Abstract
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.
Highlights
Leaders of developing countries and their donors are interested in understanding how to improve a population’s health status through high impact interventions
Uganda provides an opportunity for in-depth study of how to measure institutionalization and sustainability of LQAS methodology in health care as well as the learning that results
We first based our selection on the region because we assumed that regional differences were associated with institutionalization and sustainability
Summary
Leaders of developing countries and their donors are interested in understanding how to improve a population’s health status through high impact interventions A great advantage of studying the institutionalization process of the LQAS methodology at the district level is the ability to examine whether there is a direct link between the district level presentation of results, the making of recommendations to correct particular deficiencies, and the adoption of strategic and tactical changes in the health programmes This is the central argument about how programme evaluations can contribute to making high impact interventions. It means that with greater attendance of these meetings by those for whom the results are relevant that more effective problem solving occurs facilitating the implementation of changes, especially when they require changes in local programme tactics (Valadez et al 2005) These characteristics may make the transfer of lessons learned in Uganda to other countries more difficult, they have implications for the research methods we used
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