Abstract
BackgroundAdolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants.MethodsWe reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results.ResultsStrengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions.ConclusionsThis analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.
Highlights
Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, requiring multifaceted prevention interventions
Planning Findings related to planning and a theory of change (ToC) framework were divided into three key elements: 1) outputs, intermediate- and long-term outcomes, 2) identification of the preconditions to create change and of articulated assumptions, and 3) the intervention package, which contains a sequential pathway of change with indicators to assess the performance
The post-hoc evaluation revealed outcomes during the process of implementation, and a new Theory of Change (ToC) was developed based on the Community Embedded Reproductive Health Care for Adolescents (CERCA) documents (Fig. 2) [13], more accurately reflecting what occurred in project implementation
Summary
Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, requiring multifaceted prevention interventions. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Multi-component, community-integrated health intervention packages are necessary to address complex social problems such as adolescent pregnancy [9]. These intervention packages are often themselves complex and require intensive planning, sound implementation, and rigorous evaluation to ensure effectiveness, community acceptance, and return on investment by non-governmental organizations (NGO) and government agencies [16, 27]. Ecuador and Nicaragua face high adolescent birth rates and associated poor health and psychosocial outcomes. In Bolivia, the adolescent birth rate is 89.1 per 1000 women (2005), Ecuador 99.6 (2002) and Nicaragua 92 (2010), are settings warranting special consideration for complex interventions [31]
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