The Importance of Evidence: Does a Program Work? How? Why?

  • By: Reshma Trasi, MBBS, MHA, MPH

Do L(eadership) + M(anagement) + G(overnance) interventions result in improved service delivery outcomes (and therefore better health outcomes)?

While there is ample evidence on what constitutes high-impact public health and service delivery interventions, there is little documented evidence on the outcomes and impact of leadership, management and governance interventions or programs. The Leadership, Management and Governance (LMG) project is committed to synthesizing, collating and generating evidence about the link between L+M+G interventions and improved health systems performance, including better service delivery outcomes.

We consider evidence along a continuum with anecdotes and testimonials at one end of the continuum, and progressively more rigorous qualitative, quantitative or mixed-method evaluation and research at the other end of the continuum. The continuum also includes implementation research – exploring and examining implementation barriers and constraints to understand how the context and other factors may affect the outcomes of an intervention or program. We can help answer a range of questions that are relevant and respond to the country’s priorities as well as those of program implementers (see Figure 1).

The LMG Evidence Continuum

The LMG evidence strategy includes a combination of technical and operational strategies.

TECHNICAL STRATEGIES

  • Intertwined monitoring, evaluation, and research (MER) and technical strategies

The LMG Monitoring, Evaluation, and Research (MER) team will work with the project team in each of the countries where we work worldwide to articulate and define a programmatic logic model or ‘theory of change,’ for the activities in each country.

As the LMG project progresses, the MER team will work closely with the country teams to use project data to inform and refine our technical strategies; and we will carry out assessments, evaluations or research, where feasible,  to determine what works and why.

  • Shift from retrospective to prospective measurement, evaluation, and research

In order to help LMG country projects determine the right mix of indicators, we are collecting indicators related to leadership, management and governance across projects carried out by Management

Sciences for Health (MSH) as well as those used by other health projects. We are refining data collection and documentation of health service delivery and performance trends by health teams undertaking the LDP Plus.

The LMG Project is conducting retrospective studies to examine the sustainability of the predecessor project—the Leadership, Management and Sustainability (LMS) project—to answer the following questions:

  • Is the pre-service leadership and management (L+M) content that was integrated into universities as a result of project interventions still being delivered? What barriers do universities face in scaling up content?
  • Which changes, behaviors, practices, and outcomes were sustained in the countries where the LMS project delivered L+M interventions? Why were these changes sustained (or not)? What factors and processes helped (or hindered)?

OPERATIONAL STRATEGIES

  • Maximize opportunities to synthesize, collate and generate evidence

We are undertaking a literature review to explore and examine the links between leadership, management and governance interventions on one hand and health service delivery and health system performance on the other. One of our consortium partners, Johns Hopkins School of Public Health (JHSPH), is conducting a systematic literature review to look for the evidence.

  • Leverage LMG and local partnerships

Evaluation and research requires commitments and investments. We are committed to working with LMG’s academic partners – JHSPH as well as Yale Global Health Leadership Institute – on these important issues. We will work hand-in-hand with our local partners in-country, Ministries, USAID Missions, and local academic institutions to generate evidence around L+M+G interventions. We can help answer a range of questions that are relevant and respond to the priorities of program implementers as well as those of a country. We are setting up assessments and implementation research studies in Afghanistan, Ethiopia, and Vietnam.

  •  Use evidence deliberately and strategically

The MER team will work closely with the LMG technical teams, the advocacy team and the communication team to use evidence to inform and fine-tune the project’s technical strategy, as well as to shape our advocacy and communication as we share the results of our findings with all of you.

Reshma Trasi, MBBS, MHA, MPH, is the Monitoring, Evaluation, and Research (MER) Team Director for the Leadership, Management and Governance Project.

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