Center for Innovation, University of Maryland, College Park, MD 20742, USA.
Department of International Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Health Policy Plan. 2017 Nov 1;32(9):1248-1255. doi: 10.1093/heapol/czx066.
The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C's: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized 'stability', whereas in global health, the issue is determining how to improve the impact of services by 'changing' programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0-11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C's (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda.
实现高影响力的卫生服务的关键是使方案评估制度化并持续化。乌干达成功地使用了一种特定的方案评估方法，即整群随机抽样质量保证（Lot Quality Assurance Sampling，LQAS），这为我们提供了一个范例。制度化可以通过两个“C”来定义：有能力的方案评估人员，以及能够有效利用评估数据来改善卫生服务的控制机制。可持续性意味着持续为评估方法提供培训和资金。研究制度化的社会科学文献强调了“稳定性”，而在全球卫生领域，问题在于确定如何通过“改变”方案来提高服务的影响力。在乌干达，我们评估了在九个抽样地区实施的改变方案的程度，这些地区代表了三个主要的农村地区和不同有效卫生方案的水平。我们使用 0-11 个月儿童的母亲在卫生机构分娩的比例作为主要指标来衡量方案的有效性。我们在地区卫生办公室的主任、评估主管、数据收集员中进行了访谈和焦点小组讨论，并在中央政府一级进行了个人访谈。九个地区中有七个地区的评估实现了高度的制度化。另外两个地区仅进行了一轮方案评估。当我们控制卫生机构的可用性时，我们发现制度化的程度与婴儿在卫生机构分娩的流行程度呈中度相关。评估在中央政府一级实现了制度化。可持续性在两个层面都存在。有几个措施表明，九个地区案例研究的经验教训可能与至少进行了两轮方案评估的 74 个地区相关。我们注意到，评估数据被用于改变卫生服务，以及用于衡量妇女健康和儿童生存服务的四个独立指标之间存在关联。我们的结论是，有能力的评估人员和控制机制这两个“C”对于乌干达持续进行方案评估至关重要。
