Structural Interventions: A Proposed Agenda


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Presented by MEASURE Evaluation Deputy Director Jim Thomas, MPH, PhD.

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  • Structural Interventions: A Proposed Agenda

    1. 1. Structural Interventions: A proposed agendaJames Thomas, MPH, PhDDepartment of EpidemiologyDeputy Director, MEASURE EvaluationUniversity of North Carolina
    2. 2. What I’ll cover What a structural intervention is The measurement challenges The lure of the magic bullet Why pursue structural interventions? The example of women’s land rights A proposed agenda
    3. 3. Examples of structural interventions • Removing the pump handle • Sewers • Protected & purified water • Iodized salt • Vehicle air bags • Building regulations • Tobacco control • Closing bath houses
    4. 4. Structural interventions (behavioral) (structural) High Personal Volition LowHIV “Have fewer partners” Alleviate povertyDrugs “Just say no” Fight drug cartelsObesity “Exercise more” Walkable neighborhoods
    5. 5. Proximal and Distal D C B A
    6. 6. Proximal and Distal L J C O U Z A M E R X B Y F
    7. 7. The lure of the magic bullet • Proximal • Few other variables • Mechanistic • Quantifiable • Clear counterfactual
    8. 8. The lure of the magic bullet
    9. 9. Why pursue structural interventions? The high road • True to public health • Human rights
    10. 10. Why pursue structural interventions? The pragmatic road • Always cycling against traffic if context not addressed • Magic bullets require systems to develop and distribute them • Hitting many birds with one stone
    11. 11. Land rights as a structural factor Less able to Loss of home Loss of control remain in over one’s life treatmentLack of Loss of income- Try income Less condomland rights generating alternatives use property Inability to grow More sex Loss of land partners food
    12. 12. Exploring data on land rights and HIV Reviewed literature Reviewed datasets Interviewed land rights organizations
    13. 13. Literature Land rights and HIV: qualitative and anecdotal More proximal, more evidence (e.g., conditional cash transfer)
    14. 14. Datasets
    15. 15. Datasets Aligned with land rights or HIV Modest potential for supplementing existing data
    16. 16. Land rights organizations
    17. 17. Land rights organizations Preliminary draft
    18. 18. International Justice Mission (IJM) Data collected systematically from all clients  Quantitative and qualitative  Computerized Study of property grabbing  Baseline (2005- 2007)  Follow-up (2012)  2nd follow-up (2015)
    19. 19. Land rights . . . . . . . . . . . . . . . and HIV Silos • Professions • Thinking • Funding
    20. 20. The silo gap results in… • Fewer shared insights • Fewer shared resources • Lack of scientific evidence • Lack of interventions • No M&E • Unresolved forces of transmission
    21. 21. A proposed agenda1. Bring people together Break down silos Leverage existing opportunities
    22. 22. A proposed agenda2. Document what we know Inventory the evidence on structural interventions Identify structural components of magic bullets Establish an on-line clearinghouse Write guidance on implementation Propose agendas
    23. 23. A proposed agenda3. Build on what we have (example) Help IJM analyze their data Advise IJM on additional data to collect Collect data to complement IJM’s
    24. 24. A proposed agenda4. Use non-linear approaches Crowdsourced science
    25. 25. A proposed agenda4. Use non-linear approaches Crowdsourced science Agent-based modeling Identify data to collect Model costs and benefits
    26. 26. Thanks USAID & PEPFAR Katherine Tumlinson Megan Clarke Evette Cordoba Carolina Mejia ICRW Photo credit: McKay Savage
    27. 27. MEASURE Evaluation is a MEASURE project funded by theU.S. Agency for International Development and implemented bythe Carolina Population Center at the University of North Carolinaat Chapel Hill in partnership with Futures Group International,ICF Macro, John Snow, Inc., Management Sciences for Health,and Tulane University. Views expressed in this presentation do notnecessarily reflect the views of USAID or the U.S. government.MEASURE Evaluation is the USAID Global Health Bureausprimary vehicle for supporting improvements in monitoring andevaluation in population, health and nutrition worldwide.