Institute of Development Policy, University of Antwerp, Antwerpen, Belgium.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Int J Health Plann Manage. 2022 Dec;37 Suppl 1:37-44. doi: 10.1002/hpm.3530. Epub 2022 Jun 1.
Realist evaluation (RE) is a theory-driven evaluation approach inspired by scientific realism. It has become increasingly popular in the field of global health where it is often applied in low- and middle-income countries. This makes it timely to discuss RE's relationship to the emerging decolonisation of global health movement. In this short perspective, we argue that the principles and practices that underpin RE have great potential to contribute to the decolonisation endeavour. Both the focus on the inclusion of local stakeholders and the openness to the rival theories these stakeholders bring to the fore, are promising. However, in practice, we see that a lack of acknowledgement of power imbalances and different ontologies and an overreliance on Western-based theories thwart this potential. We therefore suggest that realist evaluations performed by external researchers, especially in the field of global health, should actively engage with issues of (power) inequities. This is not only the just thing to do, but will also contribute to a better understanding of the intervention and may facilitate the emancipation of the disenfranchised. One way of doing this is through the adoption of participatory (action) research methods, currently underused in realist evaluations. We finally give a short example of an evaluation that combines emancipatory and participatory practice development with a realist approach. The Afya-Tek project in Tanzania has an innovative bottom-up approach throughout the full evaluation cycle and shows the possible strength of the proposed combination to create better interventions, more empowered stakeholders, and more illuminating programme theories.
现实主义评价（RE）是一种受科学现实主义启发的理论驱动的评价方法。它在全球卫生领域越来越受欢迎，通常在中低收入国家应用。因此，现在及时讨论 RE 与全球卫生领域新兴的非殖民化运动的关系是很有意义的。在这篇短文中，我们认为，RE 所依据的原则和实践具有为非殖民化努力做出贡献的巨大潜力。关注纳入当地利益攸关方，以及对这些利益攸关方提出的竞争理论持开放态度，这两点都很有希望。然而，在实践中，我们发现，缺乏对权力失衡和不同本体论的认识，以及过度依赖基于西方的理论，阻碍了这一潜力的发挥。因此，我们建议，由外部研究人员进行的现实主义评价，特别是在全球卫生领域，应该积极参与解决（权力）不平等问题。这不仅是正确的做法，而且将有助于更好地理解干预措施，并可能促进被剥夺权利者的解放。一种方法是采用参与式（行动）研究方法，目前在现实主义评价中使用不足。最后，我们给出了一个简短的例子，说明如何将赋权和参与式实践发展与现实主义方法结合起来。坦桑尼亚的 Afya-Tek 项目在整个评估周期中采用了创新性的自下而上的方法，展示了所提议的组合的可能优势，即创建更好的干预措施、更有权力的利益相关者和更具启发性的方案理论。
