Abstract:
:Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Adams A,Sedalia S,McNab S,Sarker Mdoi
10.1093/heapol/czv053subject
Has Abstractpub_date
2016-03-01 00:00:00pages
267-75issue
2eissn
0268-1080issn
1460-2237pii
czv053journal_volume
31pub_type
杂志文章abstract::The burden of diarrhoeal disease remains high in the developing world. Community-based safe drinking water programmes are being promoted as cost-effective interventions that will help reduce this illness burden. However, the effectiveness of these programmes remains under-investigated. The primary argument of this pap...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czn017
更新日期:2008-11-01 00:00:00
abstract::Integrated Management of Childhood Illness (IMCI) has been adopted by over 80 countries as a strategy for reducing child mortality and improving child health and development. It includes complementary interventions designed to address the major causes of child mortality at community, health facility, and health system...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czh001
更新日期:2004-01-01 00:00:00
abstract::Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to addr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw101
更新日期:2017-02-01 00:00:00
abstract::This study compares the quality of services provided by public and private hospitals in Bangladesh. The premise of the paper was that the quality of hospital services would be contingent on the incentive structure under which these institutions operate. Since private hospitals are not subsidized and depend on income f...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/15.1.95
更新日期:2000-03-01 00:00:00
abstract::This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal pub...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx085
更新日期:2017-11-01 00:00:00
abstract::In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing result...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czq024
更新日期:2011-03-01 00:00:00
abstract::Community-based health insurance (CBHI) has gained popularity in many low- and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (200...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa135
更新日期:2020-12-02 00:00:00
abstract:OBJECTIVE:To estimate and compare the cost-effectiveness of selected interventions to reduce mother-to-child transmission (MTCT) of HIV in Mexico. METHODS:A spreadsheet-based model was used to examine five scenarios, each estimated using both zidovudine (ZDV) and nevirapine (NVP). Scenarios differ according to coverag...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czg035
更新日期:2003-09-01 00:00:00
abstract::Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv070
更新日期:2016-04-01 00:00:00
abstract::Home visiting programmes are increasingly recognized as one of the most effective interventions to improve child health and development in low-income settings. However, the best platforms to deliver such programmes remain unclear. We conducted a randomized controlled trial to test the relative effectiveness of child d...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa195
更新日期:2021-01-26 00:00:00
abstract::There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and ...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czm048
更新日期:2008-03-01 00:00:00
abstract::Since 2001 substantial resources have been allocated to the reproductive, maternal, newborn and child health sector (RMNCH) in Pakistan. Many new programmes have been started and coverage of some existing programmes has been extended to un-served and rural areas. Despite these efforts the Millennium Development Goals ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx021
更新日期:2017-07-01 00:00:00
abstract::In Papua New Guinea, investment by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has played an important role in scaling up the response to HIV and tuberculosis (TB). As part of a series of case studies on how Global Fund-supported programmes interact with national health systems, we assess...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czq058
更新日期:2010-11-01 00:00:00
abstract::A decade after the first International Conference on Safe Motherhood, maternal mortality remains very high in most West African countries, even in capital cities. The detection of high risk pregnancies, known as the risk approach, during antenatal consultations has been the basis of most maternal and child health prog...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/15.1.11
更新日期:2000-03-01 00:00:00
abstract::It has been argued that targeting delivery of anthelmintics to school-children by taking advantage of the existing education infrastructure and administrative system can be one of the most cost-effective approaches in minimizing the intensity of infections with both schistosomiasis and major intestinal nematodes in ma...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/13.4.384
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the k...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt096
更新日期:2015-02-01 00:00:00
abstract::Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs106
更新日期:2013-09-01 00:00:00
abstract::Facing escalating health care expenditures, the governments of countries with national health insurance programs are trying to control or even to reduce health care utilization. Little research has examined the effects of decreased health care utilization on health outcomes. Applying a natural experiment design to the...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr080
更新日期:2012-10-01 00:00:00
abstract::As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to dire...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx165
更新日期:2018-02-01 00:00:00
abstract::Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals. We undertook a multi-stage participatory process to identify priority research questions relevant to i...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czy079
更新日期:2018-11-01 00:00:00
abstract::This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the fr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czm007
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:We examine socio-economic status (SES) and geographic differences in willingness of respondents to pay for community-based health insurance (CBHI). METHODS:The study took place in Anambra and Enugu states, south-east Nigeria. It involved a rural, an urban and a semi-urban community in each of the two states....
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czp046
更新日期:2010-03-01 00:00:00
abstract::Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv138
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To estimate the cost-effectiveness of introducing hepatitis B vaccine into routine infant immunization services in Mozambique, which took place in the year 2001. METHODS:A decision analytic model was used to estimate the impact of hepatitis B vaccination. This model was developed for the WHO to estimate the ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czi006
更新日期:2005-01-01 00:00:00
abstract::This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of o...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/13.3.311
更新日期:1998-09-01 00:00:00
abstract::Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries und...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czl004
更新日期:2006-05-01 00:00:00
abstract::How do practitioners respond to the mental distress of HIV-affected women and communities? And do their understandings of patients' distress matter? The World Health Organization (WHO) along with advocates from the Movement for Global Mental Health (MGMH) champion a primary mental health care model to address burgeoni...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu092
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours ...
journal_title:Health policy and planning
pub_type: 历史文章,杂志文章
doi:10.1093/heapol/czq037
更新日期:2010-11-01 00:00:00
abstract::While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czi017
更新日期:2005-05-01 00:00:00
abstract::Despite efforts taken by the Government of India, mothers and newborns are excluded from the maternal and child health services, especially those in poorer and weaker sections of the society. Hence, we have utilized the most recent National Family Health Survey (NFHS-4) data to assess the socio-economic inequities in ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa020
更新日期:2020-06-01 00:00:00