Evaluating structural interventions in public health: Challenges, options and global best-practice

Pronyk, P; Schaefer, J; Somers, MA; Heise, L. Structural Approaches in Public Health, 2013; https://www.routledge.com/products/9780415500869

Structural interventions in public health pose a host of challenges to evaluation. They operate through indirect pathways and are often complex and cross-sectoral. Programmes may require extended time horizons for health effects to be observed, and their delivery at the level of communities, institutions or populations carries major implications for sampling. Finally, issues of ethics, logistics and/or political feasibility may limit opportunities for random assignment and the use of experimental designs.

However, high quality evaluation is vital. Too often, structural interventions are under-developed and under-researched because rigorous evaluation has seemed beyond the scope of established tools and methods. The range of complimentary methods that assist the design of evaluations for structural interventions in public health include:

  • adequacy assessments
  • plausibility evaluations
  • randomized experiments that include stepped-wedge designs

Case studies demonstrating methods include The Multi-Country Evaluation of Integrated Management of Childhood Illness (MCE-IMCI), Avahan – The India AIDS Initiative and the Intervention with Microfinance for AIDS & Gender Equity (IMAGE Study).

Many challenges can be overcome through:

  • adequate planning
  • choosing an appropriate comparison group
  • setting realistic evaluation objectives
  • optimizing the design
  • defining clear impact pathways
  • using an appropriate mix of methods
  • drawing upon perspectives and expertise from partners outside the health sector

Mixed-methods approaches offer particular strengths in order both to assess impact and to document implementation to facilitate the design of effective policies and programmes.

This book (not open access) was judged a CHOICE Outstanding Academic Title for 2014.

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