Health – C4D Network

How Can Evidence Bolster Citizen Action? Learning and Adapting for Accountable Public Health in Guatemala ( Accountability Research Center, Accountability Note 2. 2018)

May 31, 2018 by C4D Network

Most theories of change in the field of transparency and accountability assume that scientifically rigorous evidence increases the possibility of influencing officials and decision-makers. Generating this evidence has been the work of academic experts. Over the last decade, the Centro de Estudios para la Equidad y la Gobernanza de los Sistemas de Salud (the Center for the Study of Equity and Governance in Health Systems, or CEGSS) has considered the question of how to use evidence to influence authorities and promote participation by users of public services in rural indigenous municipalities of Guatemala.

The author’s initial approach relied on producing rigorous evidence through the surveying of health care facilities using random samples. However, when presented to authorities, this type of evidence did not have any influence on them. In the follow-up phases, the author gradually evolved the approach to employ other methods to collect evidence (such as ethnography and audiovisuals) that are easier to grasp by the non-expert public and the users of public services. The involvement of users of services in evidence collection was accompanied by civic action strategies to engage with authorities in the resolution of problems. Throughout a decade of work, it was learned that methods for gathering evidence that draw in participation from the wider community, that help communities to tell their stories, and that facilitate collective action among service users tend to be the most powerful to influence responsiveness from authorities at local and regional levels of government.

In addition, using participatory approaches to generating and interpreting evidence fosters pedagogical processes of civic action that empower service users by activating their roles as citizens and voters. This process has been used to open space for negotiating the allocation of public resources with authorities at different governance levels.

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Ensuring government accountability for expanded access to female condoms in South Africa (PATH Case Study, 2015)

May 28, 2018 by C4D Network

In 2012, the South African government launched a new National Strategic Plan on HIV, sexually transmitted infections (STIs), and tuberculosis (TB) for 2012-2016 that included ambitious female condom procurement targets. Reproductive health advocates viewed these targets as progress toward expanded protection options for women. They also saw an opportunity to monitor and encourage implementation, especially since translating health policies into concrete programming remained a challenge in South Africa. Over 18 months, they implemented a series of advocacy activities to maintain a steady drumbeat of attention on female condoms and increase accountability among South African officials for procurement and programming. The conclusion of these advocacy efforts coincided with the government releasing its largest-ever tender for female condoms, requesting a supply of 54 million units over three years. This number tracks closely with the targets laid out in the HIV/STI/TB National Strategic Plan.

The case study finds that coordinating and mobilizing local South African civil society and media partners to deliver advocacy messages through creative means—such as the “Dance4Demand” Global Female Condom Day campaign in 2014—was critical in persuading government decision-makers to act on their commitments.

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Emerging Epidemics and Risk Perception: New Evidence from Latin America and the Caribbean (IFRC/Save the Children SBCC Summit Abstract, 2018)

May 27, 2018 by C4D Network

Zika became a Public Health Emergency of International Concern (PHEIC) in February 2016 garnering international attention. There was a need to understand risk perception and behaviours related to Zika specifically, but also to gain knowledge on how risk is perceived in the context of an emerging disease outbreak.

In response, IFRC and Save the Children in Latin America and the Caribbean carried out a total of 2,711 Knowledge, Attitudes and Practices (KAP) surveys collecting data at the household level.

Results showed that awareness about Zika disease was high but understanding about what made it different from other mosquito-borne diseases was poor. Conversely, stigma and discrimination associated with the disease were low. Lack of knowledge about sexual transmission may have played a role in this.

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Monitoring and Evaluating Digital Health Interventions: A practical guide to conducting research and assessment (WHO, 2016)

May 14, 2018 by C4D Network

Since 2011, in partnership with the World Health Organization (WHO) Department of Reproductive Health and Research (RHR), the United Nations Foundation (UNF) has been supported by the Norwegian Agency for Development Cooperation (Norad) to oversee three yearly rounds of grants to mHealth projects. A total of 26 organizations received financial investments and technical assistance towards the goal of demonstrating potential for scaling up digital health innovations to catalyse achievement of the health-focused United Nations Millennium Development Goals (MDGs). The research and technical support provided through this mechanism, with assistance from the Johns Hopkins University Global mHealth Initiative (JHU-GmI), have afforded numerous opportunities to engage with and learn from implementing partners on the ground, across Asia and Africa.

This resource represents the collective learning from five years of engagement with agencies working to strengthen their digital health deployments, develop robust evaluations, and scale up their activities nationally and regionally. The lessons learnt from working with these partners are described in this document, which provides high-level guidance and systematic direction to programme planners and implementers embarking on similar journeys. Specifically, this Guide provides an introduction to the approaches and methods that were identified as useful for (i) the monitoring of project (i.e. intervention) deployments, focusing on the quality and fidelity of the intervention inputs; and (ii) the evaluation of project outputs and impacts across a number of axes, from user satisfaction to process improvements, health outcomes and cost–effectiveness.

Although more in-depth texts and curricula are available on the methods discussed, this Guide focuses on presenting pragmatic highlights and experience-informed tips for implementers to consider, together with links and resources for further study. It leads the reader through the development of value “claims”, evaluation designs and indicators associated with their digital health intervention, an assessment of the quality and availability of the data from their intervention, and finally, a series of guidelines for the reporting of findings.

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Digital Health for Social and Behavior Change: New technologies, new ways to reach people (HIPs Brief, USAID, 2018)

May 14, 2018 by C4D Network

Using digital technologies—such as mobile phones, computers, or tablets—to convey information and messages as part of an evidence-based multichannel social and behavior change (SBC) strategy may contribute to promoting, adopting, and maintaining healthy sexual and reproductive
behavior. This brief summarizes the current state of evidence in this rapidly changing field. (A companion brief reviews digital applications aimed at supporting providers and health systems.)

People in developed and developing countries are spending more time on digital devices. Smartphone ownership and Internet use are increasing rapidly among adults in most emerging and developing economies, where nearly half the adult population reports owning a smartphone or using the Internet at least occasionally. Digital technologies have the potential to provide accurate information to individuals when and where they need it. Making information available through digital applications may also reduce the time and cost related to seeking or receiving information through more traditional sources, such as print or interpersonal communication.

Use of digital technologies to support healthy sexual and reproductive behaviors is one of several promising “high impact practices in family planning” (HIPs) identified by a technical advisory group of international experts. A promising practice has limited evidence, with more information needed to fully document implementation experience and impact. The advisory group recommends that these interventions be promoted widely, provided they are implemented within the context of research and are carefully evaluated in terms of both impact and process.

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