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Where Have We Come From?


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A brief history of earlier contributions to M&E

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Where Have We Come From?

  1. 1. Where Have We Come From? A Brief History of Earlier Contributions to M&E Jane T. Bertrand Director, Center for Communication Programs Johns Hopkins University Collaborator on Evaluation: 1991-2001
  2. 2. MEASURE Evaluation <ul><li>Evolved from the rich history of family planning program evaluation </li></ul>
  3. 3. A quick review of the evolution of family planning programs <ul><li>1950-60s: Asia takes the lead in promoting FP </li></ul><ul><li>1960s: Latin America develops IPPF affiliates </li></ul><ul><li>1970s: growing acceptance of FP in Asia, LAC </li></ul><ul><li>1980s: widespread expansion of FP </li></ul><ul><li>1990s: funding shifts toward Africa </li></ul><ul><li>Recognition that the “medical model” won’t reach sufficient numbers gave birth to: </li></ul><ul><ul><li>Community based distribution, social marketing </li></ul></ul>
  4. 4. Rationale for FP and implications for program evaluation <ul><li>Demographic (especially in Asia) </li></ul><ul><ul><li>Focus on “achieving numbers” </li></ul></ul><ul><li>Catalyst to economic development </li></ul><ul><ul><li>Debates over contribution of FP vs. economic development to lowering fertility </li></ul></ul><ul><li>Maternal/child health </li></ul><ul><ul><li>Desire to show effects of FP on maternal and infant mortality/morbidity </li></ul></ul>
  5. 5. Factors driving M&E: family planning versus HIV/AIDS <ul><li>Unique to FP in the early days: </li></ul><ul><ul><li>Explore and show latent demand: KAP surveys </li></ul></ul><ul><ul><li>Inform the debate on FP programs vs. socio-economic development </li></ul></ul><ul><ul><li>Demonstrate benefits for MCH </li></ul></ul><ul><ul><li>Train researchers from developing countries to drive FP movement worldwide </li></ul></ul><ul><ul><ul><li>Strong demography programs, scholarships </li></ul></ul></ul>
  6. 6. Factors driving M&E: c ommon to FP (then) and HIV/AIDS (now): <ul><li>Ample funding </li></ul><ul><li>Need to “demonstrate numbers” </li></ul><ul><li>Need to justify spending to Congress </li></ul>
  7. 7. Growth of programs led to need for data and management tools <ul><li>K-A-P surveys to measure/track response to FP </li></ul><ul><li>World Fertility Surveys 1973-1984 </li></ul><ul><li>Contraceptive prevalence surveys (CDC) </li></ul><ul><ul><li>Started in 1975: El Salvador </li></ul></ul><ul><li>Demographic and Health Surveys (DHS) </li></ul><ul><ul><li>Started in 1985 in El Salvador; 226 surveys total </li></ul></ul><ul><li>Efforts to launch computerized MIS systems </li></ul><ul><ul><li>To track service statistics </li></ul></ul>
  8. 8. Need for data between DHS surveys <ul><li>Service statistics – often problematic: </li></ul><ul><ul><li>Performance targets led to inflated statistics </li></ul></ul><ul><ul><li>“Users” – extremely difficult to capture without duplication </li></ul></ul><ul><li>Couple-years of protection (CYP): </li></ul><ul><ul><li>Developed in 1980s, used widely in 1990s </li></ul></ul><ul><ul><li>Discredited after Cairo </li></ul></ul><ul><ul><li>Not client-centered, too narrow/demographic </li></ul></ul>
  9. 9. USAID funding for family planning program evaluation <ul><li>1970s: </li></ul><ul><ul><li>U of Chicago: FP evaluation </li></ul></ul><ul><ul><li>CDC: contraceptive prevalence surveys, MIS </li></ul></ul><ul><li>1980s: </li></ul><ul><ul><li>Operations research (Columbia Univ, Population Council, URC, Tulane) </li></ul></ul><ul><ul><li>Westinghouse/Macro International for DHS </li></ul></ul><ul><ul><li>CDC: reproductive health, young adult surveys </li></ul></ul>
  10. 10. USAID’s interest in an “evaluation project” in the early 1990s <ul><li>FP existed in most developing countries </li></ul><ul><li>Need to demonstrate effects on reducing fertility </li></ul><ul><li>Need for better management tools </li></ul><ul><ul><li>Desire for consistent indicators </li></ul></ul><ul><ul><li>Desire for annual measurements </li></ul></ul><ul><li>Desire to advance the field of program evaluation </li></ul><ul><ul><li>New tools, improved methodologies/applications </li></ul></ul>
  11. 11. The EVALUATION Project: 1991-97 <ul><li>Prime: UNC at Chapel Hill </li></ul><ul><ul><li>Director: Dr. Amy Tsui </li></ul></ul><ul><ul><li>CTO: Dr. Krista Stewart </li></ul></ul><ul><li>Subs: Tulane University, The Futures Group </li></ul><ul><li>Focus: entirely on family planning </li></ul><ul><li>Implication of university involvement: </li></ul><ul><ul><li>“Strong science” coupled with strong TA </li></ul></ul><ul><ul><li>Strengthened evidence base (manuals, articles) </li></ul></ul>
  12. 12. Key achievements of the EVALUATION Project <ul><li>Advanced the health facility survey concept </li></ul><ul><ul><li>Developed method to link health facility with household surveys </li></ul></ul><ul><li>Developed spatial analysis tools for health program evaluation and planning </li></ul><ul><li>Sought methods to control the bias of targeted resources in assessing program impact </li></ul>
  13. 13. Key achievements of the EVALUATION Project <ul><li>Provided TA in selected countries: </li></ul><ul><ul><li>India, Morocco, Paraguay, Tanzania, Uganda </li></ul></ul><ul><li>Developed consensus among CAs on indicators for all areas of FP through working groups: </li></ul><ul><ul><li>Training, IEC, commodities, </li></ul></ul><ul><ul><li>Policy, service delivery, operations research, management </li></ul></ul><ul><li>Produced several manuals ( Indicators for FP Program Evaluation) </li></ul>
  14. 14. Standing joke: <ul><li>“The EVALUATION Project doesn’t evaluate programs” </li></ul><ul><li>Not a POP-Tech (evaluating other CA programs) </li></ul><ul><li>Evaluations conducted with implementing agencies to develop/test tools, build capacity </li></ul>
  15. 15. The MEASURE Evaluation Project: 1997-2003 <ul><li>Partners: </li></ul><ul><ul><li>Prime: UNC </li></ul></ul><ul><ul><li>Subs: JSI, Macro, Tulane </li></ul></ul><ul><li>Directors: </li></ul><ul><ul><li>Dr. Amy Tsui (1997-99) </li></ul></ul><ul><ul><li>Dr. Ties Boerma (1999-2002) </li></ul></ul><ul><ul><li>Dr. Si â n Curtis (2002-present) </li></ul></ul>
  16. 16. The MEASURE Evaluation Project continued to advance the field <ul><li>Developed methodologies for measuring: </li></ul><ul><ul><li>Sustainability, quality of care (QIQ) </li></ul></ul><ul><ul><li>PLACE methodology (HIV hot spots) </li></ul></ul><ul><ul><li>Maternal mortality from a census </li></ul></ul><ul><ul><li>Capacity in the health sector </li></ul></ul><ul><li>Developed widespread consensus/African network to harmonize approach to HIV evaluation </li></ul>
  17. 17. Acknowledgements <ul><li>Reviewing and contributing to this presentation: </li></ul><ul><ul><li>Dr. Amy Tsui </li></ul></ul><ul><ul><li>Dr. Si â n Curtis </li></ul></ul><ul><li>Credits for photos: </li></ul><ul><ul><li>Photoshare, Center for Communication Programs </li></ul></ul>