals to consider this issue carefully before accepting that a causal relationship exists. (author's)
Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.
Bulletin of the World Health Organization. 2004 Feb; 82(2):106-114.To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. Patient evaluations were derived from a series of Quote (QUality of care Through patients’ Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intra-class correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 — Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. Intra–class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients’ problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider’s understanding of patients’ problems and responsiveness according to WHO. Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO’s performance measures of health care systems. (author's)
[Project-generated organizational learning: El-Haouz province and Essaouira province cases] L'Apprentissage organisationnel généré par les projets: "cas des provinces d'El Haouz et d'Essaouira".
[Rabat], Maroc, Institut National d'Administration Sanitaire [INAS], 2002 Jul. , 64,  pMoroccan healthcare structures, both at the central and peripheral levels have traditional organization and management centered on a certain fragmentation in management and vertical integration of programs and healthcare activities. It is for this reason that Morocco maintains cooperative relationships with several countries or international bodies in all domains, including that of health, for purposes of exchanging with them and benefiting from their technical and financial assistance via projects likely to improve the health of the population. Of course, each project results in learning in terms of mastering the technical tools of management by health professionals. It is in this sense that this study from the INAS (National Institute for Health Administration) was undertaken. The goal is to evaluate organizational learning generated in the context of projects initiated in the El Haouz and Essaouira provinces, and to determine its conditions, obstacles, and limits. This study should be taken as qualitative evaluative research, based on a questionnaire given to delegates of the provinces that were the study sites and to members of the local team involved in project management who had responsibilities in this area; on a focus group, and on semi-directed interviews with provincial managers. Analysis of the results led to the following syntheses: The mode of management by project offers the opportunity for health professionals to improve their abilities. But they should make an effort to adapt to conditions in the field, and show that they are committed in this process; the domain of organizational learning should revolve around three components: technical, behavioral, and managerial, provided the last is better integrated since it seems to lag behind the other two. Also, the ability to learn in the context of projects is certainly conditioned by a certain number of factors that must be considered to better master the constraints and work for the implementation of favorable conditions for organizational learning. At the end of this work, recommendations were made in order to enhance and improve the quality of implementing the project management mode in sanitary structures across which develops organizational learning for the purpose of better meeting the needs of the population and strengthening capacities in health professionals.
Promoting behavior change in Botswana: an assessment of the Peer Education HIV / AIDS Prevention Program at the workplace.
Journal of Health Communication. 2003 May-Jun; 8(3):267-281.Botswana has the highest rate of HIV prevalence in the world and AIDS has now reached crisis proportions in the country. Among the initiatives implemented as a response, to promote sexual behavior change, is the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace. This paper assesses the impact and outcome of the PEHAPP. It concludes that the PEHAPP is having a measurable positive impact in the key areas of improving knowledge, attitudes, and practices related to risky sexual behavior which, in turn, should reduce the incidence of transmission of HIV/AIDS and other STDs over the long-term. (author's)
[Unpublished] 1992 Apr.  p.Sri Lanka's review of population education studies aimed to provide a compilation and an analytical review of research and evaluation findings. Potential benefits are expected for improving policy making and practice, for locating the gaps in programs and the necessary action needed, and for facilitating the use research in planning and evaluation. Research deficiencies in program evaluation were noted by Professor J.E. Jayasuriya in 1986. The population education task in 1972 was tremendous and included introduction of curricular reform in 8000 primary schools and 5500 junior secondary schools, with only a 6-month start-up time. Program implementation was still ongoing when reforms were instituted in 1977, and 1978, and 1983. Data were collected in some fashion during this period, and evaluations were conducted on an ad hoc basis by postgraduate students. Much more research information is available on demographic trends in fertility and family planning (FP). Reforms did not include University Departments of Education, and training activities were devoted primarily to training teachers for the ever increasing demand. The review included 75 listings among the following topics: basic research studies (55), KAP studies (4), management (4), personnel training (2), curriculum development and instructional materials (4), information dissemination (1), and program impact evaluation (3). There were no studies of teaching methodology or classroom instruction. A limitation of the study is the arbitrary nature of the criteria, which was developed by UNESCO/PROAP. There also was a limited time frame which did not allow for direct contact of instructions or researchers. A summary of the research activity is provided. Each study is listed by title, place and publisher, number of pages, series of document number, language, objectives, key words, availability, methodology, and findings.
Prototype home-based mother's record: a guideline for its use, and adaptation in maternal and child health/family planning programmes and a reference manual for field testing and evaluation.
[Unpublished] 1985. , 119 p. (MCH/85.13)There is a need for a simple, home-based maternal record that can monitor breastfeeding and family planning practices during the interpregnancy period, identify high-risk women, and guide health care workers in the timely management of care to be provided in the home and at the next referral level. This record should further serve as an educational tool that promotes the concept of participation in self- care. Maternal cards used in clinics and hospitals are difficult for primary health care workers with limited education to complete and are not designed to be adapted to the changing health problems and health needs in a given community. In response to this situation, the World Health Organization's Maternal-Child Health Unit has designed a prototype home-based mother's record that can serve as a starting point for the design of more area-specific ones. The record contains 6 panels: 1 for data and risk conditions suggested by past history; 3 for data on past pregnancies, deliveries, and postpartum periods; 1 to monitor health progress before the 1st pregnancy or during the interpregnancy interval; and 1 for recording recommendations to the referral center. It is important that any mothers' records developed should be field tested to evaluate the physical condition of the card after 1 year of use, the extent of use of the record, the quantity of information collected and its usefulness, the assessment of health workers about the value of the record, risk factors identified, utilization of referral sources and family planning services, and linkages with other health records.
In: Evaluation and development: proceedings of the 1994 World Bank conference, edited by Robert Picciotto and Ray C. Rist. Washington, D.C., World Bank, 1995. 189-200. (World Bank Operations Evaluation Study)Sociocultural settings are missing variables in most evaluations of development projects and policies. This paper argues that evaluators should try to take account of differences in sociocultural contexts. Recent research demonstrates that taking culture into consideration can improve the evaluation of decentralized governance, economic and social development, and educational interventions. This paper uses the related concept of sociocultural setting to refer to shared meanings, customary institutions, and something akin to a collective personality. According to a metaphor by Robert Putnam, local sociocultural conditions are the symbolic soil in which development takes place and policies and projects may work better or worse, depending in part on the soil conditions. An important task for evaluation, indeed for applied social science, is to help in the understanding of these policies by culture interactions. An impending renaissance in applied sociocultural studies will enhance the evaluation research and improve prospects for sustainable development impacts.
An inventory and review of researches and studies on population education in the Philippines, 1971-1991. [Volume I].
[Unpublished] 1992 May. iii, 116 p.The inventory of research studies on population education in the Philippines as requested by UNESCO, revealed that there were weak links between researchers and research centers and a lack of flow of information about on-going research activities. Studies were obtained from a prior review of educational research conducted by the Philippine Association of Graduate Education, population education program abstracts, and technical reports of research groups concerned with population education. There were 124 studies over a 20-year-period abstracted, of which 27 pertained to basic research, 43 pertained to KAP (only 23 were analyzed), 3 were on personnel training, 11 were on curriculum (only 9 were analyzed), 34 were on program evaluation (21 were analyzed), and 6 were on teaching methodology. 26 were nationally representative studies, 61 were regional, 19 were personnel, 6% were district, and 11 were school level. In this volume, a summary profile is given of the studies, followed by an analysis and interpretation of research findings by each of the 6 basic topics. Volume II provides a complete listing of each study summarized in this volume and an annotated bibliography of population education studies from graduate schools. The general conclusions in volume I were that there was greater awareness of the importance of research as a tool for reform in population education, and research on population education was relevant and varied in its presentation of population education activity. The lack of funding has not impeded research efforts. Population education has been accepted by the population and has been integrated at all educational levels. The evaluation results have generally been favorable. Recommendations were to plan a national research agenda, to strength coordinating and clearinghouse functions of the Population Education Program, to assure dissemination of information for integration into program plans, and to provide impetus for creative and innovative research. Future research needs were identified for a systems analysis of the population education program and policies, an experimental curriculum study of population education in higher education, and in depth analysis of determinants of fertility and demographic behavior.
[Unpublished] 1992 Jan. 70 p.An inventory of population education research in Pakistan was conducted at the request of UNESCO; the conclusion was that there were few scholarly research conducted over 30 years. Most studies came from the University of Punjab and the National Institute of Population Studies in Islamabad. Descriptive information on the inventoried studies is not summarized in a general introduction, but a brief statement is provided at the beginning of each of the following topic headings: basic research studies (6), KAP studies (1), management (1), curriculum (1), information dissemination (1), and program impact evaluation (6). There were no studies of personnel training, teaching methodologies, or classroom instruction. Basic research studies were sample surveys of local areas and not nationally representative, and analysis was in terms of frequency distributions and percentages. Reports had missing information, such as methodological details. As available, discussion and information is presented for each study on the project title, author, institution, places and publisher, number of pages, series or document number, language, objectives, methodology, analysis, and recommendations. The KAP study was conducted in 1960 for urban areas. The one management study surveyed activities of nongovernmental organizations (NGO) registered in 1984-86 on NGOs specifically, on service outlets, and on community contact. The one study on curriculum surveyed 12,000 middle and secondary school teachers on instruction materials, student development and teacher's performance. The study on information dissemination focused on IEC effectiveness in preparation of materials, population awareness among currently married reproductive age women and some husbands, and population welfare workers IEC activities. The 3 program impact studies pertained to a study of industrial workers, outreach in family welfare centers as part of a pilot project in Rawalpindi District, and family planning perceptions, attitudes, and knowledge of a population near family welfare centers.
[Unpublished] 1992. , 67 p.The aim of this summary report on population education in Vietnam was to review and inventory research and evaluation studies on population education and family planning (FP). The Population Education Project began in 1983 and included the following activities: basic research, KAP studies, management and supervision, personnel training, curriculum development and instructional materials, teaching methodologies, classroom instruction, information dissemination and program impact evaluation. Each of the studies reviewed is condensed into a format which provides information on title of the project, name of the author(s), institution (s) involved, objectives, sample, methodology, major findings, year of publication, and sources of available materials. The main study reports are written in vietnamese, with the exception of 10 studies which are available in English. The quality of the studies vary; those of inferior quality are usually conducted locally or conducted at teacher training institutions, rather than through internationally funded programs. Report availability is limited in many cases. Funding has traditionally been limited for evaluation. Introductory commentary is provided on the history of population education, institutionalization, materials development, training integration into the various levels of education, cooperation, and preliminary 1989 census results. Over the past decade, the birth rate declined from 32.9-31.3%. There were 12 provinces of cities out of a total of 44 that had a rate under 31%. 8 provinces maintain a crude death rate of 5-6%. The dependent population has been reduced to 39.6% for those <15 years old and to 7% for those <70 years old. Marriage age increased to 24.5 years for males and 23.2 years for females; ages are higher in urban areas. Fertility was 4 women in 1989, a decline from 4.8 in 1979. Natural increase is presently at 2.1%. Population and FP has been a concern since 1963, but initial efforts were primarily in the north. Reunification in 1975 after the war contributed to program expansion and a National Commission on Mothers and Child Health Care was established. Cycles to program activity were identified as 1978-83 (7 projects), 1984-87 (8 projects and the beginning of pilots in population education), and 1988-91 (24 projects).
SINGAPORE MEDICAL JOURNAL. 1989 Aug; 30(4):390-2.In the 1980s, a study showed an association between IUD use and pelvic inflammatory disease (PID) and subsequent infertility. About the same time, 2 major manufacturers of IUDs stopped making IUDs. These 2 events caused a decline in IUD use worldwide. In Singapore, however, the decline began in the 1960s when the Family Planning Board withdrew the IUD from its 5 year plan. After that, researchers in Singapore 1st conducted randomized prospective trials of most new IUDs. For example in the late 1980s, they began a prospective trial of the MLCu380 with a complicated insertion system. Multicenter trails have demonstrated that at least 5 of the newest copper IUDs have a failure rate of <2/100 woman years and <1/100 for 3 other new copper IUDs. Some manufacturers have increased the area of exposed copper from 200-250mm to 375-380mm to increase efficacy, but a prospective trial in Singapore did not show an increase. A large multicenter trial has shown that the levonorgestrel releasing IUD (LNg20) has a very low failure rate (.12/100) and reduces menstrual loss, unlike the copper IUDs. Due to legal concerns over the medical grade plastic, however, the manufacturer stopped distributing it in the late 1980s. WHO hoped to identify a manufacturer for the plastic so further trials could begin around 1991. In the late 1980s, WHO studied the silver cored copper wire IUD used to prevent fragmentation. Since IUDs change the endometrium which suppresses intrauterine pregnancies but not extrauterine pregnancies, the risk of an ectopic pregnancy is 10 times that of a nonuser. The risk is lower in copper IUDs suggesting that copper ions reduce the chance of fertilization in the Fallopian tubes. The risk of PID in IUD users ranges from 1.5-2.6. The majority of IUD associated PID occurs within 4 months following insertion and in nulliparous patients with several sexual partners.
Further experience with the World Health Organization clinical case definition for AIDS in Uganda [letter]
AIDS. 1989 Jul; 3(7):462-3.The diagnostic value of the World Health Organization's (WHO's) clinical case definition for acquired immunodeficiency syndrome (AIDS) was reassessed in 99 patients aged 16 years and above who presented to the Internal Medicine ward of Uganda's Mulago Hospital in August-December 1987. The 39 cases met the WHO clinical case definition of AIDS with at least 2 major and 1 minor signs; the control group was comprised of 60 consecutive admissions to the emergency ward who did not fulfill the WHO case definition. Blood samples from each study participant were tested for antibodies to human immunodeficiency virus (HIV)-1 through use of the Organon-Teknika enzyme-linked immunosorbent assay (ELISA) and the DuPont Western blot tests. 85% of the cases and 30% of controls were seropositive for HIV-1. Thus, the WHO clinical case definition had a sensitivity of 65%, a specificity of 88%, and a positive predictive value for HIV-1 seropositivity of 85%. Similar values have been recorded in other centers in Uganda and in Zaire. Various modifications of the case definition were explored; however, none resulted in any significant overall improvements in its diagnostic value. It was concluded that the WHO clinical case definition for AIDS is adequate in central African populations and its continued use is recommended.
[Unpublished] 1989 May. ii, 39 p.The chief methods for assessing programme impact on fertility were codified in the 1970's through a collaboration between the U.N. Population Division and the IUSSP Committee on the Comparative Analysis of Fertility and Family Planning. Since then there has been no attempt to review their actual use in 1) programme assessment; 2) target setting, and 3) training. This paper identifies, through an inquiry to numerous institutions and individuals, as well as through a literature search, the ways in which these methods have been used. We also suggest reasons for non-use of certain of the methods, and we discuss their successes and failures in research, training and program evaluation at the country level. Several factors were identified as important in this regard: 1) the growing availability of fertility and family planning surveys drawn from nationally representative samples of reproductive aged women; 2) the improvements in the measurement of program effort; 3) the rapid dissemination of microcomputers, and 4) the growing interest in target setting for policy making at the country level. Conclusion emphasize the value of population-based methods of measuring net program impact (e.g, multivariate techniques and experimental designs), the importance of well designed and documented software and growing interest in family planning evaluation in Africa. (Author's modified)
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
Washington, D.C., SOMARC, .  p.This document contains briefing materials for the participants of an upcoming meeting of the advisory council and working groups of Social Marketing for Change (SOMARC), an organizational network, funded by the US Agency for International Development (USAID) and composed of 5 firms which work together in helping agencies, organizations, and governments develop contraceptive social marketing programs. Social marketing is the use of commercial marketing techniques and management procedures to promote social change. The briefing materials include 3 background and 18 issue papers. The background papers provide brief summaries of USAID's population activities and of the history of social marketing programs, an overview of USAID sponsored contraceptive social marketing programs in 14 countries and of 3 major non-USAID programs, and a listing of the skills and resources needed to develop effective contraceptive social marketing programs. The issue papers provide a focus for the discussion sessions which are scheduled for SOMARC's working groups on marketing communication, management, and research. USAID's objective is to promote the development of family planning programs which are completely voluntary and which increase the reproductive freedom of couples. Contraceptive social marketing programs are consistent with this objective. USAID provides direct funding for family planning programs as well as commodity, technical, and training support. USAID's involvement in social marketing began in 1971, and USAID is currently sponsoring programs in Jamaica, Bangladesh, Nepal, El Salvador, Egypt, Honduras, Ecuador, the Caribbean Region, Costa Rica, Guatemala, and Peru. In the past, USAID provided support for programs in Mexico, Tunisia, and Ghana. The Mexican project is now functioning without USAID support, and the projects in Tunisia and Ghana are no longer operating. Major non-USAID contraceptive social marketing programs operate in India, Sri Lanka, and Colombia. These programs received only limited technical support from USAID. To ensure the success of social marketing programs, social marketers must have access to the knowledge and skills of commercial marketers in the areas of management, analysis and planning, communications, and research. Social marketers must also have expertise in social development and social research. In reference to the issue papers, the working groups and the advisory council were asked to develop suggestions for 1) overcoming social marketing program management problems, 2) motivating health professionals toward greater involvement in social marketing programs, 3) improving the media planning component of the programs, 4) improving management stability and training for management personnel, and 5) improving program evaluation. Areas addressed by the issue papers were 1) whether social marketing programs should be involved in creating a demand for contraceptives or only in meeting the existing demand, 2) the development of a methodology for assessing why some programs fail and others succeed, 3) the feasibility of using anthropological and questionnaire modules for conducting social marketing research, 4) techniques for overcoming the high level of nonsampling error characteristic of survey data collected in developing countries, 5) techniques for identifying contraceptive price elasticity, 6) the feasibility of using content analysis in social marketing communications, 7) the applicability of global marketing strategies for social marketing, and 8) how to select an an appropriate advertising agency to publicize social marketing programs.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 270-88. (International Conference on Population, 1984; ST/ESA/SER.A/91)This paper reviews the technical cooperation efforts undertaken by the United Nations Department of Technical Cooperation for Development (DTCD) to help combat the high mortality levels in developing countries and to evolve policies in response to the World Population Plan of Action. Although the transfer of medical technology and the provision of drugs and other medical supplies remain important means of controlling death and disease, there is growing recognition of the need to develop national skills to deal with mortality, to maintain a continuous record of mortality and morbidity levels and their response to ameliorative programs, and to analyze the interrelationships between demographic, health, and socioeconomic variables. DTCD has focused on data collection and analysis, the integration of research findings into population policy formulation, and training and skill development to facilitate self-reliance. However, the lack of regular mechanisms for coordinating the activities of the various United Nations agencies that play a role in in technical cooperation in the areas of mortality and health policy has been a serious limitation. Another problem has been the dearth of tested alternative techniques for conducting simple health surveys whose results could be used in planning. Closer cooperation between United Nations agencies in this field is urged. It is also important that the recent reassignment of a low priority to data collection and analysis on the part of the United Nations Development Program be reversed. Unless data collection, analysis, and evaluation are reassigned a high priority, planners will be forced to depend on subjective judgments to evolve mortality policies. Finally, technical cooperation activities that aim to integrate mortality and morbidity control into population policies must be responsive to human rights.
Health programme evaluation: guiding principles for its application in the managerial process for national health development.
Geneva, Switzerland, WHO, 1981. 47 p. (Health for All Series, No. 6)Evaluation of health programs, policies, and institutions is part of the managerial process of national health development; general guidelines for evaluating health policies and the components of health care systems are provided. The guidelines are general and can be adapted to specific situations. Evaluation is the responsibility of those carrying out policies at each level of the health system, but personnel from both lower and higher levels of organization should also participate in the evaluation. Evaluation is a continuous process, and the results of the evaluation should be written up periodically. The evaluation process involves 1) identifying the subject (policy, program, service, or institution) to be evaluated, 2) specifying the organizational level to be evaluated, 3) defining the objective of the evaluation, 4) determining informational requirements and ensuring that the information is available, 5) assessing the relevancy and adequacy of the component under evaluation, 6) measuring progress to date, 7) assessing the results achieved by the component in reference to the level of effort and and resources which were devoted to the component, 8) assessing the degree to which the component attained its objectives, 9) assessing the impact of the component on the target population's overall health status or quality of life, and 10) summarizing the results and formulating recommendations to continue, improve, or discontinue the policy, program, service, or institution. Guidelines are also provided for evaluating the managerial process for national health development. Evaluation studies require the use of indicators. Ideally, quantifiable indicators should be used. A list of suggested indicators for evaluating health policies, socioeconomic conditions, the delivery of health care, and the health status of a particular popultion is provided. Reaslistic criteria and standards to be achieved in reference to each indicator should be determined.