This presentation shows how the Belgian Red Cross uses the principles of Evidence-Based Practice to support its humanitarian and development aid activities.

1. 1
Evidence-Based Practice
to Support Humanitarian and
Development Aid Activities
Centre for Evidence-Based Practice (CEBaP) of the Belgian Red Cross
Hans Van Remoortel (Coordinating Researcher CEBaP)
On behalf of:
Emmy De Buck (Manager CEBaP)
Philippe Vandekerckhove (CEO Belgian Red Cross)
Briefing session
ICRC Analysis & Evidence Week 2021
2 december 2021 (2.30-3.30 PM)

2. Key figures of the Belgian Red Cross-Flanders
1,600 employees
• Blood Service
• Humanitarian Services
• Central Supporting Services
13,000 volunteers (Flanders)

3. Key figures of the Belgian Red Cross-Flanders
1,600 employees
• Blood Service
• Humanitarian Services – International Cooperation Department
• Central Supporting Services
13,000 volunteers (Flanders)

4. Belgian Red Cross-Flanders: International Operations
4
REASON TO EXIST
International Operations wants to help sister national
societies by building their capacity to carry out
impactful activities and by providing surge capacity in
times of disaster.
VISION
We want to be the reference point for delivering
evidence-based expertise & support in first aid, blood
programs, disaster preparedness and hygiene
promotion, making optimal use of digital learning.

5. 5
Burundi
Tanzania
Rwanda
South-Africa
Mozambique
Malawi
Eswatini
Lesotho
Uganda
Zimbabwe
Zambia
Belgian Red Cross-Flanders: International Operations
Supported programs 2021
WASH
First Aid Education &
Delivery
Blood Banking Disaster
Preparedness &
Response

6. 6
Social activities
EVIDENCE-BASED
DECISION-MAKING
Blood collection and banking
International disaster and development aid
First aid education

7. 7
 For many practical questions, there are often no clear-cut answers
 Different experts, manuals, websites may have different opinions
 It is often unclear which intervention is most (cost-)effective, safest
 By relying solely on expert opinion, there is always a risk of choosing
harmful/bad/ineffective techniques or practices
Why do we need scientific evidence?

8. ?
Example: Dr. Spock
✚ Dr Spock advised millions of readers that babies should sleep
on their tummies (1946-1988)

9. Example: Dr. Spock
9
Gilbert et al. 2005; Int J
Epidemiol:
Prone vs supine position
1

10. Example: Dr. Spock
 We now know that this advice led to the cot deaths of tens of thousands
of infants
 The opinion of 1 expert can have big consequences…
Number of cot deaths in The Netherlands

11. What lessons can we learn from this example?
Main lesson: Theories about
‘what works’ should be tested
through systematic observations in humans
Failure to do so may lead to us doing more harm than
good

13. Centre for Evidence-Based Practice (CEBaP)
13
cebap@rodekruis.be
www.cebap.org
www.twitter.com/CEBaP_Evidence
9 Researchers
- PhD in biomedical/rehabilitation sciences, bioscience engineering or biology
- EBP/EBM methodologists
- Biostatistics
Emmy De Buck (Manager)
Niels De Brier
Jorien Laermans
Irvin Kendall
Vere Borra
Hans Scheers
Bert Avau
Evy Verbueken
Hans Van Remoortel

14. 14
Centre for Evidence-Based Practice (CEBaP)
Blood
Services
Humanitarian
Services
Scientific support by CEBaP
Methodological
support PMER
(Type A)
Systematic
Review (Type B)
Primary
Research (Type C)
Evidence-Based
Guideline (Type B)
National International

15. Blood Service
Type A
Type B
Type C
Effectiveness
Effectiveness
Cost-Effectiveness
Cost-Effectiveness
Platelets Donors First aid education
& hygiene promotion
First Aid assistance
& Disaster
preparedness
Humanitarian Services
Methodological support operational activities (PMER)
(time spent in 2020: 3%)
Systematic reviews & Evidence-Based Guidelines
(time spent in 2020: 89%)
Primary research (e.g. randomized controlled trial)
(time spent in 2020: 8%)
Research strategy Belgian Red Cross

16. Narrative reviews vs Systematic reviews
Traditional narrative review Systematic review
Broadly describing the ‘state of the art’ of a
research field
Specific research question
Unclear methods Explicit methods
‘Cherry picking’ evidence All the evidence
Subjective Objective
Hypothesis confirming
Supporting clinical decision making &
designing new research

17. Evidence-based guideline
 32 items organized into 6 quality domains
1. Scope and purpose
2. Stakeholder involvement
3. Rigour of Development
4. Clarity of presentation
5. Applicability
6. Editorial independence

18. Evidence-based guideline – rigour of development
 Systematic methods were used to search for evidence
 The criteria for selecting the evidence are clearly described
 The methods for formulating the recommendations are clearly
described
 There is an explicit link between the recommendations and the
supporting evidence

19. Evidence-Based Practice principles
Best available
scientific evidence
Expert input +
operational experience
Preferences and interest
of the target group

20. African First Aid Materials
Best available
scientific evidence
Expert input +
operational experience
Preferences and interest
of the target group
264 evidence reviews
Search strategy expanded with African
databases (Afrolib and African Index
Medicus)
+ focus on studies performed in Africa
Centre for
Evidence-Based Practice
Target group = African population
International Operations
Multidisciplinary expert panel of
11 African experts
Panel of external experts

21. 21
Evidence Ecosystem
https://magicevidence.org/

22. 22
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence Ecosystem
Adapted from magicevidence.org

23. 23
Evidence-Based Practice to Support
Humanitarian and Development Aid Activities:
the example of hygiene promotion

24. 24
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – hygiene promotion
Adapted from magicevidence.org

25. 25
 We conducted a Campbell Mixed Method Systematic review to show:
Evidence-Eco System – hygiene promotion
> which promotional approaches are
effective to change sanitation and
handwashing behaviour in LMIC
(n=42), and
> which implementing factors affect
the success or failure of such an
intervention (n=28).
De Buck et al., 2017. Campbell Library
4. Data extraction
3. Selection of articles
2. Developing a search strategy
1. Defining research question
5. Quality assessment
6. Data synthesis

26. 26
Evidence-Eco System – hygiene promotion
De Buck et al., 2017. Campbell Library

27. 27
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – hygiene promotion
Adapted from magicevidence.org

28. Evidence-Eco System – hygiene promotion
28
 Target group evidence dissemination
> Lay people
> Volunteers
> Other Red Cross Societies or NGOs
> Academic Institutions
> Funding or Governmental Bodies

29. Evidence-Eco System – hygiene promotion
29
 Dissemination systematic review via:
> 2 face-to-face stakeholder meetings
Development practitioners and
consultants (Red Cross
UK/Malawi/Netherlands/Philippin
es, WaterAid, Oxfam, WSUP,
Helvetas)
Policy makers (IFRC/ICRC/World
Bank)
Topic expert (LSHTM)
Donors (WSSCC/3ie/Belgian Red
Cross)

30. Evidence-Eco System – hygiene promotion
30
 Dissemination systematic review results via:
> Policy brief

31. Evidence-Eco System – hygiene promotion
31
 Dissemination systematic review results via:
> Online sources (blog, webinar, websites, social media)

32. Evidence-Eco System – hygiene promotion
32
 Dissemination systematic review results via:
> Conferences
Oral presentation @ Global Evidence Summit (Cape Town, 2017)
Poster presentation @ Water, Engineering and
Development Centre (WEDC) (Loughborough University,
UK, 2017)

33. Evidence-Eco System – hygiene promotion
33
 Dissemination systematic review results via:
> Peer-reviewed publications

34. 34
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – hygiene promotion
Adapted from magicevidence.org

35. Evidence-Eco System – hygiene promotion
35
 Incorporating systematic review results in Belgian Red Cross WASH
programs
> Community involvement
> Adding elements of psychosocial theory
> Barriers and facilitators of implementation

36. 36
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – hygiene promotion
Adapted from magicevidence.org

37. Evidence-Eco System – hygiene promotion
37
 Monitoring & evaluation output, outcome and impact indicators in Belgian
Red Cross WASH programs
 Methodological support
> Participants & setting (sample size calculation)
> Data management & (comparative) statistical analysis (baseline-midline-endline)
27
3.9 7.9
18.8
2.6 4.8
0
20
40
60
80
100
<5 years
(p = 0.013)
≥5 years
(p = 0.105)
Overall
(p = 0.003)
Diarrhea
prevalence
(%)
Karongi Rutsiro
18.2
48.3
0.2
26.8
0 2.3 4.3
1.8
63.8
2.9
23.9
0.2
7.1
0.4
0
20
40
60
80
100
Private Public Pump River Rain Swamp Other
Main
water
source
for
drinking
and
cooking
(%)
Karongi Rutsiro
Indicator “Diarrhea prevalence” in Karongi vs Rutsiro
Indicator “Use of an improved water source” in Karongi
vs Rutsiro (p=.517)

38. 38
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – hygiene promotion
Adapted from magicevidence.org

39. Evidence-Eco System – hygiene promotion
39

40. Evidence-Eco System – hygiene promotion
40
Design Cluster randomized controlled trial
Location Buhigwe district, Kigoma Region, Tanzania
Collaboration Tanzania Red Cross Society
Research
objectives
1. Determine the effectiveness of two add-on software interventions for
improving hand washing behavior
2. Evaluate the effects of these add-on interventions on latrine use, health, and
the available hardware facilities
3. Calculate the cost-effectiveness
Population A random sample of 1500 HH was selected from a total of 4787 households in the
area
Timeline April 2018 – May 2021
Dockx et al., 2019. Effect of Contextualized Versus Non-Contextualized
Interventions for Improving HandWashing, Sanitation, and Health in Rural
Tanzania: Study Design of a Cluster Randomized Controlled Trial

41. 41
Hardware +
CLTS/PHAST +
mini-RANAS
Hardware + CLTS/PHAST + placebo
Hardware +
CLTS/PHAST +
RANAS
 Risks, Attitudes, Norms, Abilities, Self-regulation (RANAS)
Evidence-Eco System – hygiene promotion
1. Identify possible behavioural factors
2. Measure the behavioural factors
identified and determine those
steering the behavior
3. Select corresponding behavior
change techniques
4. Develop appropriate behavior

42. 42
Evidence-Based Practice to Support
Humanitarian and Development Aid Activities:
the example of first aid education

43. Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
43
Evidence-based guideline development: Basic First Aid guideline (adults/children)
Systematic Review about effectiveness first aid training
Operational Red Cross Staff
Evidence-based guideline:
translation into evidence-
based training materials, i.e.
first aid blended learning
training (FABL)
Target group
Dissemination to local
trainers in BRC’s partnering
countries
Training of local trainers
Implementation of different training
packages in BRC’s African partnering
countries (e.g. BFA, FABL)
Data collection and analysis on first
aid knowledge, skills, and helping
behavior
Field trial (RCT) effectiveness
FABL program on educational
outcomes
Actors
and
flow of
data

44. 44
Evidence-Based Practice to Support
Humanitarian and Development Aid Activities:
the example of blood banking

45. Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
45
Scoping review to identify the best available evidence and evidence gaps on blood
donation and safety among African blood donors.
Operational Red Cross Staff
Evidence Gap Map and
discussion future research
Target group
Various stakeholders in blood
transfusion services (local Red
Cross, National Blood
Transfusion Services, etc)
Strategies to improve quality
and quantity of blood supply
Data collection and analysis on donor
recruitment, retention, blood safety, etc.
Database analysis on blood collections
in and around a refugee camp in
Tanzania
Field trial (RCT) effectiveness
recruitment/retention
strategies on blood
supply/safety?
Actors
and
flow of
data

46. 46
Evidence
synthesizers
Evidence
disseminators
Evidence
implementers
Evidence
evaluators
Evidence
producers
Actors
and
flow of
data
Evidence-Eco System – actors and flow of data
Adapted from magicevidence.org

47. 47
Evidence-Eco System – actors and flow of data
Actors
and
flow of
data
Common
methods
Culture to
promote
EBP
Universal
standards
 Recruitment scientific/STEM profiles
 Basic training in EBP via blended learning (E-learning + classroom
session)
 Monthly journal clubs
 Methodological charter CEBaP (https://www.cebap.org/methodology/methodological-
charter/)
 AGREE-II: evidence-based guideline
 Cochrane: systematic review
 GRADE (Grading of Recommendations Assessment, Development and Evaluation):critical
appraisal + translation evidence -> recommendations via EtD framework)
 ISO9001:2015 certification (evidence summaries,
systematic reviews)
 Use of
 Quality management system
 Quality manual
 Standard Operating Procedures (SOPs)

48. 48
 The EBP principles are used to successfully implement the International
Operations of the Belgian Red Cross on hygiene promotion, first aid
education and blood banking at the different levels of the Evidence
Ecosystem
 This evidence-based approach further supports the quality of BRC
research projects, and will result in more (cost-)effective interventions,
ultimately benefitting the beneficiaries of these projects/programs.
Conclusions

49. Acknowledgments
www.cebap.org info@cebap.org
@CEBaP_evidence CEBaP
49
 Research Foundation Belgian Red Cross
 Colleagues from CEBaP and International Cooperation Department

50. Questions? Remarks? Suggestions?
www.cebap.org info@cebap.org
@CEBaP_evidence CEBaP
50