The last one heard: the importance of an early stage participatory evaluation for programme implementation

Eilish McAuliffe,Frédérique Vallières,Brynne Gilmore,Gilbert Muyambi,Nazarius Tumwesigye

doi:10.1186/preaccept-1176510617107092

Abstract

The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle. Understanding how positive and negative feedbacks obtained from communities can subsequently be used to inform and iterate existing programmes is an important step towards ensuring the success of community health workers for maternal and child health programming and, ultimately, for improving health outcomes. The study took place over a period of 4 weeks in North Rukiga, Kabale District of southwestern Uganda. Using a cross-sectional qualitative study that employed an epistemological approach of phenomenology, nine focus group discussions and eight in-depth interviews were conducted with a total of 76 female participants across six different sites. Women were identified as either users or non-users of the maternal and child health programme. Purposeful sampling was employed to recruit women from six different locations within the programme catchment area. Translated and transcribed transcripts were subjected to a bottom-up thematic analysis using NVivo 10 Software, whereby themes were arrived at inductively. Predominant themes emerging from the focus groups and key informant interviews identified early trends in programme strengths. Beneficiaries reported confidence in both the programme and the relationships they had forged with community health workers, exhibited pride in the knowledge they had received, and described improved spousal involvement. Beneficiaries also identified a number of programme challenges including barriers to adopting the behaviours promoted by the programme, and highlighted issues with programme dependency and perceived ownership. It also emerged that community health workers were not reaching the entire population of intended programme beneficiaries. This research provides support for the importance of an early-stage participatory evaluation of beneficiaries’ perceptions of newly initiated health programmes. Our results support how evaluations conducted in the early phases of programme implementation can provide valuable, timely feedback as well as yield recommendations for programme adjustment or re-alignment, and in turn, better meet end-user expectations. Potential reasons for the observed lack of community participation in early stages of programme implementation are considered.

Highlights

The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle
Programme strengths Predominant themes emerging from the focus groups and interviews that highlighted early trends in programme strengths were as follows: Confidence in and importance of community health worker (CHW) and 7–11 The value ascribed to both the work of the CHWs and the maternal and child health (MCH) programme initiatives was high for all, as they identified the potential benefits
This article reports on the investigation of user perceptions of a newly initiated MCH programme in southwest Uganda that delivers evidence-based interventions through community health workers

Summary

Introduction

The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle. A growing body of literature advocates for the important contribution of formative evaluations in the implementation of health programmes [1,2]. These early-stage evaluations provide in-depth, contextually relevant, and timely information on factors that can potentially enhance or impede implementation success. Despite the Paris Declaration on Aid Effectiveness’ recommendation to increase the use of local systems for programme design, implementation, and monitoring and evaluation, local involvement in health programmes remains low and limited during the formative stages of a project cycle [3,4]. The key characteristics and processes through which effective outcomes are achieved and the opinions of the end-users with regard to how effective they perceive the intervention to be [5]

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Conclusion