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Lessons learned from implementing evaluations for Gavi, the Vaccine Alliance and the Global Fund for AIDS, Tuberculosis, and Malaria can help inform the design and implementation of ongoing or future evaluations of complex interventions. We share 5 lessons distilled from over 7 years of experience implementing evaluations in 7 countries.
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When providing immunization services, health care workers balance the mandate of achieving high coverage with limiting vaccine wastage. Workers in 3 countries said that containers with fewer vaccine doses for measles and BCG would enable them to immunize all children who present, while reducing concerns about wasting vaccine.
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Among young first-time mothers, participation in a comprehensive, community-based program led to a 3-fold increase in voluntary modern contraceptive use and other positive changes. These results demonstrate the importance of investing in interventions for this youth population that ideally address a range of priorities across the first-time parent lifestage.
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This program to strengthen laboratory quality management systems in Cambodia demonstrated significant improvements in conformity to ISO 15189 standards in participating laboratories, correlating with laboratory participation time in video conference training activities led by quality improvement mentors over the program implementation period.
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Community-based maternal child health programs should foster a sense of community ownership to promote sustainability. In rural Zambia, health interventions should be accessible to target communities and clear roles should be established among stakeholders for effective governance.
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In household trials of improved practices, rural Ethiopian women were motivated to adhere to antenatal calcium supplementation regimens, and tailored home-based strategies helped them overcome barriers such as regimen complexity, forgetfulness, side effects, and discouragement from others.
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Geographic information systems can be used to support informed decisions about practical issues related to implementing community health worker (CHW) programs. Demands placed on CHWs regarding expected population and surface area coverage and travel time to facilities need to be carefully considered to ensure they are rational and realistic.
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We provide a framework to quantify the use of electronic immunization registry systems at the facility level and results show the importance of behavioral and organizational factors in explaining their sustained use in Tanzania and Zambia.