From clean birth kits to call centres: making sense of diverse efforts for a common purpose
published 31 March 2015
published 31 March 2015
The first step in our evaluation is to make sense of the diverse set of innovations the foundation supports. We call this exercise a “characterisation”, a detailed description of the innovation, what is supposed to change and where in order to save lives. We can then compare what is supposed to happen to what is actually happening and draw lessons from the comparison. Characterisations can also be used by donors and policy-makers to think strategically and identify where their efforts should be focused when funding complex interventions.
The foundation implements its maternal and newborn health strategy by funding around 50 diverse innovations through its projects in Ethiopia, Northeast Nigeria and Uttar Pradesh, India. The innovations vary considerably, from training frontline workers to detect and manage newborn sepsis, to building a team of taxi drivers who transport women to health facilities for childbirth or in the event of an obstetric complication.
The foundation has a Theory of Change which states that the innovations will lead to enhanced interactions between frontline workers and service users and that those enhanced interactions will lead to higher coverage of evidence-based life-saving interventions. These may be caesarean sections for an obstetric complication, Tetanus Toxin vaccination during antenatal care or antibiotics for postnatal sepsis.
We worked collaboratively with the projects implementing innovations in each country. Through discussions with project staff, we developed a common framework to describe how the innovations work and how they are expected to impact on maternal health and newborn survival. The characterisations framework is based on five questions:
Once we’d completed this process for an innovation, we mapped it onto a table to show the detailed breakdown of how the foundation’s maternal and newborn health strategy is operationalised across time and geography and how the anticipated pooled effect of their innovations would contribute to maternal health and newborn survival. The common framework means that projects could see how their work contributes to the broader strategic efforts of the foundation, something they were keen to find out.
The characterisations are essential for IDEAS, so we know exactly what we are evaluating and whether anticipated changes match the changes we observe. They are also of use to the foundation, to see how their maternal and newborn health funding strategy is implemented in Ethiopia, Northeast Nigeria and Uttar Pradesh, India. This is also a way of highlighting gaps and areas of focus in the implementation of the strategy and may thus contribute to operational or strategic decision-making.
The generosity of project personnel who gave their time and energy to help with this work and even arranged field visits to help us understand how their innovations worked is greatly appreciated. The characterisations took time and self-evidently, without their engagement the task could not have been completed.