The context for global health interventions and their evaluations has become more complex in the 21st century. Donor assistance for global health has increased dramatically in the last 15 years, and most of these resources are channeled through complex global health initiatives that target various health outcomes through a multitude of interventions, implemented by diverse partners in multiple countries and regions of the world. Rigorous evaluations are needed to assess the achievements of these initiatives and to justify and increase investments in them. Large-scale evaluations of complex global health initiatives are relatively new, and knowledge of how to improve such evaluations is needed.
Our recent experiences have repeatedly exposed the challenges in evaluating global health initiatives that involve any degree of complexity. Health initiatives are often implemented at national scale, and reasonable comparison groups cannot be identified. Even though many initiatives monitor progress toward outputs and outcomes using performance- or results-based strategies, these strategies rarely provide insight as to whether or how different implementing partners were able to achieve success; what problems were or were not addressed successfully; and how situational variability affected successes and challenges. Often, we simply don’t gain the learning needed from evaluations about how a complex intervention worked or did not, and how implementation context affected intervention success.
We need to do …