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A Guide to the Fundamentals of Economic Evaluation in Public Health

A Guide to the Fundamentals of Economic Evaluation in Public HealthManagers and decision makers in public health face choices in a world with limited resources. This Guide to the Fundamentals of Economic Evaluation in Public Health presents an overview of methods and tools that can help to inform public health decisions based on economic principles. Although the guide’s perspective is economic, the principles address health outcomes. The guide is intended for public health program planners, managers, and funders who are not familiar with economic evaluation but want to become familiar with its fundamentals. Some chapters provide more detail than others, especially in areas that may not be well known to many audiences: costing, cost-effectiveness analysis, and cost-benefit analyses. This is not a textbook; the intention is for readers to become familiar with the basic principles of economic evaluation; know when to use economic evaluation methods; be able to read an economic evaluation report; and be able to understand, at a general level, the approaches used and the conclusions reached. The guide will help program managers/decision makers know which approach is the most appropriate to use.

Evaluations of public health interventions, programs, or strategies look at their effectiveness in achieving the intended goal of improved health outcomes. Economic evaluation provides an additional element of understanding the cost factors of an intervention. The guide presents the main tools and approaches used in economic evaluation.

Throughout the guide, the authors have strived to provide concrete, real-world examples and case studies. Where judged to be appropriate, mathematical examples of the required calculations are given. The limitations of each approach as well as any ethical considerations are also discussed.

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Snapshot of the Strength of the Health Information System as a Source of HIV Data

fs-19-349-botswana.JPGHealth information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.

MEASURE Evaluation, funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief, prepared 13 briefs to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the collection of briefs.

Caring for Armenia’s Vulnerable Children: Institutionalizing a Platform for Cross-Sector Collaboration

Caring for Armenia's Vulnerable Children: Institutionalizing a Platform for Cross-Sector CollaborationIn Armenia, the MEASURE Evaluation project—funded by the United States Agency for International Development (USAID) and USAID’s Displaced Children and Orphans Fund—facilitated development of a governance structure for the reform of national policies and systems for the care of vulnerable children: “national care reform.” The governance structure was a country core team (CCT) established by Armenia’s Ministry of Labor and Social Affairs in June 2017.

Team members represent government partners and other stakeholders. Their task is to develop and strengthen the country’s leadership in assessing and ultimately accelerating national care reform. This brief explains the structure and roles of this CCT and the team’s usefulness as a platform for collaboration.

Read more about MEASURE Evaluation’s work on alternative care for children here.

Read more about MEASURE Evaluation’s work in Armenia here.

MEASURE Evaluation’s Strategy to Respond to National Malaria Control Program Needs in Surveillance, Monitoring, and Evaluation

MEASURE Evaluation’s Strategy to Respond to National Malaria Control Program Needs in Surveillance, Monitoring, and EvaluationThe Malaria Technical Area (MTA) of the United States Agency for International Development-funded MEASURE Evaluation project—with support from the President’s Malaria Initiative (PMI)—has increased its country presence in priority countries to provide direct technical support to national malaria control programs (NMCPs). This support is provided through a MEASURE Evaluation-appointed malaria resident advisor (MRA). MRAs have extensive experience in malaria surveillance, monitoring, and evaluation (SME), and their responsibilities consist of overseeing MEASURE Evaluation’s in-country work, developing close relationships with the NMCP, and liaising with the MTA headquarters staff. Depending on the scope of the country’s portfolio, additional SME staff may provide support to the MRA and form the rest of the in-country team.

Each MRA has a tailored set of duties and challenges related to the needs of his or her assigned country’s NMCP. Although each MRA works to achieve the same goal of supporting the NMCP, there is limited direct interaction across countries. To promote the exchange of MRA experiences and lessons learned, MEASURE Evaluation hosted a meeting in October 2017 under the theme, “MEASURE Evaluation’s Malaria Technical Area: Transitioning to effective NMCP leadership in generating and using malaria information.” This four-day “cross-fertilization” meeting brought together MRAs and NMCP staff from the Democratic Republic of the Congo (DRC), Liberia, Madagascar, and Mali to discuss approaches and experiences in providing effective support to NMCPs. The meeting objectives were as follows:

  • Understand MTA in-country activities and how they link with NMCP needs in SME
  • Review country strategies to support NMCPs and identify best practices
  • Develop a platform to optimize and utilize team expertise across countries

This report summarizes the meeting, synthesizes best practices and lessons learned from providing technical support to NMCPs and collaborating with stakeholders, and presents a strategy for continued cross-country exchange of expertise and experience.

A Menu of Tools for Data Quality Assessment and Review

A Menu of Tools for Data Quality Assessment and ReviewRobust systems are essential to track progress toward health objectives, such as the United Nations Sustainable Development Goals, and to support evidence-based decision making. Different approaches may be followed, to assess and improve data quality and data management and to make informed decisions for planning to improve quality and to achieve expected health outcomes.

This document presents a menu of options for data quality assessment and is meant to provide guidance on which approach would be the most suitable for the data and system to be assessed. The scope of the assessment and the depth of data to be collected will depend on the purpose of the assessment. Data quality assessments will focus on one or more dimensions of data quality, such as accuracy, completeness, reliability, timeliness, confidentiality, precision, and integrity.

Strengthening the Performance of Kenya’s Health Information System: Improvements in Data Quality and Use at the County Level

Strengthening the Performance of Kenya’s Health Information System: Improvements in Data Quality and Use at the County LevelTo shed light on how to strengthen HIS to meet the needs of the health sector, particularly by improving data quality and data use available for decision making, we studied the MEASURE Evaluation PIMA (MEval-PIMA) project’s efforts to strengthen the organizational, technical, and behavioral components of routine health information systems in Kenya through participatory approaches with the county health management teams (CHMTs). Although the context of this study is specific to Kenya, we aimed to learn from the processes used for HIS strengthening within regional units of the health sector.

In 2014, MEVAL-PIMA undertook an assessment of M&E capacity in CHMTs from 17 counties using the MEVAL-PIMA-developed Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) (https://www.measureevaluation.org/pima/m-e-capacity). The assessment sought to identify the status of behavioral, organizational, and technical capacity in the use of data for programming. Baseline scores were used to identify priorities and inform interventions and to establish a benchmark for measuring progress in project M&E. Shortly after the baseline assessments, changes in funding priorities led MEVAL-PIMA to shift their work to a subset of 10 counties identified as high-priority in the areas of reproductive health, malaria, HIV/AIDS, or a combination of the three.

Because MEVAL-PIMA conducted baseline assessments in 17 counties but then ended up working in only 10 counties, a good opportunity arose to capitalize on these initial investments and study the effect over time in comparison and intervention counties. Thus, this study aimed to assess how MEVAL-PIMA-supported interventions affected changes in data quality and data use compared with the comparison county.

Exploring gaps in monitoring and evaluation of male engagement in family planning

Exploring gaps in monitoring and evaluation of male engagement in family planningBackground: Male engagement is becoming more common in family planning (FP) strategies and interventions, yet effective monitoring and evaluation (M&E) of this approach lags. This review sought to understand how male engagement in FP is defined, identify gaps in M&E of male engagement and make recommendations.

Methods: We conducted key informant interviews and a desk review of peer-reviewed articles and gray literature, including national FP strategies and policies.  We then facilitated an online forum with experts in the field of male engagement in FP to provide feedback on our proposed indicators for male engagement in FP to reach consensus on and validate key indicators.

Results: Although there is no universal definition of male engagement in FP, the most common definition is the inclusion of men in FP programming as FP clients, supportive partners, and agents of change. The most common approach was engaging men as clients exclusively, followed by engaging men as partners. Few papers reported on programs that engaged men across the full spectrum of the definition. There’s significant variation in the degree to which male engagement in FP is included in M&E, planning, and approaches. Few programs reported findings disaggregated by sex and by contraceptive method, making it difficult to determine the effect of programming on male use of methods. There is a dearth of indicators for measuring male engagement in FP in national strategies and policies. Other gaps are a lack of core indicators for male engagement, qualitative indicators, and indicator reference sheets for many commonly used indicators. Among over 100 indicators being used to monitor and evaluate male engagement in FP, 15 key indicators were identified and validated, with accompanying guidance.

Conclusions: As programming for male engagement in FP increases, coordinated efforts should be made to improve the systems that collect, analyze, and use data.

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