This paper systematically evaluates the performance of 234 variants of DDM methods in three different validation environments where the researchers knew or had strong beliefs about the true level of completeness of death registration. Using these datasets, it identified three variants of the DDMs that generally perform the best. It also found that even these improved methods yield uncertainty intervals of roughly one-quarter of the estimate. Finally, it demonstrates the application of the optimal variants in eight countries. In its conclusion, it notes that partial vital registration data in measuring adult mortality levels and trends still has a role, but such results should only be interpreted alongside all other data sources on adult mortality and the uncertainty of the resulting levels, trends, and age-patterns of adult death considered.
Monitoring equity and research policy
Globally, concerted efforts and substantial financial resources have gone toward strengthening national monitoring and evaluation (M&E) systems for HIV programmes. This paper explores whether those investments have made a difference in terms of data availability, quality and use for assessing whether national programmes are on track to achieve the 2015 Millennium Development Goal of halting and reversing the global HIV epidemic. It found a marked increase in the number of countries where the prerequisites for a national HIV M&E system are in place, as well as in human resources devoted to M&E at the national level. However, crucial gaps remain, such as available M&E data and data quality assurance. The extent to which data are used for programme improvement is difficult to ascertain. There is a potential threat to sustaining the current momentum in M&E, as governments have not committed long-term funding and current M&E-related expenditures are below the minimum needed to make M&E systems fully functional. Nonetheless, essential data gaps will need to be filled urgently to provide quality data to guide future decision making.
This study questions the assumption that the measurement of health inequalities is a value-neutral process that provides objective data that is then interpreted using normative judgments about whether a particular distribution of health is just, fair or socially acceptable. The study discusses five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Overall, it found that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, the study urges researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. Policymakers and other consumers of health inequalities data should pay close attention to the measures on which they base their assessments of current and future health policies.
The economic benefits of healthcare research require study so that appropriate resources can be allocated to this research, particularly in developing countries. This study took the form of a systematic review to identify the methods used to assess the economic impact of healthcare research, and the outcomes. The initial search yielded 8,416 articles, of which 18 articles were included in the analysis, as well as eleven other reports. It found that the outcomes assessed as healthcare research payback included direct cost-savings, cost reductions in healthcare delivery systems, benefits from commercial advancement, and outcomes associated with improved health status. The study found that different methods and outcomes can be used to assess the economic impacts of healthcare research. However, none of the research from low- and middle-income countries had evaluated the economic return of research. The authors recommend a consensus on practical guidelines at international level in order to build capacity, arrange for necessary informative infrastructures and promote necessary skills for economic evaluation studies in developing countries.
This paper begins by introducing the scope of and rationale for engaging in advocacy work as part of development interventions. It notes that effective advocacy can prove to be a very powerful and empowering strategy, and contrasts this with ineffective advocacy strategies, which can be hugely wasteful of time and resources and leave stakeholders feeling bewildered, disempowered or uninterested. It then focuses on the issue of monitoring and evaluating (M&E) these efforts – offering reasons why and when these processes should be planned and implemented, what’s involved, and who should be engaged in the process. The paper discusses organisational approaches to M&E of a number of agencies in the development sector, like Oxfam and the Institute of Development Research (IDR), and offers tools and methods for M&E of advocacy projects in international and national non-governmental organisations.
Country teams from ten low- and middle-income countries (LMICs), including Tanzania, participated in the development and testing of a questionnaire to assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. The study found that internal consistency (Cronbach's alpha) for sets of related items was very high, ranging from 0.89 to 0.96, suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures. Assessments using convergent measures also showed significant associations. In conclusion, while no direct comparison can be made to a comparable questionnaire, the findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.
Country teams from ten low- and middle-income countries, including Tanzania, participated in the development, translation, pilot-testing and administration of a questionnaire designed to measure health-care providers' views and activities related to improving their clinical practice and their awareness of, access to and use of research evidence, as well as changes in their clinical practice that they attribute to particular sources of research evidence that they have used. The study found that the questionnaire had high internal consistency, with Cronbach's alphas between 0.7 and 0.9 for 16 of 20 domains and sub-domains (identified by factor analyses). Cronbach's alphas were greater than 0.9 for two domains, suggesting some item redundancy. In conclusion, the analysis points to a number of strengths of the questionnaire – high internal consistency (reliability) and good face and content validity – but also to areas where it can be shortened without losing important conceptual domains.
The act of telling a story is a deceptively simple and familiar process, a way to evoke powerful emotions and insights. By contrast, working with stories in organisational settings – to aid reflection, build communities, transfer practical learning or capitalise experiences – is more complicated. This guide is designed to create story-telling skills and confidence. It provides ideas about development cooperation contexts in which stories can be an effective communication tool. The authors argue that story telling is not suitable for every situation. Methodologies should be selected by practitioners with due care to the wider working context and intention. Some methods, for example the systemic introduction of story into core organisational processes such as evaluation, need patience and management backing over a long period, for the right approach to be developed through trial and error.
This article explores the use of multimedia to enhance development enquiry and analysis, and the design and implementation of process interventions aimed at poverty alleviation in sub-Saharan Africa. It discusses some important interventions in Africa: the Catalyzing Access to ICT in Africa (CATIA) programme; the LINK Centre (University of the Witwatersrand); the Acacia Initiative; the African Information Society Initiative (AISI); the APC (Association for Progressive Communications); and Research ICT Africa. Despite these interventions, Africa still faces problems of access and use of these interventions and services, especially among poor and vulnerable people. The areas of weakness include: poor performance in the telecommunications sector; little e-access and use in small and medium enterprises; and absence of an equitable system of intellectual property rights that is friendly to developing countries in sub-Saharan Africa. As a result the author observes barriers to access often expensive, modern technologies.
The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. According to this article, the target is critically off track. Despite difficulties inherent in measuring maternal mortality, it notes that interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV and AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. The article analyses historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa.