Publications

D4I publishes and shares resources that support the generation and use of high-quality data for decision making. Our publications database includes D4I briefs and fact sheets, datasets, graphics and infographics, guidance and tools, journal articles, manuals, presentations, technical reports, working papers, workshop reports, plus time-tested knowledge products produced under MEASURE Evaluation.

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Recent Publications

TitleAuthorYearLanguageKeywordsAbstractShortnameDownloadRegions
TitleAuthorYearLanguageKeywordsAbstractShortnameDownloadRegions
Resources and Training Models to Strengthen the Gender Competency of Family Planning Providers: A case example from Ghana comparing in-person, blended, and virtual trainingKatherine Andrinopoulos, Janna Wisniewski, Evelyn Koko2024English, , , , , Gender competency refers to the knowledge, attitudes, and skills that family planning (FP) providers need to acquire and use to help clients overcome gender-related barriers to achieving their reproductive health goals. The United States Agency for International Development (USAID) supported the development of a provider self-assessment tool and eLearning course that can be used in trainings to strengthen gender competency among FP providers. This activity explored how to design trainings using these resources to inform future trainings conducted by the Ghana Health Services (GHS) Division of Family Planning, and as a model for other similar contexts. FP providers participated in three training modalities: in-person, blended, and virtual. Feedback was gathered through surveys and group discussions. While all providers in the in-person and blended modalities completed the eLearning course, only 65% of virtual participants did so. Higher levels of peer-to-peer engagement in the in-person and blended formats may have increased accountability and helped contextualize global content to the local setting. The virtual training offered flexibility and broader access, but poor internet connectivity was a significant barrier, requiring some participants to complete the training during their off-hours or travel to areas with better connectivity. Provider self-assessment tool scores increased after taking the eLearning course for all three training modalities. Future training using these resources should be tailored based on providers’ internet access, digital literacy, and preference.SR-24-238
Assessment of a Post Partum Family Planning (PPFP)Intervention in Selected Areas of BangladeshData for Impact2024English, , , , , , , This brief assesses a study performed on postpartum family planning (PPFP) in selected regions of Bangladesh. This brief is based on the full report, Assessment of a Postpartum Family Planning (PPFP) Intervention in Selected Areas of Bangladesh. Closely-spaced pregnancies increase the risk of poor maternal and child health outcomes. In Bangladesh, 11% of non-first births occur within 24 months of the previous birth, according to the 2017–2018 Bangladesh Demographic and Health Survey (BDHS). The total fertility rate (TFR) in Bangladesh is 2.3 births per woman, which is 0.6 higher than the desired rate of 1.7. Additionally, 10% of married women have an unmet need for family planning (FP). PPFP plays a critical role in preventing unintended and closely-spaced pregnancies during the first year after childbirth by offering FP counseling and services. With the recent rise in antenatal care (ANC) coverage and facility deliveries in Bangladesh, there is a significant opportunity to provide PPFP services through both public and private health facilities. 1,3 Approximately two-thirds of facility deliveries occur in private health facilities, while one-third take place in public facilities, mainly under the Directorate General of Health Services (DGHS). Nearly 90% of women receive ANC from these facilities, presenting an opportunity to integrate FP counseling and services widely. This study aimed to achieve three primary objectives:
  • To measure the effect of strengthened and systematic PPFP counseling during ANC visits at health facilities and/or offering FP methods during facility- based delivery on the acceptance of FP methods during the PP period.
  • To understand women’s perspectives on receiving counseling on PPFP during ANC visits at facilities and/or during facility delivery, and their decision-making process regarding the use of FP methods during the PP period.
  • To examine healthcare providers’ view of PPFP service delivery, including the overall service delivery system.
FS-24-711
Data for Impact (D4I) in MoldovaData for Impact2024English, , , , This set of slides summarizes the work of D4I in Moldova from February 2020 to August 2024, especially as it relates to the capacity of the government and its partners to collect, analyze, and use data to the benefit of children in adversity and other vulnerable populations. For more information on D4I's work in Moldova, please visit the D4I country page.PR-24-122
Measuring Performance Improvement in Monitoring, Evaluation, Research, and Learning (MERL)Liz Millar, Tory Taylor2024English, , , Data for Impact (D4I) is a global monitoring, evaluation, research, and learning (MERL) project working to support data generation and use for more effective, equitable, and sustainable health programming. Capacity strengthening is critical to this approach. This guide draws from the experience of D4I and predecessor MEASURE Evaluation, USAID’s Local Capacity Strengthening (LCS) Policy, and other sources to help MERL actors apply the LCS principle “plan for and measure performance improvement in collaboration with local partners” to their work. The information and resources here can be used to design, implement, and learn from MERL capacity strengthening focused on improving performance according to locally identified priorities and metrics. Information on localization and partnership practices is also included to help readers understand how these concepts intersect with effective capacity strengthening.SR-24-266
Does counseling on family planning at maternity care points increase the uptake of postpartum family planning?: Evidence from nationally representative surveyM. Moinuddin Haider, Md. Mahabubur Rahman, Shusmita Khan, & Mizanur Rahman2024English, , , , , , The World Health Organization (WHO) defines postpartum family planning (PPFP) as a family planning (FP) behavior to prevent unintended and closely spaced pregnancies through the first 12 months following childbirth. It is also considered a high impact practice and an essential component of birth care helping avert maternal and newborn health hazards by preventing short-spaced births. The National Technical Committee (NTC) of the PPFP action plan in Bangladesh identified no or limited information about PPFP counseling provided to women during pregnancy and postpartum contact. The NTC laid out an initial general implementation plan for generating demand, including behavior change communication activities, the availability of the PPFP methods package, the training of providers, logistics and supply management, and quality improvement activities that are likely to increase PPFP use.  As part of the demand generation actions, the NTC also approved integrating information and counseling about FP during maternity and child care points and the provision of FP services from the child immunization sites. However, no published study has examined whether women receive FP counseling during antenatal care (ANC) and postnatal care (PNC) visits. Also, there is a lack of evidence on whether FP counseling during ANC and PNC visits improves PPFP acceptance among Bangladeshi women. This technical brief analyzes data from the nationally represented 2017-18 Bangladesh Demographic and Health Survey. The analysis focused on whether women who had their last live birth in the past three years received PPFP counseling during any ANC or PNC visits.FS-24-707
Nigeria HPN Multi-Activity Evaluation: Trends in Select DHIS2 and Population-Level Malaria, Antenatal Care, and Family Planning IndicatorsSiân Curtis, Milissa Markiewicz, Emmanuel Adegbe, Kristen Brugh, & Ting Chen2024English, , , , , Data for Impact (D4I) conducted a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). Evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. The evaluation was implemented in three case study states. The purpose of this report is to summarize trends in health behavior and service delivery outcomes for select malaria, antenatal care (ANC), and family planning (FP) indicators using the data from the District Health Information System (DHIS2) and three population-based studies: (1) the Multi Indicator Cluster Survey (MICS), (2) the Malaria Indicator Survey (MIS), and (3) the Demographic and Health Survey (DHS). Results include an assessment of trends over time within each state as well as descriptive comparisons and trends across the three case study states.TR-24-581
Evaluation of Family Planning Program Transitions in Selected CountriesMai Do, Molly Weber, Jennifer Racher, Layla Babahaji, and Shay Slifko 2024English, , , , , , The United States Agency for International Development (USAID) is the largest bilateral donor of family planning (FP) assistance, having provided financial support and technical assistance to countries around the globe for more than five decades. Such assistance has contributed to significant increases in modern contraceptive use and reductions in fertility in recipient countries. More than two dozen countries have since transitioned out of USAID’s financial support over the last three decades and demonstrated sustained programmatic achievements at the country level. Despite the remarkable FP results and USAID’s emphasis on long-term sustainability, there have been only a handful of large-scale evaluations of the extent to which FP programs and outcomes have been sustained after the transition. Our exercise, therefore, was aimed to advance the work of strategic transition planning, implementation, and evaluation of large-scale global health programs by developing a guiding framework for this process. The earlier phase of this activity involved the development of the FP program transition framework to guide the planning and M&E of the FP/ reproductive health (RH) program transition through a thorough literature review. In this report, we discuss the application of the framework to the evaluation of FP programs in four selected countries after they transitioned out of USAID support. While the evaluation was still retrospective and focused on the post-transition period, we discussed how the framework could be useful in the future for the pre-transition assessments, planning, implementation, and evaluation of FP program transitions. Four countries— Honduras, Indonesia, Morocco, and Peru—were selected, in consultation with USAID, for two main reasons: (1) they presented different geographical regions and (2) distinct graduation periods.SR-24-232
Group-Based Trajectory Modeling to Understand Trends in Under-Five MortalitySingh, K., Angeles, G., Reyes, H.L., Simmons, E., Siwatlo, A., Weiss., W.2024English, , In this analysis, group-based trajectory modeling was used to analyze under-five mortality data from 78 low- and middle-income countries for 2000–2019. The analysis allowed for the identification of distinct groupings of countries that followed similar trajectories in under-five mortality. Associations between health and non-health factors in under-five mortality among groups and within groups were also studied. The objective was to determine factors that could be particularly important to countries in their efforts to reduce under-five mortality. This policy brief highlights key points from a paper currently under peer review.FS-204-708
Zana za Viashiria vya Kila Mtoto Mchanga – Uboreshaji wa Upimaji kwa Watoto Wachanga na Watoto Waliozaliwa Wafu (EN-MINI) Zana za Mifumo ya Kawaida ya Taarifa za AfyaData for Impact2024Swahili (Tanzania), , , , , , The Every Newborn-Measurement Improvement for Newborn and Stillbirth Indicators (EN-MINI) Tools guide priority actions to improve the availability, quality, and use of newborn and stillbirth indicators in routine health information systems (RHIS). The tools are free, easy to use, and generate automated reports for sub-national and national use in support of the Every Newborn Action Plan (ENAP). The EN-MINI tools are designed to optimize RHIS data that can be used to review progress and performance while enabling data use for policy and action for newborns and stillbirths. The tools strengthen communication between key stakeholders and facilitate standardized data as recommended in global guidance. The seven tools are grouped into three categories—Map Newborn Data, Use Newborn Data for Decisions, and Improve Newborn Data Quality. This is the Kiswahili version of this English language brief.FS-24-659
Data for Impact (D4I) Year 6 Semi-Annual HighlightsData for Impact2024English, Data for Impact (D4I) works with country partners to strengthen capacity to generate and use high-quality data, investigate program effectiveness, and learn from evidence. This brief shares highlights from D4I's work in Year 6 of the project.FS-24-709
Impact Analysis of Selected Indicators of USAID’s MaMoni Maternal and Newborn Care Strengthening ProjectKhan S, Haider MM, Rahman MM, Nusrat S, Amin, MT, Rahman M, Angeles G, Curtis, S. 2024English, , , The goal of the United States Agency for International Development’s (USAID) Maternal and Newborn Care Strengthening Project (MaMoni MNCSP) (2018–2023) was to improve public sector maternal and newborn care (MNC) services by developing and scaling up successful MNC initiatives and improving learning. The project worked to increase fair and consistent use of high-quality MNC services to address the major health system concerns at the national, district, and sub-district levels. After completion of the project, based on USAID/Bangladesh’s request, D4I conducted an impact analysis of selected indicators using baseline and endline data collected by icddr,b. This impact analysis aims to determine the impact of MaMoni MNCSP on key maternal and newborn health performance indicators; evaluate its differential impact on the use of MNC services between socioeconomic classes; and examine the increase in use of delivery services in union level public healthcare facilities.TR-23-546
Driving Positive Attitudes towards Evidence UseData for Impact2024English, , , , This infographic presents some of the findings and recommendations on messaging from the report, "Strategies to Increase Endorsement of Evaluation Use: Insights from South Africa." Literature and D4I’s primary research have identified multiple barriers to the use of evidence, including the use of evaluation findings from USAID’s global health programs. Evidence based on qualitative research often faces additional skepticism, with some decision makers prioritizing quantitative evidence over qualitative because they view it as more credible and objective. Precisely because so many factors impact the perception of research, modifying the presentation and framing of information regarding research, including evaluations, may be an effective tactic for increasing evidence use.GR-24-174
Strategies to Increase Endorsement of Evaluation Use: Insights from South AfricaAgata Slota, Afroditi Tsourgianni, and Lucinda Jones2024English, , , , Literature and D4I’s primary research have identified multiple barriers to the use of evidence, including the use of evaluation findings from USAID’s global health programs. Evidence based on qualitative research often faces additional skepticism, with some decision makers prioritizing quantitative evidence over qualitative because they view it as more credible and objective. Precisely because so many factors impact the perception of research, modifying the presentation and framing of information regarding research, including evaluations, may be an effective tactic for increasing evidence use. This study sought to explore whether messages can change people’s perceptions of evaluation findings in a way that increases their willingness to endorse the use of evidence for decision making. The study used an experimental design to examine messages addressing the challenges of: (1) qualitative evidence being viewed as less trustworthy or of a lower quality than quantitative research, and (2) perceptions of evaluators impacting perceptions of the credibility and quality of evaluation evidence. The study was conducted in South Africa, with the primary audience being USAID and the secondary audience being implementing partners. The aim was to help those producing or disseminating global health evaluation evidence describe evaluations in a way that supports evidence use.SR-24-223
Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems and Findings from its Implementation in TanzaniaData for Impact2024English, , , , , , , The Every Newborn-Measurement Improvement for Newborn and Stillbirth Indicators (EN-MINI) Tools guide priority actions to improve the availability, quality, and use of newborn and stillbirth indicators in routine health information systems (RHIS). The tools are free, easy to use, and generate automated reports for sub-national and national use in support of the Every Newborn Action Plan (ENAP). The EN-MINI tools are designed to optimize RHIS data that can be used to review progress and performance while enabling data use for policy and action for newborns and stillbirths. The tools strengthen communication between key stakeholders and facilitate standardized data as recommended in global guidance. The seven tools are grouped into three categories—Map Newborn Data, Use Newborn Data for Decisions, and Improve Newborn Data Quality. This brief includes findings and recommendations from EN-MINI implementation in Tanzania.FS-24-659a
Malawi Secondary Education Expansion for Development (SEED) Impact Evaluation Baseline and Midline (Dataset)Data for Impact (University of North Carolina at Chapel Hill)2024English, , , , , , , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. The Malawi Secondary Education Expansion for Development (SEED) activity is a $90 million commitment from the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) for urban expansion and rural construction of Community Day Secondary Schools (CDSSs). Data for Impact (D4I) is conducting an evaluation of the SEED activity to understand whether there is an impact on SEED communities. This mixed methods impact evaluation covers a range of development outcomes, including the impact of SEED on children who are enrolled in Standard 7 in primary schools at baseline in rural SEED CDSS catchment areas. The outcomes evaluated include educational outcomes; sexual behaviors; water, sanitation, and hygiene behaviors; and child safety. At baseline, we recruited Standard 7 students (n=761) from 32 rural primary treatment schools that will feed into new rural CDSSs, as well as from 32 rural comparison primary schools outside new CDSS catchment areas. To measure the pre-intervention primary to secondary school transition rate, we surveyed a retrospective cohort of students (n=599) enrolled in Standard 8. At midline, we followed students in the prospective cohort. However, the construction of SEED schools in the Northern region was incomplete, and the Northern region was excluded. At both timepoints, the qualitative component consisted of focus group discussions (FGDs) with students and caregivers, key informant interviews (KIIs) with community leaders and teachers, and in-depth interviews (IDIs) with students. Rural findings showed positive impacts of the SEED activity, including reduced absenteeism among girls due to menstrual hygiene management and reduced child marriage. Urban qualitative findings also showed perceived positive outcomes, including a conducive learning environment and reduced absenteeism among girls. (2023-12-31)DS-24-011
Behavioral Interventions for the Use of Evaluation Findings in South Africa (Dataset)Data for Impact (University of North Carolina at Chapel Hill; Palladium), USAID South Africa (United States Agency for International Development)2024English, , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. This study used an experimental design to empirically answer five research questions regarding the impact of different messages on evidence use. The questions ask whether mentioning the following in the description of the evaluation impacts on the willingness to endorse the use of evidence from qualitative evaluations for decision making: Q1: appropriateness of qualitative methods for the line of inquiry Q2: triangulation of data sources and/or methods Q3: subject matter expertise of the evaluators Q4: independence of the evaluators Q5: that the evaluators are from the same location as the activity they are evaluating. The study entailed two separate experiments, with two participant panels. The first experiment addressed the first two research questions, and the second the last three research questions. (2024-05-31)DS-24-012
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Health Facility Assessment (Dataset)Data for Impact (University of North Carolina at Chapel Hill)2024English, , , , , , , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. Data for Impact (D4I) conducted a mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). D4I conducted a health facility assessment (HFA) as part of the evaluation to gather information on health facilities’ service availability and readiness to provide services both generally and specifically for malaria, family planning, and antenatal care service domains. (2021)DS-24-010a
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Organizational Network Analysis (Dataset)Data for Impact (University of North Carolina at Chapel Hill)2024English, , , , , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. Data for Impact (D4I) conducted a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health-programming approach with a disease-focused approach (malaria). As part of this evaluation, we conducted an organizational network analysis (ONA) to better understand collaboration and coordination through structural aspects of resource, information, and funding exchange in Ebonyi, Kebbi, and Zamfara. (2022)DS-24-010b
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Provider Survey (Dataset)Data for Impact (University of North Carolina at Chapel Hill)2024English, , , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. Data for Impact (D4I) conducted a mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). This dataset is from a health provider survey conducted by D4I as one component of a mixed methods outcome evaluation of four United States Agency for International Development (USAID)/Nigeria Health, Population, and Nutrition (HPN) activities. The objective of the health provider survey evaluation component was to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). (2022)DS-24-010c
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Sustainability Survey (Dataset)Data for Impact (University of North Carolina at Chapel Hill), Data Research and Mapping Consults (Nigerian Organization)2024English, , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab. Data for Impact (D4I) conducted a mixed-methods portfolio evaluation of four USAID/Nigeria HPN Activities, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). The 2022 sustainability assessment explores how the HPN Activities are contributing to the sustainability of health systems and health outcomes in Ebonyi, Kebbi, and Zamfara states. The assessment used a mixed-method approach that featured a quantitative survey and semi-structured key informant interviews (KIIs). Both quantitative and qualitative findings find evidence that HPN Activities are contributing to sustainable state health systems and outcomes.  DS-24-010d
Strengthening Maternal Care: The Evolution of Midwives in Upazila Health Complexes in BangladeshMahbub Elahi Chowdhury, Anadil Alam, Aklima Chowdhury, Hosne Ara Beena, Md. Mahbubur Rahman, Shafayatul Islam Shiblee2024English, , , , , Given the significant shortage of trained personnel to provide quality maternal healthcare services, the Government of Bangladesh initiated the development of the midwifery cadre in 2010. New midwife posts were created at Upazila Health Complexes (UHCs) and Union Sub-Centers (USCs), and by July 2023, a total of 2,547 midwives had been posted at 411 UHCs (4/facility) and 903 USCs (1/facility). The Research for Decision Makers (RDM) project, supported by the United States Agency for International Development (USAID), conducted a study to assess the current state of midwives’ adaptation to their workplace, identify related challenges, and anticipate changes in maternal and newborn health (MNH) care service provision following the integration of midwives into the health system. The study aimed to propose effective strategies for maximizing midwives’ impact and achieving desired outcomes.FS-24-700
Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems (Bangla)Data for Impact2024Bengali (Bangladesh), , , , , , , This is the Bangla language version of an English language brief. The Every Newborn-Measurement Improvement for Newborn and Stillbirth Indicators (EN-MINI) Tools guide priority actions to improve the availability, quality, and use of newborn and stillbirth indicators in routine health information systems (RHIS). The tools are free, easy to use, and generate automated reports for sub-national and national use in support of the Every Newborn Action Plan (ENAP). The EN-MINI tools are designed to optimize RHIS data that can be used to review progress and performance while enabling data use for policy and action for newborns and stillbirths. The tools strengthen communication between key stakeholders and facilitate standardized data as recommended in global guidance. The seven tools are grouped into three categories—Map Newborn Data, Use Newborn Data for Decisions, and Improve Newborn Data Quality.FS-24-659
Assessment of a Postpartum Family Planning (PPFP) Intervention in Selected Areas of BangladeshM Mahabubur Rahman, M Moinuddin Haider, Prianka Barman, Md. Ali Imam, Shusmita Khan, Anadil Alam, Quamrun Nahar, Zubair Shams, Nurun Nahar Begum, Mizanur Rahman2024English, , , , , , , Closely spaced pregnancies are associated with a higher risk of poor maternal and child health outcomes. Appropriate and timely use of postpartum family planning (PPFP) helps women prevent unintended and closely spaced pregnancies through the first 12 months following childbirth. PPFP focuses on providing FP counseling and services to women and couples in the first 12 months after birth. The World Health Organization (WHO) has identified different points of contact with maternal, newborn, and child health (MNCH) interventions during the 12-month period after childbirth, which provide opportunities to integrate PPFP activities. An effective way of increasing PPFP uptake is to create demand for PPFP through counseling during antenatal care (ANC) and offering FP methods during facility delivery or soon afterward. However, to what extent women may accept PPFP if they are counseled at ANC visits and offered PPFP during facility delivery is not well studied in Bangladesh. Therefore, it is important to measure the effect of strengthened and systematic PPFP counseling during facility-based ANC visits, delivery care, and postnatal care (PNC) visits and offering FP methods during facility delivery and PNC visits on the uptake of FP methods within the postpartum period. This report summarizes and analyzes the study's findings on PPFP counseling during facility visits.TR-23-550
Kangaroo Mother Care and Special Care Newborn Units for Small and Sick Newborns in Bangladesh: Gaps in Service Availability, Readiness, and FunctionalityShafiqul Ameen, Shusmita Khan, Supriya Sarkar, Md. Jahurul Islam, Ahmed Ehsanur Rahman2024English, , , , , , The objective of this technical brief is to report the service availability, readiness, and functionality of the Kangaroo Mother Care (KMC) and Special Care Newborn Units (SCANU) facilities to provide inpatient care for small and sick newborns in Bangladesh. Service availability and readiness of health facilities are pivotal factors influencing the capacity of health systems to deliver health services to the target population. The insufficiency in service readiness and availability of healthcare facilities, specifically for the care of small and sick newborns, could pose a substantial impediment to the large-scale effective coverage of these interventions. A study was conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in conjunction with the National Newborn Health and Integrated Management of Childhood Illness (NNHP & IMCI) program, and the Hospital Services Management program of the Directorate General of Health Services (DGHS), and with financial assistance from USAID’s Research for Decision Makers (RDM) Activity, to appraise the present state of implementation and practices of the Comprehensive Newborn Care Package in Bangladesh. This evaluation encompassed an assessment of all facilities offering KMC and SCANU services.FS-24-701
Assessment of the VIVA CampaignLauren Blum, Matt Worges, Janna Wisniewski, David Hotchkiss2024English, , , , , A primary objective of the USAID’s Integrated Health Program (USAID IHP) is to increase healthy behaviors and utilization of health services in the nine USAID IHP targeted provinces in the Eastern, Katanga, and Kasai regions of the Democratic Republic of the Congo (DRC). Breakthrough ACTION (BA) developed a social and behavior change (SBC) approach to reduce barriers to care seeking in formal facilities and to motivate the adoption of essential household healthy practices (EHHP), particularly related to maternal and child health. Starting in 2020, BA piloted the campaign called VIVA over a period of 18-months in eight health zones located across three provinces, Sud Kivu, Kasai Oriental, and Haut Katanga, targeted by USAID IHP. In FY22, VIVA 2.0 was transferred to USAID IHP for scale up in all nine of the project target provinces. A Data for Impact (D4I) team used a mixed methods approach to carry out a performance evaluation of the VIVA campaign. The purpose of the evaluation was to describe the development and implementation of the VIVA community interventions and to assess changes in targeted behaviors. Study findings are intended to inform recommendations regarding modifications in the VIVA approach and scale up.TR-24-565
Quality of Life Survey: Republic of MoldovaData for Impact2024English, , , , The Quality of Life Survey in the Republic of Moldova (QLS-Moldova), inspired by the European Quality of Life Surveys (EQLS), was conducted by Data for Impact (D4I) in partnership with IMAS – Cercetare si Strategii SRL ([imas]), a Moldovan research institute, with funding from the United States Agency for International Development (USAID). This survey aims to assess the well-being and quality of life of Moldovan residents, providing valuable insights into various socioeconomic and political factors affecting their lives. The dimensions of quality of life included in this report, like the EQLS-2016, promote well-being as a public policy issue. The QLS-Moldova results are intended to assist policy makers in making decisions that consider the multi-faceted nature of quality of life. This report starts by explaining respondents’ perceptions of their subjective well-being, income, and material deprivation. The second chapter focuses on work, care responsibilities, and personal development. The third chapter looks at the quality of public services. The fourth chapter addresses indicators of the quality of society, including satisfaction with democracy, the economy, confidence in institutions, involvement in the community, and relationships and tensions among people and groups. The final chapter provides a summary of those respondents and groups experiencing multiple personal and social insecurities.SR-24-213
Evaluation of the AmplifyPF Regional ProjectJanna Wisniewski, Sethson Kassegne, Rebecca Ezouatchi, Robert-Hugues Yaovi Nagbe, Dzidzova Kossitsè Apedo, Lorimpo Baboguou, Annie Gauly, Ghislaine Kouame, Miriam Makali, Farida Moussa, Oroumon Ogoua, Edoh Léon Soklou, Martha Silva2024English, , , , , , , , , , , Data for Impact conducted a performance and impact evaluation of the USAID-funded AmplifyPF project, which was implemented from 2018–2023, focusing on its impact on modern contraceptive prevalence and reproductive health services in Burkina Faso, Côte d’Ivoire, Niger, and Togo. The evaluation, building on Phase 1 results, employs a mixed-methods approach using secondary and primary data, including a data validation workshop. Evaluation questions spanned the extent of AmplifyPF’s impact on access to family planning services, sustainability of quality assurance systems, localization, scale-up, and adolescent reproductive health. This report summarizes the findings of Phase 2 of the performance evaluation of the USAID/West Africa FP and reproductive health projects.TRE-23-39
Chlorhexidine Coverage for Newborn Umbilical Cord Care in Bangladesh and NepalSingh, K., Simmons, E., Garriga, B., Hoover, G., Ijdi, R.E., & Ashish, K.C.2024English, , , , , , This policy brief summarizes findings from a paper by Singh et al. (2024), which looked at coverage and factors associated with receipt of chlorhexidine for newborn umbilical cord care in Bangladesh and Nepal. Reducing neonatal mortality is a pressing global health issue. In 2022, it was estimated that there were 2.3 million deaths among children under one month old. Infection is among the leading causes of neonatal mortality, including omphalitis, which is an infection of the umbilical cord. Hygienic cord care is an important means of preventing newborn infections and death. In 2022, the World Health Organization (WHO) recommended chlorhexidine for newborn umbilical cord care for the first week of life in settings where potentially harmful substances are often applied.FS-24-702
Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators EN-MINI-PRISM Tools for Routine Health Information Systems: KiswahiliData for Impact2024Swahili (Tanzania), , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Learn more and access additional resources on the EN-MINI Tools site. This is the Kiswahili version of the English language resource.  TL-23-102
Malawi Secondary Education Expansion for Development (SEED) Impact Evaluation: Midline Summary ReportKristen Brugh, Gustavo Angeles, Chrissie Thakwalakwa, Jessica Fehringer, Tawonga Mwase-Vuma, Milissa Markiewicz, McPherry Kuntembwe, Dadirai Mkombe, Janine Kayange, Liz Millar, Becky Wilkes, Ting Chen, Esme Kadzamira, and Sam Manthalu 2024English, , , , , , , , , , The Malawi Secondary Education Expansion for Development (SEED) activity is a $90 million commitment from the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) for urban expansion and rural construction of Community Day Secondary Schools (CDSSs). Data for Impact (D4I) is conducting an evaluation of the SEED activity to understand whether there is an impact on SEED communities. This mixed methods impact evaluation covers a range of development outcomes, including the impact of SEED on children who are enrolled in Standard 7 in primary schools at baseline in rural SEED CDSS catchment areas. The outcomes evaluated include educational outcomes; sexual behaviors; water, sanitation, and hygiene behaviors; and child safety. This report summarizes key findings of the impact evaluation at midline to determine whether the indicators are oriented towards SEED's key outcomes and provides recommendations for the activity moving forward.SR-24-214
Strengthening Capacity for Rigorous Evaluation in MalawiData for Impact2024English, , , , , , Data for Impact (D4I) conducted an impact evaluation of the Malawi Secondary Education Expansion for Development (SEED) activity in collaboration with the Centre for Social Research (CSR). Local engagement extended to all aspects of the evaluation, including design, planning, capacity strengthening through collaborative implementation and training, and support for evidence use in policies and programs. This brief highlights D4I’s partnership with CSR at the University of Malawi and how D4I strives to practice the principles of effective programming and equitable partnerships outlined in USAID’s Local Capacity Strengthening (LCS) Policy through an intentional, partner-centered approach.FS-24-667
Theory of Change: Midline Status UpdateMwase-Vuma, T., Kuntembwe, M., Kayange J, Evance, S., Amin, C., and Kholowa, A. 2024English, , , , , , , , , , , , The Malawi Secondary Education Expansion for Development (SEED) activity is a $90 million commitment by the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) for urban expansion and rural construction of Community Day Secondary Schools (CDSSs). In urban areas, the SEED program constructed prefabricated classroom blocks, new boy and girl latrine blocks, and changing rooms for girls in 30 existing CDSSs in the cities of Blantyre, Lilongwe, Mzuzu, and Zomba. In rural areas, the SEED program is constructing new “greenfield” CDSS facilities in areas where secondary school access has historically been limited. The first group of 30 new CDSSs in the Central and Southern regions of Malawi opened in January 2023. Data for Impact (D4I) and the Centre for Social Research (CSR) conducted an impact evaluation of the SEED program to help understand whether there is a change or impact on communities where the SEED program is carrying out the expansion and construction of CDSSs. Two rounds of data collection were conducted—baseline in 2021 and midline in 2023. This brief presents the Malawi SEED theory of change, midline results, and recommendations.FS-24-668
Secondary Education Costs in Malawi: What Financial Barriers Persist?Data for Impact2024English, , , In Malawi, fewer than half of primary school students transition to public secondary schools, with the transition rate increasing from 37% in 2021 to 43% in 2022. Students who enroll in a Form 1 school often have to travel long distances or board, and the cumulative costs of secondary education pose a financial burden for many families. The Malawi Ministry of Education (MoE) announced a 2018–19 strategy to increase secondary school enrollment. This brief presents quantitative and qualitative data triangulated from the Malawi SEED midline impact evaluation survey respondents, including rural students, their caregivers, and head teachers about perceived and actual barriers to educational achievement, including the financial costs of sending children to school. A corresponding brief from baseline evaluation data was published in 2022.FS-24-666
Malawi Secondary Education Expansion for Development (SEED) Impact Evaluation: Midline ReportKristen Brugh, Gustavo Angeles, Chrissie Thakwalakwa, Jessica Fehringer, Tawonga Mwase-Vuma, Milissa Markiewicz, McPherry Kuntembwe, Dadirai Mkombe, Janine Kayange, Liz Millar, Becky Wilkes, Ting Chen, Esme Kadzamira, and Sam Manthalu2024English, , , , , , The Malawi Secondary Education Expansion for Development (SEED) activity is a $90 million commitment from the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) for urban expansion and rural construction of Community Day Secondary Schools (CDSSs). Data for Impact (D4I) is conducting an evaluation of the SEED activity to understand whether there is an impact on SEED communities. This mixed methods impact evaluation covers a range of development outcomes, including the impact of SEED on children who are enrolled in Standard 7 in primary schools at baseline in rural SEED CDSS catchment areas. The outcomes evaluated include educational outcomes; sexual behaviors; water, sanitation, and hygiene behaviors; and child safety. This report analyzes the findings of the impact evaluation at midline to determine whether the indicators are oriented towards SEED's key outcomes and provides recommendations for the activity moving forward.SR-24-220
Malawi SEED Urban: Midline Qualitative FindingsData for Impact2024English, , , , , , , , , The USAID-funded Malawi Secondary School Expansion for Development (SEED): Urban activity involved the design-build construction of prefabricated classroom blocks, new boy and girl latrine blocks, and changing rooms for girls in 30 existing Community Day Secondary Schools (CDSSs) in the cities of Blantyre, Zomba, Lilongwe, and Mzuzu. Data for Impact (D4I), in collaboration with the Centre for Social Research (CSR) at the University of Malawi, is conducting an impact evaluation of the SEED activity to help understand whether there is a change or impact on communities where SEED is carrying out expansion and construction of CDSSs. This brief summarizes results from the midline (2023) urban qualitative component which was conducted at three expanded SEED schools—one each in Blantyre, Lilongwe, and Mzuzu—to explore perceived positive and unintended impacts of the expansion. Results will inform understanding of how education and health outcomes can result from secondary school construction in Malawi.SR-23-208
Behavioral Interventions to Increase Engagement with Evaluation Findings in NigeriaData for Impact2024English, , , , Data for Impact (D4I), in cooperation with the United States Agency for International Development (USAID), ran a pilot to test two strategies to mitigate behavioral barriers and leverage behavioral enablers of the use of evaluation findings from USAID global health programs. The aim was to learn lessons on how to implement behavioral interventions to improve the use of evidence within USAID and offer a blueprint for testing similar interventions in other contexts. The pilot was carried out in Nigeria, with the primary target group for increasing evaluation findings being USAID Nigeria Mission staff. The focus was increasing engagement with qualitative findings from the Nigeria Multi-Activity Evaluation, an outcome evaluation of four USAID Nigeria Mission Health, Population, and Nutrition (HPN) activities. The pilot consisted of two strategies: (1) tailored email messages about evaluation findings using a combination of behavioral insights, and (2) strengthening an evaluation findings dissemination event with behavioral techniques.TR-24-40
Assessment of Health Facility Supervision in the Democratic Republic of the CongoMatt Worges, PhD; Lauren Blum, PhD; David Hotchkiss, PhD; Janna Wisniewski, PhD; Paul-Samson Lusamba-Dikassa, MD, PhD2023English, , The objective of this study was to develop a better understanding of the supervision system across the United States Agency for International Development (USAID) Integrated Health Program (IHP)-targeted provinces of the Democratic Republic of the Congo (DRC) by focusing on supervision content, structure, and styles as well as perceptions of supervision quality as described by individuals conducting the supervisory visits as well as those receiving the visits. Qualitative research questions focused on the function the supervision system serves, types of supervision schemes, the mechanistic properties of supervisory visits (i.e., what happens during a visit), the atmosphere in which the visit is conducted, the kinds of interactions that occur between supervisor and supervisee, the perceptions of the supervision system with respect to its purpose and effectiveness, and the role USAID-IHP has in supporting supervision schemes. This report shares more on the study and findings.TR-23-533 D4I
Data for Impact Annual Report Year 5Data for Impact2023English, , , Data for Impact (D4I) is a five-year cooperative agreement funded by the United States Agency for International Development (USAID). D4I partners with countries to mobilize data to improve programs, policies, and—ultimately—health outcomes. D4I seeks to achieve the following results:
  • Generate strong evidence needed for program and policy decision-making through the appropriate use of available data sources and the generation of new data using innovative, rigorous, and efficient methods, approaches, and tools
  • Strengthen individual and organizational capacity to generate evidence and use data
  • Facilitate and enhance the use of data for global health programs and policies through compelling, user-friendly data organization, visualization, and communication
This report describes D4I’s work during Year (Y) 5: October 1, 2022, to September 30, 2023.		TR-23-535
Nigeria HPN Multi-Activity Evaluation FGD and KII Results: Ebonyi, Kebbi, and Zamfara statesData for Impact2024English, , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) Activities. The primary focus of this evaluation is to compare an integrated health programming approach with a disease-focused malaria approach. The evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. D4I partnered with the Nigerian research firm, Data Research and Mapping Consult Ltd. (DRMC), to conduct a qualitative assessment in Ebonyi, Kebbi, and Zamfara states to monitor the implementation progress and effectiveness of the HPN Activities. The assessment included key informant interviews (KIIs) with health facility officers in-charge (OICs) and focus group discussions (FGDs) with FMC and WDC members, as well as with men and women who were primary caregivers for children under five in communities. This document details the KIIs and FGDs conducted in Ebonyi, Kebbi, and Zamfara over the course of this assessment as well as key takeaways and considerations.SR-23-199a
Nigeria HPN Multi-Activity Evaluation FGD and KII Results: Ebonyi StateData for Impact2024English, , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) Activities. The primary focus of this evaluation is to compare an integrated health programming approach with a disease-focused malaria approach. The evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. D4I partnered with the Nigerian research firm, Data Research and Mapping Consult Ltd. (DRMC), to conduct a qualitative assessment in Ebonyi, Kebbi, and Zamfara states to monitor the implementation progress and effectiveness of the HPN Activities. The assessment included key informant interviews (KIIs) with health facility officers in-charge (OICs) and focus group discussions (FGDs) with FMC and WDC members, as well as with men and women who were primary caregivers for children under five in communities. This document details the KIIs and FGDs conducted in Ebonyi over the course of this assessment as well as key takeaways and considerations.SR-23-199b
Nigeria HPN Multi-Activity Evaluation FGD and KII Results: Kebbi StateData for Impact2024English, , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) Activities. The primary focus of this evaluation is to compare an integrated health programming approach with a disease-focused malaria approach. The evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. D4I partnered with the Nigerian research firm, Data Research and Mapping Consult Ltd. (DRMC), to conduct a qualitative assessment in Ebonyi, Kebbi, and Zamfara states to monitor the implementation progress and effectiveness of the HPN Activities. The assessment included key informant interviews (KIIs) with health facility officers in-charge (OICs) and focus group discussions (FGDs) with FMC and WDC members, as well as with men and women who were primary caregivers for children under five in communities. This document details the KIIs and FGDs conducted in Kebbi over the course of this assessment as well as key takeaways and considerations.SR-23-199c
Nigeria HPN Multi-Activity Evaluation FGD and KII Results: Zamfara StateData for Impact2024English, , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) Activities. The primary focus of this evaluation is to compare an integrated health programming approach with a disease-focused malaria approach. The evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. D4I partnered with the Nigerian research firm, Data Research and Mapping Consult Ltd. (DRMC), to conduct a qualitative assessment in Ebonyi, Kebbi, and Zamfara states to monitor the implementation progress and effectiveness of the HPN Activities. The assessment included key informant interviews (KIIs) with health facility officers in-charge (OICs) and focus group discussions (FGDs) with FMC and WDC members, as well as with men and women who were primary caregivers for children under five in communities. This document details the KIIs and FGDs conducted in Zamfara over the course of this assessment as well as key takeaways and considerations.SR-23-199d
Good Practices in Data Use: Enhancing Social Services for Children with Disabilities in Dondușeni District, MoldovaD4I Moldova2024English, , , In Moldova’s Dondușeni district, a dedicated team of social workers identified a troubling pattern: children with disabilities were not receiving the support they needed, such as specialized rehabilitation services and inclusive education, to thrive. Recognizing the urgency, they set out to ensure that every child with a disability could access essential services and resources. In April 2022, stakeholders from numerous sectors convened, united by a shared sense of urgency to address the pressing needs of children. A diverse ensemble of representatives from social services, finance, education, and healthcare assembled to chart a collective course of action based on solid data and evidence. They were supported by the Data for Impact (D4I) project, funded by the United States Agency for International Development (USAID). The findings revealed that despite the availability of support services, there were gaps in both accessibility and the quality of services for children with disabilities. Through open dialogue and collaborative brainstorming sessions, the team explored potential solutions and strategies for expanding social services to a greater number of children with disabilities. They deliberated on resource allocation, the development of new programs, and the enhancement of existing services to better meet the needs of the community. Together, they laid the foundation for a more inclusive and nurturing environment for children with disabilities, paving the way for transformative change in Dondușeni.FS-24-663
Good Practices in Data Use: Transforming the lives of Vulnerable Children in Chișinău, MoldovaD4I Moldova2024English, , , With support from the Data for Impact (D4I) project, the Directorate-General for the Protection of Children’s Rights (DGPDC) conducted an annual review of the child protection landscape in Chișinău, the capital city of the Republic of Moldova, revealing the harsh realities faced by its children. Data from 2022 paint a bleak picture, with 1,874 children identified as being at risk—an alarming 3.8-fold increase from the previous year and a staggering 4.2-fold increase from 2019. Further analysis revealed a particularly vulnerable demographic: children ages 7-15, predominantly residing in urban areas, emerged as the most-at-risk, with over half of them being female. Root causes such as neglect, violence, and inadequate parental care (see Figure 1), compounded by impoverished living conditions, underscored the urgent need for intervention and support. In response to the troubling findings, the Chișinău DGPDC implemented a comprehensive system for regularly documenting incidents of violence, neglect, exploitation, and trafficking of children. Through collaborative efforts, it has entered into partnership agreements with civil society organizations and donors, aiming to enhance support and assistance for children lacking parental care, as well as those from vulnerable families. Working closely with various stakeholders, the DGPDC organized regular capacity strengthening activities for approximately 500 specialists in child rights protection, along with parental skills development sessions for around 1,700 parents and other caregivers. These efforts were designed to bolster child safety measures and prevent instances of abuse.FS-24-662
Good Practices in Data Use: Ludotecas in Ștefan Vodă District, MoldovaD4I Moldova2024English, , , In the wake of the refugee crisis, the Ștefan Vodă district in Moldova, nestled along the border with Ukraine, emerged as a central location for refugee families seeking safety. Among them, the most vulnerable were children, facing uncertainties compounded by their displacement. Data analysis, initiated in 2022 and perpetuated through the establishment of a dedicated Data Review Room, funded by the United States Agency for International Development (USAID) through the Data for Impact (D4I) project, revealed that as of January 2023, the district housed 370 refugee children, comprising 140 preschool-aged children and 230 of school age. These children required access to education and support for their successful integration into the host communities. The findings underscored the pressing need for focused interventions, particularly in education, to provide refugee children with stability, protection, and opportunities for their growth and development. Monthly data review sessions, convened by the Directorate General for Social Assistance and Family Protection (DGASPF) in Ștefan Vodă and facilitated by D4I, were pivotal gatherings where stakeholders from diverse sectors converged to address the pressing challenges facing refugee children. Representatives from the social assistance, education, law enforcement, and healthcare sectors collaborated in these forums, pooling their expertise and insights to fuel discussions and empower stakeholders to propose tangible solutions. During these discussions, a visionary concept emerged: community ludotecas, or recreational centers serving as socio-educational hubs, designed to provide comprehensive support for refugee and at-risk children, including both preschool and school-aged groups. These centers would serve as safe spaces where children could engage in learning, play, and access essential services, fostering their holistic development. The decision-making process that led to this innovative solution involved comprehensive analyses of community needs, resource availability, and the potential for partnerships.FS-24-664
Recommendations for Strengthening Research and Evaluation Capacity to Support Sustainable Health ProgramsData for Impact2024English, , , , There is growing interest, particularly among health program funders, in assessing and measuring the sustainability of country-level health programs. However, recent initiatives to promote sustainability have primarily focused on programmatic needs. This has led to research and evaluation that is part of programming receiving less attention. Since sustainable health programming requires continual assessment and realignment to meet evolving needs, it is important to have corresponding research and evaluation capabilities. Drawing on peer-reviewed and grey literature alongside interviews with a range of stakeholders both at the United States Agency for International Development (USAID) and in research organizations based in low- and middle-income countries (LMICs), this document summarizes the main findings and presents key recommendations to support sustainable research and evaluation capacity for health programs. USAID requested that D4I conduct an activity examining how to support sustainable research and evaluation capacity. Thus, this document was drafted with USAID as the primary audience. Additionally, it offers valuable insights and recommendations for USAID collaborators, including governments and research organizations, to enhance their strategies for evidence-based research capacity interventions. This guidance document is based on a review of published literature and key informant interviews with USAID staff and country-based organizations.WP-24-267
An Overview of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information SystemsData for Impact2024English, , , , , The Every Newborn-Measurement Improvement for Newborn and Stillbirth Indicators (EN-MINI) Tools guide priority actions to improve the availability, quality, and use of newborn and stillbirth indicators in routine health information systems (RHIS). The tools are free, easy to use, and generate automated reports for sub-national and national use in support of the Every Newborn Action Plan (ENAP). The EN-MINI tools are designed to optimize RHIS data that can be used to review progress and performance while enabling data use for policy and action for newborns and stillbirths. The tools strengthen communication between key stakeholders and facilitate standardized data as recommended in global guidance. The seven tools are grouped into three categories—Map Newborn Data, Use Newborn Data for Decisions, and Improve Newborn Data Quality. Follow the link here to see a version of the brief with findings and recommendations from EN-MINI implementation in Tanzania.FS-24-659b
Family Planning Needs across the Life Cycle in Bangladesh: System Considerations for the DGFP and DGHMizanur Rahman, M. Moinuddin Haider, M. Mahabubur Rahman, Shusmita Khan, Sian L. Curtis2023English, , , , A recent technical brief synthesized evidence from a series of analyses conducted by Data for Impact (D4I) of family planning (FP) behaviors across the life course to provide evidence-based recommendations for FP policies in Bangladesh (Rahman et al. 2023a). That brief introduced the “Life Cycle Approach to Family Planning,” which is a person-centered approach that addresses different FP needs at each stage of the reproductive life cycle. Different points in the life cycle offer different opportunities to reach individuals with specific and tailored interventions. In this brief, we elaborate on some system considerations for the Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS) to implement this approach.FS-24-657
Family Planning Needs across the Life Cycle in Bangladesh: Synthesis of Recent Evidence and a Proposed New ApproachMizanur Rahman, M. Moinuddin Haider, M. Mahabubur Rahman, Shusmita Khan, Sian L. Curtis2023English, , , The MEASURE Evaluation and Data for Impact (D4I) project have conducted several analyses of fertility and family planning (FP) in Bangladesh in recent years (Box A.1). This Technical Brief synthesizes findings of these studies and related additional analysis across the life cycle and proposes a new person-centered approach to strengthen FP in Bangladesh. An accompanying policy brief discusses policy and program considerations to operationalize a life cycle approach to FP within the Bangladesh health system (Rahman et al., 2023).FS-24-658
Data for Impact (D4I) Year 5 Annual HighlightsData for Impact2024English, Data for Impact (D4I) works with country partners to strengthen capacity to generate and use high-quality data, investigate program effectiveness, and learn from evidence. This brief shares highlights from D4I's work in Year 5 of the project.FS-24-656
Child Development and Protection Sub-Cluster Meetings, October 2022 to August 2023Data for Impact2024English, , In 2022, the National Child Development Agency Rwanda established the Child Development and Protection Sub-Cluster (CDPSC) coordination mechanism to enhance collaboration between actors in early childhood development (ECD) and the child protection sector. The CDPSC is comprised of governmental and non-governmental institutions and operates under the National Gender and Family Cluster (NGFC) chaired by the Ministry of Gender and Family Promotion (MIGEPROF). The primary mandate of the CDPSC is to strengthen the synergy between the Government of Rwanda and its stakeholders, in the design and implementation of policies, strategies, and plans related to ECD, child rights, and child protection. Sub-cluster meetings provide all actors with insights into ongoing project implementation, allow for knowledge sharing and troubleshooting, reduce duplicative efforts, and encourage cooperation, transparency, and accountability. D4I participates in the CDPSC meetings to provide technical assistance to NCD and its partners in all its efforts of strengthening monitoring and evaluation processes at both the national and district levels. The CDPSC meetings are forums that enable the NCD to track progress on implementations of the various interventions as per the Operational Plan.FS-24-654
Progress Brief: M&E Framework Implementation Plan in RwandaData for Impact2024English, , , , , In 2021, the Government of Rwanda (GOR) undertook a midterm review to assess the progress of the health, nutrition, and early childhood development (ECD) programs as part of the monitoring progress towards maximizing children’s potential. The midterm review aligned with the objectives of the National Early Childhood Development Program (NECDP) Strategic Plan 2018–2024 and the Strategic Plan for the Integrated Child Rights Policy in Rwanda (ICRP) 2019–2024. As a result of the review, the National Child Development Agency (NCD) developed a rolling three-year NCD operational plan (2022/3–2024/5) that integrates objectives and activities from the NECDP and ICRP Strategic Plans. The NCD operational plan (2022/3–2024/5) reflects six new strategic directions in line with the GOR mandate and underscores the need to develop a comprehensive monitoring and evaluation (M&E) plan. During the same period (FY23), the Data for Impact (D4I) project supported NCD to develop an M&E plan (MEP) for the operational plan. The NCD MEP is a national-level harmonized mechanism for performance monitoring and evaluation with an agreed-upon set of activities, outputs, and outcome indicators for tracking progress over the three-year implementation period (2022–2025). The NCD MEP addresses standardization, measurability, accountability, transparency, accuracy, responsiveness, and learning.FS-24-655
Private Sector Engagement (PSE) Self-Assessment Monitoring (SAM) ToolData for Impact2024English, , , , Effective private sector engagement (PSE) is increasingly understood as critical to sustaining development outcomes. USAID maintains that “private enterprise is the single most powerful force for lifting lives, strengthening communities, and accelerating sustainable development.” Accordingly, USAID’s PSE Policy recognizes the importance of “engaging private sector entities early and gaining insight into their roles, motivations, and responses as market and system actors.” However, few resources exist to gauge the partnership process and inform PSE management strategies. Based on the Perceived Worth of Continued Engagement (PWCE) framework developed in 2021, the PSE Self-Assessment Monitoring (SAM) Tool helps fill this gap. It is designed for self-administration by partners engaged in development or humanitarian assistance activities or projects. Used at intervals over the life of a partnership, the tool forms part of a participatory, evidence-informed approach to PSE strengthening. The tool is also available for online use and includes automated analysis and results visualization (just click “register” at the top of the page to get started).TL-22-100
FUTURES Project Midline Evaluation: Key FindingsData for Impact2024English, , , , , The FUTURES—My Forest, My Livelihood, My Family— Packard Foundation-funded project is implemented by CARE Ethiopia and its local partners in the Yayu Coffee Forest Biosphere Reserve of southwestern Oromia, Ethiopia, through an integrated, multisectoral approach with a focus on women and youth. The project is designed to deliver targeted services at the individual, household, and community levels. The project is coordinating with stakeholders from the economic, agricultural, conservation, and reproductive health (RH) sectors to efficiently address the complex and interrelated needs of individuals and communities in the Chora, Dorani, and Yayu woredas. The FUTURES project evaluation, funded by the United States Agency for International Development (USAID), is implemented by Data for Impact (D4I) in collaboration with local research partner Jimma University. A qualitative midline evaluation was conducted to understand knowledge, attitudes, perceptions, and the most meaningful outcomes to date of the project’s multisectoral approach to improving RH, livelihood opportunities, and agricultural and conservation practices. This brief summarizes the Evaluation of the FUTURES Project: Midline Report, by Mitiku, F., Millar, L., Bekele, A., Barden-O’Fallon, J. (2023).FS-23-651
D4I/USAID Tanzania – Intensive Site Monitoring ProcessData for Impact2024English, , , , This document is Appendix A of the D4I Tanzania Intensive Site Monitoring Year End Report. The appendix details the site monitoring process across its three phases: before, during, and after site visits.  
D4I Tanzania Intensive Site Monitoring: Year End ReportData for Impact2024English, , , , , USAID Tanzania required ongoing intensive monitoring and administrative support services to utilize high-quality data to improve programs in real-time and ensure that United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded programs and other technical area programs, including reproductive, maternal, newborn, child, and adolescent health (RMNCAH) and tuberculosis (TB), are meeting their performance targets and providing high-quality services. D4I supported USAID’s needs by conducting intensive site-level monitoring using customized tools developed by USAID. The goal of these intensive site-level monitoring visits was to determine if sites were meeting service quality standards and best practices and to make recommendations for corrective action at the site level based on the assessments. Areas assessed include human immunodeficiency virus (HIV), TB, RMNCAH, and FP. As part of the site-level intensive monitoring visits, the D4I team conducted root cause analysis for each focus area to determine the most important factors, or “why” factors, affecting providers, service delivery, the health system, and processes. This analysis is a collaborative effort with facility staff in identifying the core issues regarding performance. D4I also provides technical assistance to the service providers in the areas where gaps are identified and supports sites in identifying capacity-building needs to improve quality service provision. The geographic focus for these site visits were in the Southern Agricultural Growth Corridor of Tanzania, including the regions of Iringa, Mbeya, Morogoro, Tanga, Katavi, Dodoma, Singida, Dar es Salaam, Manyara, Arusha, Kilimanjaro, Njombe, Ruvuma, Lindi, Mtwara; and the Lake Western Zone, including the regions of Tabora, Geita, Simiyu, Mwanza, Mara, and Shinyanga.TR-23-547
Standard Operating Procedure for Integrating Gender in Monitoring, Evaluation, and ResearchData for Impact2024English, , , This document details D4I's standard operating procedure and provides guidance on integrating gender in monitoring, evaluation, and research. It includes definitions of key terms, details on why gender must be integrated into activities, guidance on language use, example scenarios, and prompts to aid researchers in considering gender integration at every stage of the process.MS-23-229
FUTURES Project Midline Evaluation: Most Significant Change (MSC) ResultsData for Impact2024English, , , , Data for Impact (D4I) conducted a qualitative midline evaluation of the Packard Foundation-funded My Forest, My Livelihood, My Family (FUTURES) project in the Yayo Coffee Forest Biosphere Reserve in the southwestern Oromia Region of Ethiopia to understand perceptions and outcomes of the project’s multisectoral approach to combining interventions in reproductive health (RH), agricultural practices, forest conservation, and livelihood improvement. D4I, in collaboration with local research partner Jimma University, conducted key informant interviews (KIIs) and focus group discussions (FGDs) with project participants, implementors, and collaborators. The Most Significant Change (MSC) approach was used to understand changes resulting from the project.FS-23-650
Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 CountriesMosiur Rahman ,Md. Jahirul Islam, Izzeldin Fadl Adam, Nguyen Huu Chau Duc, Prosannajid Sarkar, Md. Nuruzzaman Haque, Md. Golam Mostofa2023English, , , , Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools—which break down health systems into measurable, trackable components—are one useful way to assess service readiness and the ability of health institutions to deliver FP services.
Investigation of Facility-Level Gender-Based Violence Data Collection and TrackingData for Impact2023English, , , , Gender-based violence (GBV), a prevalent but underreported public health problem, disproportionately affects millions of women and girls worldwide. A key objective of the U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally is to improve the collection, analysis and use of data and research to advance GBV prevention and response efforts. Further, integrating GBV services in family planning (FP) programming is a technical priority for the Office of Population & Reproductive Health. However, one area that needs further investigation is how to efficiently and effectively monitor routine screening for GBV, including but not limited to reproductive coercion and other forms of intimate partner violence (IPV) and non-partner sexual violence (NPSV). In response to this gap, this report focuses on data collection and reporting practices related to GBV identification and response, including routine screening and first-line support, in FP clinics and other facilities that provide sexual and reproductive health services (SRHS). This activity involved conducting a literature review, a review of USAID-funded project monitoring documents, and informational interviews to gather information on facilities’ practices related to data collection and reporting on routine screening and first-line support for GBV among FP clients. The findings from all stages of the investigation were analyzed to identify common themes and provide insights into data collection processes and challenges.SR-23-202
Activité ACCESS à Madagascar : Dossier d’évaluation à mi-parcoursData for Impact2023French, , , , Le programme pour l’Accessibilité du continuum de soins et la pérennisation desservices essentiels (ACCESS) est un programme de santé quinquennal financé à hauteur de 90 millions de dollars par l’Agence des États-Unis pour le développement international (USAID). Cette initiative est axée sur l’amélioration des capacités et de la qualité de la prestation de services au niveau des districts, de la communauté et des établissements de santé. ACCESS collabore également avec le ministère de la Santé publique (MSP) et d’autres parties prenantes à l’échelle nationale pour guider la formulation de politiques et de directives, en complément des efforts de plaidoyer ciblant certains problèmes clés liés à la prestation de services de santé. Le programme a pour but d’accélérer et de pérenniser certaines dynamiques sanitaires au sein de la population malgache, ces impacts étant mesurés par une réduction durable de la mortalité et de la morbidité maternelles et infantiles. Le projet Data for Impact (D4I) a facilité l’évaluation à mi-parcours pour fournir à l’USAID et aux partenaires de mise en œuvre d’ACCESS des informations leur permettant de tirer certains enseignements et de réorienter leurs efforts. L’évaluation devait déterminer les points positifs et les lacunes à combler, et ainsi offrir des solutions ou des axes de travail pour les années restantes du programme.FS-23-630
Madagascar ACCESS Activity: Midterm Evaluation BriefData for Impact2023English, , , The Accessible Continuum of Care and Essential Services Sustained (ACCESS) program is a five-year, $90 million health program funded by the United States Agency for International Development (USAID). The program focuses on improving the capacity and the quality of service delivery at district, community, and facility levels. ACCESS also works with the Ministry of Public Health (MOPH) and other national-level stakeholders to inform policy and guideline development in addition to advocacy on key health service delivery issues. The goal of ACCESS is to accelerate sustainable health impacts for the Malagasy people—as measured by sustained reductions in maternal and child mortality and morbidity. Data for Impact (D4I) facilitated the midterm evaluation to provide information to USAID and ACCESS implementing partners for learning and course correction. The evaluation sought to identify what is working and what is not working and offer solutions or areas of focus for the remaining program years.FS-23-630
Strengthening Local Capacity in Monitoring and Evaluation in MoldovaCamelia Gheorge, Viorica Toartă2023English, , , , There are 37 Territorial Social Assistance Structures (TSAS) in Moldova. TSAS are specialized local bodies with the mission to improve the quality of life of individuals and families by providing support to prevent, reduce or overcome adversity and promote social inclusion. They are also important producers of data on social assistance, reporting on beneficiaries to the central and district governments and other stakeholders. Following an assessment of monitoring and evaluation (M&E) capacity in 2020, TSAS have been developing and implementing an M&E capacity strengthening plan with support from D4I. The results of the assessment showed that, despite a continuously increasing demand for data from different users, TSAS have faced challenges in assuring data quality as well as in the analysis and use of these data to inform decision-making, e.g., limited expertise with available software for basic analyses and data visualization, challenges in formulating performance indicators, and confusion between data reporting and data use. To address these challenges, D4I developed an M&E training curriculum and conducted training programs for all TSAS staff. The project also provided mentoring to 25 priority TSAS and their partners from education, health, and public safety sectors, whose service area covered 74% of the population of Moldova.FS-23-646
Data Standards for Child Care and Protection Case Management Information SystemsData for Impact2023English, , , The purpose of this paper is to provide an overview of data standards and their potential use case in the field of case management information systems (CMISs) for child care and protection, to review the work that has already been done that could be built upon to develop these data standards, to understand the challenges that they would need to overcome, and finally, to identify next steps toward creating them. Open data standards can be considered a cornerstone piece of digital public infrastructure that allows for more meaningful transmission, manipulation, use, and management of data. They are used in many sectors to foster better understanding and transparency of data by making it easier to exchange, thus improving accessibility and usability.TR-23-542
Strengthening the C-TIP Efforts in ArmeniaData for Impact2023English, , This infographic addresses counter-trafficking in persons efforts in Armenia in recent years. It provides an overview of Armenia's three-year National Action Plan and data on the Plan's three primary domains of intervention: prevention, prosecution, and protection.FS-23-647
Summary of the Counter-Trafficking in Persons Working Group MeetingsData for Impact2023English, , The Countering-Trafficking in Persons (C-TIP) Inter-Agency Working Group (WG) on combating trafficking in human beings was established in October 2002 by the Republic of Armenia (ROA) Prime Minister’s Decree No 591-A. The main mandate of the C-TIP WG is to report the progress of combatting human trafficking and exploitation activities to the Anti-Trafficking Council, as per the C-TIP National Action Plan (NAP) in the ROA. The C-TIP WG also submits recommendations to the Anti-Trafficking Council for its comments and approval and submits semiannual reports to the Ministry of Labor and Social Affairs (MOLSA) on their respective activities within the NAP.FS-23-637
Nigeria Health, Population, and Nutrition (HPN) Multi-Activity Evaluation: Sustainability Sentinel IndicatorsData for Impact2023English, , , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (malaria). A set of 15 sentinel indicators were identified to measure progress in commitment/engagement and capacity outcomes across five domains that are expected to support sustainability. Data were gathered from the HPN implementing partners state governments, and a 2021 health facility assessment and 2022 organizational network analysis conducted by D4I. This brief shares more.FS-23-636 D4I
Guide pour les utilisateurs de l’approche intégrée d’évaluation de la qualité des données de planification familialeData for Impact2023French, , Ce document vise à fournir des conseils aux personnels de S&E de Track20, aux gestionnaires de données de PF et aux autres personnels de S&E sur la façon d’utiliser l’approche intégrée de SS to EMU et RDQA afin d’évaluer et de suivre la performance de la qualité des données de PF. Les principaux objectifs sont les suivants :
  • Comprendre comment les méthodologies et les outils de SS to EMU et RDQA peuvent être utilisés conjointement pour produire des mesures complètes et exactes de la performance de la qualité des données de PF.
  • Utiliser les données collectées par la mise en oeuvre de l’approche intégrée SS to EMU et RDQA pour comparer les données de PF recueillies systématiquement avec les données des enquêtes.
  • Développer des recommandations ciblées pour améliorer la qualité des données de PF et encourager la confiance et de la responsabilisation dans le système de santé.
Access the English version.
Evaluation of the FUTURES Project: Midline ReportFikadu Mitiku, Liz Millar, Adugna Eneyew Bekele, Janine Barden-O’Fallon2023English, , , , , The FUTURES—My Forest, My Livelihood, My Family project (FUTURES) serves communities in the Yayu Coffee Forest Biosphere Reserve (YCFBR), located in Oromia Regional State, Ethiopia. The three-year project was launched in April 2021 to address health, environment, and livelihood concerns of the YCFBR region. The project is implemented by CARE Ethiopia and its three local partners, Oromia Development Association (ODA), Environment and Coffee Forest Forum (ECFF), and Kulich Youth Reproductive Health and Development Organization (KYRHDO). FUTURES project activities are designed to target the economy, agriculture, and reproductive health (RH) sectors simultaneously, while working across household, community, and institutional levels, with a focus on women and youth. Project activities include health provider training and community education to reduce stigma to accessing RH services, entrepreneurship training and savings and loan programs for women and youth, diversified livelihood schemes, improved and climate smart agricultural interventions, and the formation and strengthening of multisectoral steering committees and mechanisms for knowledge sharing across sectors. The FUTURES project evaluation, funded by the United States Agency for International Development (USAID), and led by Data for Impact (D4I), aims to understand the impact of the FUTURES project on key health, agricultural, and livelihood and conservation behavioral outcomes, and to contribute to knowledge about the implementation of cross-sectoral programs, including monitoring, evaluation, and learning of such programs. A mixed-methods baseline evaluation was conducted November–December 2021. The baseline evaluation showed fairly high levels of family planning (FP) utilization, livelihood opportunities for women and youth, and improved forest conservation practices. Exceptions were the percentage of women actively using financial services; participation in participatory forest management programs; and the application of various improved crop production practices, technologies, and inputs. Additionally, a low percentage of FP providers had received recent youth-friendly health services training. The full baseline report is available here: https://www.data4impactproject.org/publications/evaluation-of-the-futures-project-baseline-report/. The main development hypothesis that this evaluation aims to address is that integrating a health, livelihood, and environmental programming approach will lead to broader and more sustainable improvements than implementation of single-sector approaches. This report shares findings from the midline evaluation, which sought to contribute to what is known about the process of implementing cross-sectoral programs, including the community response to this type of programming.TR-23-531
USAID Integrated Health Program (IHP) Evaluation Report: Midline Qualitative AddendumDavid Hotchkiss, Lauren S. Blum, Paul-Samson Lusamba-Dikassa, Anicet Yemweni, Janna Wisniewski, Eva Silvestre2023English, , , , , , This report details the methods, informants, and qualitative findings of Data for Impact's evaluation report on the USAID Integrated Health Program (IHP) in the Democratic Republic of Congo. Through key informant interviews, focus group discussions, data collection, and health facility observation, the report describes the ways in which the USAID IHP supports the strengthening of healthcare services through an integrated approach that includes technical, administrative, financial, and personnel management training and the delivery of essential medication, supplies, and formative supervision. The report addresses the IHP as it has been implemented across three provinces in the DRC: Lualaba, South Kivu, and Kasai Oriental.TR-23-522
Child Wellbeing Management Information System (CWMIS): Case Management Data FlowData for Impact2023English, , , , Uganda's Ministry of Gender, Labour, and Social Development (MGLSD) is currently implementing the National Child Policy, 2020. The policy is structured around five priority areas: child health and survival, education and development, childcare and protection, child participation, and systems strengthening. One of the key priority actions under system strengthening is to promote evidence-based planning and programming for children through the development of a comprehensive and integrated Child Wellbeing Management Information System (CWMIS) to improve access to and availability of quality data, information-sharing and national tracking of children’s care and protection outcomes. Currently, the existing information management systems within the MGLSD are fragmented (with limited interoperability), limited in scope and unable to track children longitudinally. The Ministry of Gender, Labour, and Social Development, with support from UNICEF, Data for Impact (D4I) and USAID Strategic Information Technical Support (SITES) conducted an assessment to review the existing management information systems on children’s care and protection in Uganda, to inform the development of a conceptual framework and roadmap for integration of the existing systems. The assessment provided two main recommendations. The first is that the new CWMIS should be aligned to the case management process, with the ability to capture data longitudinally, and ensure interoperability with existing MIS under other government ministries, departments, and agencies such as the Electronic Court Case Management Information Systems, the Police Crime Records Management System, and the Education Management Information Systems. The second recommendation is that the development of the CWMIS should be preceded by a comprehensive mapping of indicators and data flow processes to capture stakeholder information needs and review and initiate the process to standardize tools.SR-23-192
Situația copiilor în sistemul de servicii sociale din municipiul Chișinău, 2019- 2022Data for Impact2023Romanian, Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din municipiul Chișinău în perioada 2019-2022, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel municipal pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Generală pentru Protecția Drepturilor Copilului a municipiului Chișinău pe parcursul celor patru ani.TR-23-537
Situația copiilor în sistemul de servicii sociale din raionul Rezina, 2019-2022Data for Impact2023Romanian, Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din raionul Rezina în perioada 2019-2022, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel raional pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Asistență Socială și Protecție a Familiei (DASPF) din raionul Rezina pe parcursul celor patru ani.TR-23-538
The Two-Stage Integrated Approach MethodologyData for Impact2023English, , , , Efforts to assess and improve the quality of family planning (FP) data are often poorly planned and uncoordinated, leading to inconsistent findings, duplication of effort, and poor management of already limited resources. Decisions on where to target resources for data quality improvement are often based on where there may be partner resources and interest, as opposed to where resources may be most needed or well spent. Dependencies of this kind also lead to an increased burden on national programs to manage the application of multiple partner-developed tools and systems, and attempts to integrate or triangulate their information with existing health management information system (HMIS) data free from the duplication of reported data. This integrated approach to data quality assessment represents a joint effort between the Bill & Melinda Gates Foundation Track20 Project and the United States Agency for International Development (USAID) Data for Impact (D4I) project to target data quality in a way that accounts for limited resources in FP programs by providing a framework to integrate two tools specifically developed for HMIS data quality and use through both a top-down and bottom-up approach. Combining the routine data quality assessment (RDQA) approach with the Service Statistics to Estimated Modern Use (SS to EMU) approach for identifying sources of “quality issues” in data represents an important step toward improving targeted management of health information and moving this assessment to facilities and subnational levels with the greatest need. The implementation of the integrated approach will consist of (1) using the SS to EMU tool to conduct a data quality desk review at the management level to identify data inconsistencies in selected indicators, and (2) to use the RDQA to assess the quality of data at the health facility and community site levels. Access the Training Curriculum for the Integrated Approach to Family Planning Data Quality Assessment resources in English and French.FS-23-644
High Impact Practices (HIPs) in Family Planning: Measuring and Monitoring HIP Implementation with Core Components: Example HIP Core Component ChecklistsData for Impact2023English, , , , , , The High Impact Practices (HIPs) in family planning (FP) are a collection of evidence-based practices, identified by global experts, that have demonstrated impact on contraceptive uptake and other related outcomes in varied settings. As FP programs increasingly integrate HIPs, questions have arisen about defining the essential elements that make up a HIP. Data for Impact (D4I) assessed three of eight service delivery HIPs across selected USAID-funded projects in Bangladesh and Tanzania to address these questions. The assessment sought to understand the extent that the three service delivery HIPs follow implementation standards or core components. Administering HIPs core components checklists is one method to monitor HIPs implementation. This document includes the 20 core component checklists used by the data collection teams in the D4I assessment. A methodological brief provides step-by-step guidance for FP projects to conduct a self-assessment of HIPs implementation. Download a summary brief or read the full assessment report here: High Impact Practices (HIPs) in Family Planning (FP): A qualitative assessment of quality and scale of implementation for three service delivery HIPs in Bangladesh and Tanzania.    TL-23-107 D4I
High Impact Practices (HIPs) in Family Planning Summary Brief: Assessing HIP Core ComponentsData for Impact2023English, , , , This brief summarizes the methodology, results, and recommendations of a Data for Impact (D4I) assessment, High Impact Practices (HIPs) in Family Planning (FP): A qualitative assessment of quality and scale of implementation for three service delivery HIPs in Bangladesh and Tanzania. FS-23-632a D4I
High Impact Practices (HIPs) in Family Planning: Methodological Brief on Monitoring HIPs Implementation with Core ComponentsData for Impact2023English, , , , This brief summarizes a methodology used in a Data for Impact (D4I) assessment, High Impact Practices (HIPs) in Family Planning (FP): A qualitative assessment of quality and scale of implementation for three service delivery HIPs in Bangladesh and Tanzania, and provides step-by-step guidance for FP projects monitoring HIP implementation.FS-23-632b D4I
Effect of COVID-19 on Health Services Use in Bangladesh and Uganda (Dataset)Data for Impact (University of North Carolina at Chapel Hill), Ministry of Health and Family Welfare (Government of Bangladesh), Ministry of Health (Republic of Uganda) 2022English, , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.     We used routine health information system data since January 2017 to analyze the effect of COVID-19 on reporting and service utilization for a variety of health services. Based on data availability and completeness rate of the basic essential health services, we selected 11 indicators for Uganda and eight indicators for Bangladesh. The variables included overall attendance in the outpatient department, 1st and 4th antenatal visits, facility deliveries, BCG/measles/DPT/pentavalent vaccines, family planning services, and childhood diarrhea/malaria/pneumonia cases. DS-22-009 D4I
Assessment of the Zimbabwe Assistance Program in Malaria (Dataset)Data for Impact; Zimbabwe National Malaria Control Program (NMCP); President's Malaria Initiative (PMI)2022English, , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.     This data was aggregated for the purposes of evaluating ZAPIM in Zimbabwe. Data for Impact (D4I) sought to document the current status of malaria management practices and progress that the project has made since its inception with an assessment to address these questions: - What are the trends in malaria intervention coverage in ZAPIM and non-ZAPIM districts? - What are the trends in malaria morbidity and mortality in ZAPIM and non-ZAPIM districts? - What is the capacity of the NMCP and the districts to manage and implement various malaria interventions in ZAPIM and non-ZAPIM districts? - What are the facilitators of and barriers to planned achievements by the ZAPIM project? The assessment used a mixed-methods approach comprising a document review, secondary data analysis, key informant (KI) interviews, health facility assessments, and an organizational capacity assessment. This data was aggregated to address the first two points. DS-22-008 D4I
Evaluation of the Private Health Sector Project in Ethiopia: Private Health Facility Assessment (PHFA) 2020 (Dataset)Data for Impact; USAID/Ethiopia; Addis Continental Institute of Public Health (ACIPH); Private Health Sector Project (PHSP)2022English, , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.     The five-year (2015-2020) Private Health Sector Project (PHSP) aimed to improve the quality and availability of priority health services (tuberculosis, malaria, family planning and maternal and child health) in Ethiopia through strengthened partnerships between the private and public health sectors. As part of the PHSP’s endline evaluation, a health facility assessment was conducted at 106 PHSP-supported private health facilities. Topics covered in the assessment were general information about the types of services provided by the health facility; the kinds of support received from the PHSP, including details on training, supportive supervision, and mentorship; and information on the different program areas, stockouts of drugs, and the cost of services.  DS-22-007 D4I
2021 DRC Health Facility Survey: Midline Data Collection (Dataset)Data for Impact; Tulane University; Kinshasa School of Public Health, Ministry of Public Health2022English, , , , , , his dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.     As part of its strategy to improve health outcomes in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) funded the USAID Integrated Health Program (IHP) in 2018. The program began operations in July 2018 and is being implemented by Abt Associates and several partner organizations. The purpose of USAID IHP is to strengthen the capacity of Congolese institutions and communities to deliver high-quality, integrated health services to sustainably improve the health status of the country’s population. The specific health, population, and nutrition areas of focus for the project are maternal health; neonatal, infant, and child health; tuberculosis (TB); malaria; child nutrition; water, sanitation, and hygiene (WASH); and family planning (FP). USAID IHP is working in nine contextually diverse provinces in the regions of Eastern Congo, Katanga, and Kasai, and implements a wide array of interventions. Given the breadth and depth of the planned interventions, the USAID Mission in DRC requested Data for Impact (D4I) to conduct an independent, third-party evaluation of the performance and impact of USAID IHP on key health systems-related outcomes, including the uptake of FP and healthcare services; health systems functioning (i.e., improved disease surveillance, the availability of essential commodities, and health worker motivation); and the practice of key healthy behaviors. The available data sets constitute the basis for the performance evaluation and provide information on provincial health offices, health zone offices, hospitals, health centers, and community-based health systems (i.e., health area development committees and community health workers). DS-22-006 D4I
Evaluation of the Improving Nutrition through Community Approaches (INCA) Project in Bangladesh: Outcome and Impact Evaluation (Dataset)Khan, S., Angeles, G., Rahman, M., Chakraborty, N., Moinuddin Haider, M., Escudero, G., Ahsan, K.Z., Ijdi, R.E. (Data for Impact, University of North Carolina at Chapel Hill) 2022English, , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.     The Improving Nutrition through Community-Based Approaches (INCA) project was designed to provide a comprehensive set of community and service strengthening activities with the objective of strengthening nutrition knowledge, practices, and use of services to improve the nutritional status of pregnant women and children under age two (0–23 months) living in selected areas in southern Bangladesh. INCA was a three-year project (May 2017‒May 2020) with the specific objective to improve nutritional practices during the “first 1,000 days of life” to prevent irreversible stunting in children under the age of two. The overall purpose of the INCA evaluation was to assess how well the project achieved that objective by examining changes in key population-level indicators of knowledge, practices, use of services, and nutritional status between the 2017 baseline and the 2019 endline surveys. The baseline and endline surveys were conducted in September 2017–October 2017 and December 2019–January 2020, respectively, with mothers with children under two years and pregnant women in the project and comparison areas (eight upazilas bordering/neighboring the INCA areas). The evaluation was based on a prospective, quasi-experimental difference-in-differences (DID) design and used data from representative household surveys conducted in the 2017 baseline and 2019 endline. The endline survey was conducted on a representative sample of pregnant women and women with children under age two living in the INCA target areas and in the comparison areas. In total, 5,810 households were surveyed in INCA intervention areas and 5,271 households in comparison areas, along with 457 facilities and 272 out of 471 Community Nutrition Providers (CNPs), in the endline survey—the sample size was selected to be sufficiently large to detect the expected changes in the key indicators, with 95% confidence and 80% power. DS-22-005 D4I
Organizational Network Analysis of AGYW Referrals in Botswana (Dataset)Data for Impact2022English, , , , , , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the “File” tab.     The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program, a public-private partnership, is being implemented by the United States Agency for International Development (USAID) in two districts of Botswana to address the structural drivers that increase Adolescent Girls and Young Women's (AGYW) HIV risk, including poverty, gender inequality, GBV, and a lack of education. To support the implementation of DREAMS activities in Gaborone and Kweneng East, USAID contracted Data for Impact (D4I), which is funded by USAID and the United States President’s Emergency Plan for AIDS Relief, to conduct a mixed-methods study in these districts to learn more about referral networks that provide AGYW with DREAMS-related services. D4I conducted an organizational network analysis (ONA) to map the referral network in use by DREAMS partners that provide the following services: HIV and GBV prevention, HIV testing, condom distribution and other family planning (FP) services, pre-exposure prophylaxis (PrEP), contraceptive services, post-GBV care services, and socioeconomic interventions. DS-22-004 D4I
Bangladesh Adolescent Health and Wellbeing Survey 2019-2020 (Dataset)Data for Impact2021English, , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.   The primary objective of the Bangladesh Adolescent Health and Wellbeing Survey (BAHWS) 2019-20 was to examine and better understand the state of health and wellbeing of male and female adolescents ages 15-19 years in the country. The survey was conducted with a nationally representative sample of 72,800 households, and 67,093 households (98%) were successfully interviewed. A total of 4,926 ever-married female (97% response rate), 7,800 unmarried female (94% response rate), and 5,523 unmarried male (85% response rate) adolescents ages 15-19 were successfully interviewed from the selected households using three types of individual questionnaires (ever-married female adolescents, unmarried female adolescents, and unmarried male adolescents) that were piloted before data collection began. Data collection occurred in five phases, with each phase taking approximately four weeks to complete. Data collection started on July 25, 2019 and was completed on January 10, 2020.DS-21-003 D4I
Journalist Training Assessment, 2020 (Dataset)Data for Impact2021English, , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.    These are data from an assessment of training of journalists and youth advocates in family planning and reproductive health that was conducted by projects funded by the United States Agency for International Development Office of Population and Reproductive Health (PRH) from 2014 through 2020. The Population Reference Bureau (PRB) conducted a majority of the PRH-funded journalist trainings through their flagship Women’s Edition training and their Youth Multimedia trainings. ICF International also delivered PRH-funded journalist training under the Demographic and Health Survey (DHS) project. The purpose of this assessment is to provide a complete picture of the trainings from the perspective of the implementing organizations and trainees. These data are of: (1) online survey of trainees (2) Tweets posted by trainees. DS-21-002 D4I
Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016 (Dataset)National Institute of Population Research and Training, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and MEASURE Evaluation. (University of North Carolina at Chapel Hill) 2021English, , , , This dataset is available through UNC Dataverse. To download the data, click the link and use the “Access Dataset” option or select and download individual files under the File tab.   The major objectives of the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS) were to provide a nationally representative estimate of the maternal mortality ratio (MMR) for three years preceding the survey (approximately 2014–2016), to identify the causes of maternal deaths, and to assess maternal health seeking behavior indicators and compare them with the BMMS 2010 to see how well the country is progressing toward national and global targets for maternal health since the 2010 survey. The survey was conducted in a nationally representative sample of 306,961 households. In each selected household, ever-married women ages 13 to 49 were interviewed and any deaths among women of reproductive age in the household were investigated using a verbal autopsy instrument, with particular attention to maternal and pregnancy-related deaths. Data collection was carried out over a period of six months from August 22, 2016 to February 10, 2017. DS-21-001 D4I
Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systemsGustavo Angeles, Hannah Silverstein, Karar Zunaid Ahsan, Mohammad Golam Kibria, Nibras Ar Rakib, Gabriela Escudero, Kavita Singh, Jamiru Mpiima, Elizabeth Simmons, William Weiss2023English, , , , Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country. We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services. The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services.
Area-specific COVID-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system dataGustavo Angeles, Hannah Silverstein, Matt Worges, David R. Hotchkiss, Janna M. Wisniewski, Paul Samson Lusamba Dikassa, William Weiss & Karar Zunaid Ahsan 2023English, , , , Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017–February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic.
Improving Information System Usability for Child Protection in ColombiaAndrea Navarrete, Allison Connolly2023English, , , , This report describes the methodology used by D4I to assist Colombian Institute for Family Welfare (ICBF) to improve the usability of the Sistema de Información Misional (SIM), an operational information system. Specifically, the report explains how D4I guided ICBF to identify the most important end user needs to manage child protection cases in SIM, devise solutions and validate them with end users, and create the associated technical documentation. In addition to qualitative inquiries, customer journey mapping, user stories, and interactive prototyping are among the methods discussed. This report is also available in Spanish.TR-23-538
Fortalecimiento de la usabilidad del Sistema de Información Misional para apoyar la protección de los niños, niñas y adolescentes en ColombiaAndrea Navarrete, Allison Connolly2023Spanish, , , , , Este informe describe la metodología utilizada por el proyecto Data for Impact (D4I) para trabajar en conjunto con el Instituto Colombiano de Bienestar Familiar (ICBF) en el fortalecimiento de la usabilidad del Sistema de Información Misional (SIM). Específicamente, el informe describe el proceso metodológico utilizado por D4I para guiar al equipo de profesionales del ICBF en identificar las principales necesidades de los usuarios finales del sistema en lo que respecta a las pantallas relacionadas con los usuarios, y con la verificación y el restablecimiento de sus derechos, en idear soluciones y validarlas con los usuarios finales, y en elaborar los requerimientos técnicos necesarios para realizar el desarrollo en SIM. Este documento tiene como objetivo principal ser un recurso metodológico útil para proyectos futuros al interior del ICBF. A lo largo de este, no se profundizará en los resultados de cada fase del proceso, ya que estos ya han sido descritos en otros documentos. Este informe está disponible en inglés también.TR-23-534
Curriculum de formation pour l’approche intégrée d’évaluation de la qualité des données de planification familialeData for Impact2023French, , Comprendre pourquoi il est important de collecter des données de planification familiale de bonne qualité et introduire une approche holistique que le personnel de suivi et évaluation (S&E) de la planification familiale (PF) et les gestionnaires des programmes peuvent utiliser pour assurer la disponibilité de données de PF de bonne qualité pour la prise de décision et la planification stratégique. Also available in English.MS-20-198-FR D4I
Guide pour les utilisateurs de l’approche intégrée d’évaluation de la qualité des données de planification familialeData for Impact2023French, , Ce document vise à fournir des conseils aux personnels de S&E de Track20, aux gestionnaires de données de PF et aux autres personnels de S&E sur la façon d’utiliser l’approche intégrée de SS to EMU et RDQA afin d’évaluer et de suivre la performance de la qualité des données de PF. Les principaux objectifs sont les suivants :
  • Comprendre comment les méthodologies et les outils de SS to EMU et RDQA peuvent être utilisés conjointement pour produire des mesures complètes et exactes de la performance de la qualité des données de PF.
  • Utiliser les données collectées par la mise en oeuvre de l’approche intégrée SS to EMU et RDQA pour comparer les données de PF recueillies systématiquement avec les données des enquêtes.
  • Développer des recommandations ciblées pour améliorer la qualité des données de PF et encourager la confiance et de la responsabilisation dans le système de santé.
Access the English version.
Association of gender-related factors and household food security in southwest Oromia, Ethiopia: Evidence from a cross-sectional studyHonelgn Nahusenay Hiruy, Janine Barden-O’Fallon, Fikadu Mitiku, and Elizabeth Millar 2023English, , , Background Food insecurity is a major concern across Ethiopia and a long-standing public health problem. Vulnerability to food insecurity varies by several individual and household factors; however, understanding the role of gender-related factors can serve as additional input for designing policy and interventions. A cross-sectional survey was conducted in the Yayu Coffee Forest Biosphere Reserve in southwest Oromia, Ethiopia as part of a baseline assessment for the My Forest, My Livelihood, My Family program. A total of 1.113 households were selected from six woredas (districts) using a two-stage sampling procedure. The outcome variable was measured using the Household Food Insecurity Access Scale, version 3. The association between gender-related factors and household food security was assessed by fitting a logistic regression. Results The prevalence of food insecurity was 62.4%, with 28.1% of households assessed as severely food insecure. Households with both the wife and husband making decisions about major purchases were associated with an increased odds of household food security (adjusted odds ratio [AOR] 1.44, confidence interval [CI] 1.06, 1.96). The odds increased when the woman alone made these decisions (AOR 2.15, CI 1.20, 3.85). Women’s formal education was also associated with increased odds of household food security. Conclusions This study adds evidence that policy and programmatic interventions that improve the agency of women to participate in asset ownership and household economic decision making, expand female literacy and education, and diversify income sources to include off-farm wage employment in the Yayu Coffee Forest Biosphere Reserve are important steps for improving household food security.JA-23-298 D4I
Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systemsGustavo Angeles, Hannah Silverstein, Karar Zunaid Ahsan, Mohammad Golam Kibria, Nibras Ar Rakib, Gabriela Escudero, Kavita Singh, Jamiru Mpiima, Elizabeth Simmons, William Weiss2023English, , , , Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country. We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services. The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services.
Curriculum de formation pour l’approche intégrée d’évaluation de la qualité des données de planification familialeData for Impact2023French, , Comprendre pourquoi il est important de collecter des données de planification familiale de bonne qualité et introduire une approche holistique que le personnel de suivi et évaluation (S&E) de la planification familiale (PF) et les gestionnaires des programmes peuvent utiliser pour assurer la disponibilité de données de PF de bonne qualité pour la prise de décision et la planification stratégique. Also available in English.MS-20-198-FR D4I
Guide pour les utilisateurs de l’approche intégrée d’évaluation de la qualité des données de planification familialeData for Impact2023French, , Ce document vise à fournir des conseils aux personnels de S&E de Track20, aux gestionnaires de données de PF et aux autres personnels de S&E sur la façon d’utiliser l’approche intégrée de SS to EMU et RDQA afin d’évaluer et de suivre la performance de la qualité des données de PF. Les principaux objectifs sont les suivants :
  • Comprendre comment les méthodologies et les outils de SS to EMU et RDQA peuvent être utilisés conjointement pour produire des mesures complètes et exactes de la performance de la qualité des données de PF.
  • Utiliser les données collectées par la mise en oeuvre de l’approche intégrée SS to EMU et RDQA pour comparer les données de PF recueillies systématiquement avec les données des enquêtes.
  • Développer des recommandations ciblées pour améliorer la qualité des données de PF et encourager la confiance et de la responsabilisation dans le système de santé.
Access the English version.
D4I Technical Assistance on the Establishment of the Case Management Information System (CMIS) in ArmeniaData for Impact2023English, , , To foster improved services for children in difficult life situations, prevent unnecessary separation, and support early reunification with a focus on breaking the cycle of re-institutionalization, the social workforce needs routine and reliable data as well as tools to easily mobilize existing services. The case management information systems (CMIS) can help case workers operate more efficiently and effectively, providing them with reliable data on child-specific resources, services, needs, and wellbeing outcomes. The CMIS can also support effective referral systems and information sharing among provider agencies (e.g., day care centers, emergency shelters, schools, police, hospitals, courts, and social services), ensuring that children receive timely, coordinated services for the best outcomes. This brief summarizes the continuous efforts of D4I in promoting the establishment of an operational and multifunctional CMIS for the Ministry of Labour and Social Affairs of Armenia (MOLSA) to collect, monitor, and report data on the situation of children in residential and family-based alternative care as well as those who may be at risk of violence, abuse, or neglect.FS-23-635
Levels and trends in mortality and causes of death among women of reproductive age in Bangladesh: Findings from three national surveysQuamrun Nahar, Anadil Alam, Kaiser Mahmud, Shahnaj Sultana Sathi, Nitai Chakraborty, Abu Bakkar Siddique, Ahmed Ehsanur Rahman, Peter K Streatfield, Kanta Jamil, Shams El Arifeen2023English, , , Information on the mortality rate and proportional cause-specific mortality is essential for identifying diseases of public health importance, design programmes, and formulating policies, but such data on women of reproductive age in Bangladesh is limited. We analysed secondary data from the 2001, 2010, and 2016 rounds of the nationally representative Bangladesh Maternal Mortality and Health Care Survey (BMMS) to estimate mortality rates and causes of death among women aged 15-49 years. We collected information on causes of death three years prior to each survey using a country-adapted version of the World Health Organization (WHO) verbal autopsy (VA) questionnaire. Trained physicians independently reviewed the VA questionnaire and assigned a cause of death using the International Classification of Diseases (ICD) codes. The analysis included mortality rates and proportional mortality showing overall and age-specific causes of death. There was a gradual shift in the causes of death from communicable to non-communicable diseases among women of reproductive age in Bangladesh. Suicide as the primary cause of death among teenage girls demands urgent attention for prevention.JA-23-299
D4I Year 5 Semi-Annual HighlightsData for Impact2023English, Data for Impact (D4I) works with country partners to strengthen capacity to generate and use high-quality data, investigate program effectiveness, and learn from evidence. This brief shares highlights from D4I's work in Year 5 of the project.FS-23-634
Assessment of the Medical Equipment Information System in USAID IHP-Supported Provinces in the Democratic Republic of CongoJanna Wisniewski, Marc Bosonkie, Jonathan Niles, Paul-Samson Lusamba-Dikassa2023English, , , , Efforts to improve health-related supply chains in the Democratic Republic of Congo (DRC) typically focus on medicines and vaccines, while the medical equipment system is either overlooked or considered incidental. This research was conducted to assess the performance of the medical equipment information system in the DRC and make recommendations for its improvement. The study aimed to understand the design and functionality of the medical equipment information system, identify strengths and weaknesses, and examine the impact of the system on health service delivery. The research also explored the role of donor support in the medical equipment information system. Data for the study came from a desk review of national policies and procedures, as well as key informant interviews conducted at central and provincial levels in three provinces. In-depth interviews were also conducted with health zone chief physicians, hospital heads, and head nurses in selected health zones. Overall, the medical equipment information system in the DRC is not functioning as designed, leading to inadequate availability and maintenance of equipment in health facilities. The Ministry of Public Health should consider investing in strengthening this system as a means of improving overall health service delivery. The findings of this study can serve as an example methodology for assessing medical equipment systems in other low-income countries, highlighting the importance of this often-overlooked component of quality health services.SR-23-187
Situația copiilor în sistemul de servicii sociale din raionul Drochia, 2019-2022, Buletin informativData for Impact2023Romanian, , Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din raionul Drochia în perioada 2019-2022, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel raional pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Asistență Socială și Protecție a Familiei din raionul Drochia pe parcursul celor patru ani.TR-23-524-RO D4I
Care System Reform Information Needs FrameworkData for Impact2023English, , To aid decision makers in tracking their efforts on national care system reforms, the Data for Impact (D4I) team developed a care system reform logic model and completed an indicator mapping exercise. This resource presents a shared conceptual and measurement framework along with indicators that can be used to gauge the progress and outcomes of reforms at the country level. To supplement this logic model and indicator mapping, D4I has produced a care system reform information needs framework. Through easy-to-reference tables on the different and distinct information sources that can be used, alongside scenarios illustrating their use, this framework is intended to help decision makers, program designers, and implementers in identifying the most appropriate data for answering key questions around care system reform and in their broader monitoring and evaluation activities.SR-23-189 D4I
Counter-Trafficking in Persons (C-TIP): Data Sources Review ReportData for Impact2023English, , , The United States Agency for International Development-funded (USAID) Data for Impact (D4I) project is strengthening the Government of Armenia’s (GOAM) capacity and systems to support efforts in counter trafficking and forced labor. Specifically, D4I is supporting the Ministry of Labor and Social Affairs (MOLSA) to effectively implement and monitor the 2020–2022 National Action Plan (NAP) and to strategically communicate the issues surrounding counter-trafficking in persons (C-TIP) and the country’s response with key stakeholders, at-risk populations, and the public at large. D4I supports the use of evidence to strengthen MOLSA’s capacity to accelerate immediate implementation of the NAP while also building practices and systems that will promote a sustained national C-TIP response in the years to come. C-TIP actors need data on trafficking to understand the magnitude of trafficking, the gender and age of those affected, and the forms of exploitation reported. The C-TIP data flow mapping exercise was conducted to document the current institutional data flow and reporting for the Division of Anti-Trafficking and Women’s Affairs and to improve the data collection and reporting processes, identify gaps, and provide recommendations to improve data flow in the division. The report provides a summary of information flow among the C-TIP actors. It maps the different sources of case data to be collated. The summary data sources report provides data needed for case management and for policy planning and implementationSR-23-186 D4I
Compendiu statistic privind monitorizarea drepturilor persoanelor cu dizabilități în Republica Moldova pentru anii 2019-2022Ministerului Muncii și Protecției Sociale al Republicii Moldova2023RomanianUn Compendiu statistic privind drepturilor persoanelor cu dizabilități în Republica Moldova pentru anii 2019-2022 a fost elaborat, la solicitarea Ministerului Muncii și Protecției Sociale, pentru a consolida sistemului centralizat de colectare a datelor statistice în domeniul dizabilității în scopul analizei și utilizării datelor în beneficiul persoanelor cu dizabilități. Studiul a fost realizat cu suportul proiectul „Date pentru impact”, finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională. Compendiul cuprinde date statistice pentru cele nouă domenii incluse în Matricea de indicatori statistici a drepturilor persoanelor cu dizabilități din Republica Moldova. Fiecare secțiune conține informații statistice cu vizualizări, tabele și diagrame pe domeniile: demografie, ocupare, educație, sănătate, protecție socială, justiție (drepturile omului), acces la transport și infrastructură, participare la viața publică, privată și culturală, viața publică și limitări funcționale. Concomitent, documentul prezintă date și informații referitoare la situația persoanelor cu dizabilități la nivel național, necesare pentru atingerea următoarelor obiective: – sprijinirea procesului de luare a deciziilor bazate pe evidențe; – monitorizarea progresului în implementarea documentelor de politici relevante persoanelor cu dizabilități; – susținerea raportării pe bază de date corecte, complete și la zi în conformitate cu angajamentele internaționale ale țării; – creșterea transparenței și a bunei guvernări în promovarea și respectarea drepturilor persoanelor cu dizabilități. Compendiul statistic privind monitorizarea drepturilor persoanelor cu dizabilități în Republica Moldova pentru anii 2019-2022 reflectă situația reală din țara noastră, sintetizată în baza informațiilor prezentate de 26 de producători de date, cu care Ministerul va colabora în continuare, pentru a putea genera date utile în procesul de elaborare și promovare a politicilor din domeniu.
Differences by age group in gender-related attitudes in Oromia, Ethiopia: Findings from a cross-sectional study of women of reproductive ageElizabeth Millar, Fikadu Mitiku, Honelgn N. Hiruy, and Janine Barden-O’Fallon2023English, , , Attitudes on gender roles affect decision-making dynamics, resource distribution, and income-generating opportunities. However, little is known about how attitudes on gender roles differ by age group. Cross-sectional data collected from 1,113 households in Oromia, Ethiopia were used to assess differences in gender-related attitudes across female “youth” (ages 15–24), “young adults” (ages 25–34), and “older adults” (ages 35–49). Fifteen survey questions using a Likert scale measured attitudes on sexual and reproductive behaviors, expectations around livelihood activities, and perceived influence in household decision making. Associations between attitudes and age group were assessed using the Chi-squared test. Measures of perceived influence in decision making differed significantly by age group for household decisions about participation in wage employment, and use of revenue generated from wage employment, and crop and livestock production. Response patterns were consistent, with youth least likely to feel they have influence in decision making. The results suggest that policies and programs should continue to support the agency of female youth.JA-23-296 D4I
Republica Moldova: Copiii beneficiari ai serviciilor sociale în 2022Data for Impact2023Romanian, , Acest buletin statistic a fost realizat în cadrul proiectului ”Date pentru impact” (D4I), finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională (USAID). Proiectul urmărește valorificarea puterii datelor în scopul îmbunătățirii politicilor, programelor și rezultatelor acestora pentru copii și alte grupuri vulnerabile ale populației (https://www.data4impactproject.org). În Republica Moldova, USAID susține implementarea proiectului „Date pentru Impact: Valorificarea puterii datelor în beneficiul copilului”, care are drept obiectiv general consolidarea capacității guvernului și a partenerilor săi, la nivel național și subnațional, de colectare, analiză și utilizare a datelor pentru a genera un impact pozitiv asupra copiilor aflați în dificultate. Acest buletin prezintă o imagine statistică de ansamblu asupra copiilor beneficiari de servicii sociale în anul 2022 în baza datelor colectate de Agenția Națională Asistență Socială (ANAS) în conformitate cu Planul anual de lucrări statistice. Colectarea, centralizarea și analiza datelor a avut loc în perioada ianuarie – martie 2023. Serviciile sociale reprezintă ansamblul de măsuri și activități realizate pentru satisfacerea necesităților sociale ale persoanei sau familiei, în scop de depășire a unor situații de dificultate, precum și de prevenire a marginalizării și excluziunii sociale. Dreptul la servicii sociale este stabilit în mod individual, în baza evaluării necesităților persoanei/familiei.SR-23-188-RO D4I
2023-2025 թ.թ. Մարդկանց Թրաֆիքինգի դեմ պայքարի գործողությունների ազգային ծրագրի արդյունքային շրջանակData for Impact2023Armenian, , Նպատակ՝ Բարելավված արձագանք մարդկանց թրաֆիքինգին կամ շահագործմանըTL-23-106b ARM
Results Framework for Human Trafficking and Exploitation: The 2023-2025 National Action PlanData for Impact2023English, , The results framework is intended to further the goal of improving response to human trafficking and exploitation in Armenia.TL-23-106a D4I
C-TIP Data Flow Brief: Collection, Reporting, and Recommendations of Identified GapsData for Impact2023English, This data flow brief provides an overview of collection and reporting in Armenia and shares recommendations for identified gaps.FS-23-623 D4I
Rapport de visite d’étude : Visite d’échange de Madagascar en ÉthiopieData for Impact2023French, , , Du 26 mars au 1er avril 2023, une délégation formée de décideurs et de professionnels de santé de Madagascar a réalisé une visite en Éthiopie dans le cadre d’un échange pour apprendre en quoi consistent le système des soins de santé primaires (SSP) et le programme de santé communautaire. Cette visite d’échange de connaissances a été organisée par le projet Data for Impact (D4I), en collaboration étroite avec l’International Institute for Primary Health Care – Ethiopia (IPHC-E), John Snow Inc. (JSI) et ses bureaux nationaux en Éthiopie et à Madagascar. La délégation était dirigée par la secrétaire générale de la Santé Publique de Madagascar et a inclus le secrétaire général du ministère de l’Économie et de la Finance, le directeur général du ministère de l’Intérieur et de la Décentralisation, ainsi que des membres du personnel de chaque niveau du ministère de la Santé Publique, des représentants du projet « Accessible Continuum of Care and Essential Services » (ACCESS) de l’USAID (Agence des États-Unis pour le développement international)/Management Sciences for Health (MSH), et USAID Madagascar1. Cette visite d’échange a compris des réunions avec le personnel du ministère de la Santé éthiopien d’Addis Abeba, dont des réunions avec Son Excellence la Dre Lia Tadesse, ministre de la Santé éthiopienne ; des réunions avec le personnel médical des bureaux de santé régionaux et des districts ; des visites sur le terrain dans des centres de santé ruraux, périurbains et urbains ; ainsi que des interactions étroites avec le personnel éthiopien responsable des soins de santé primaires (SSP), des agents de vulgarisation sanitaire (HEW) et des bénévoles de santé communautaire. Ce rapport décrit les objectifs et les principales activités de la visite et met en évidence certaines observations et les domaines d’intérêt exprimés par la délégation qui pourraient être appliqués pour renforcer le programme de SSP et de santé communautaire de Madagascar. English: https://www.data4impactproject.org/publications/study-visit-report-madagascar-exchange-visit-to-ethiopia/ SR-23-180-FR D4I
Nigeria HPN Multi-Activity Evaluation Most Significant Change (MSC) Workshop Results: Ebonyi, Kebbi, and Zamfara StatesData for Impact2023English, , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused (malaria) approach. D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd. (DRMC), conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara states in July and August 2022 to better understand the perceived impact of HPN activities where different combinations of the four activities are being implemented.SR-23-177a D4I
Nigeria HPN Multi-Activity Evaluation Most Significant Change Workshop Results: Ebonyi StateData for Impact2023English, , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused (malaria) approach. D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd. (DRMC), conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara states in July and August 2022 to better understand the perceived impact of HPN activities where different combinations of the four activities are being implemented. This report presents the results from Ebonyi.SR-23-177d D4I
Nigeria HPN Multi-Activity Evaluation Most Significant Change Workshop Results: Zamfara StateData for Impact2023English, , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused (malaria) approach. D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd. (DRMC), conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara states in July and August 2022 to better understand the perceived impact of HPN activities where different combinations of the four activities are being implemented. This report shared the results from Zamfara.SR-23-177i D4I
Nigeria HPN Multi-Activity Evaluation Most Significant Change Workshop Results: Kebbi StateData for Impact2023English, , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused (malaria) approach. D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd. (DRMC), conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara states in July and August 2022 to better understand the perceived impact of HPN activities where different combinations of the four activities are being implemented. This report shared the results from Kebbi.SR-23-177g D4I
Preeclampsia and eclampsia-specific maternal mortality in Bangladesh: Levels, trends, timing, and care-seeking practicesShusmita Khan, Abu Bakkar Siddique, Sabrina Jabeen, Aniqa Tasnim Hossain, M Moinuddin Haider, Fatema Tuz Zohora, Md Mahabubur Rahman, Shams El Arifeen, Ahmed Ehsanur Rahman, Kanta Jamil2023English, , Background: Despite improvements in many health indicators, maternal mortality has plateaued in Bangladesh. Achieving the global target of reductions in maternal mortality and the associated Sustainable Development Goals will not be possible without actions to prevent deaths due to preeclampsia/eclampsia. Here we examined the levels, trends, specific causes, timing, place, and care-seeking behaviours of women who died due to these two causes. Methods: We used nationally representative Bangladesh Maternal Mortality and Health Care Surveys (BMMSs) conducted in 2001, 2010, and 2016 to examine levels and trends of deaths due to preeclampsia/eclampsia. We based the analysis of specific causes, timing, and place of preeclampsia/eclampsia deaths, and care seeking before the deaths on 41 such deaths captured in the 2016 survey. We also used BMMS 2016 survey verbal autopsy (VA) questionnaire to highlight stories that put faces to the numbers. Results: The preeclampsia/eclampsia-specific mortality ratio decreased from 77 per 100 000 live births in the 2001 BMMS to 40 per 100 000 live births in the 2010 BMMS, yet halted in the 2016 BMMS at 46 per 100 000 live births. Although preeclampsia/eclampsia accounted for around one-fifth of all maternal deaths in the 2010 BMMS, in the 2016 BMMS, the percentage contribution reached the 2001 BMMS level of 24%. An analysis of the VA questionnaire’s open section showed that almost all such death cases left their homes to seek care; however, most had to visit more than one facility before they died, indicating an unprepared health system. Conclusions: A cluster of preeclampsia/eclampsia-specific mortality observed during the first trimester, during delivery, and within 48 hours of birth indicates a need for preconception health check-ups and strengthened facility readiness. Awareness of maternal complications, proper care seeking, and healthy reproductive practices, like family planning to space and limit pregnancy through client-supportive counselling, may be beneficial. Improving regular and emergency maternal services readiness is also essential.JA-23-296 D4I
Maternal mortality in Bangladesh: Who, when, why, and where? A national survey-based analysisAniqa Tasnim Hossain, Abu Bakkar Siddique, Sabrina Jabeen, Shusmita Khan, M Moinuddin Haider, Shafiqul Ameen, Tazeen Tahsina, Nitai Chakraborty, Quamrun Nahar, Kanta Jamil, Shams El Arifeen, Ahmed Ehsanur Rahman2023English, , Background: Despite a notable decline in recent decades, maternal mortality in Bangladesh remains high. A thorough understanding of causes of maternal deaths is essential for effective policy and programme planning. Here we report the current level and major causes of maternal deaths in Bangladesh, focusing on care-seeking practices, timing, and place of deaths. Methods: We analysed data from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS), conducted with nationally representative sample of 298 284 households. We adapted the World Health Organization's 2014 verbal autopsy (VA) questionnaire. Trained physicians reviewed the responses and assigned the cause of death based on the International Classification of Diseases (ICD-10). We included 175 maternal deaths in our analysis. Results: The maternal mortality ratio was 196 (uncertainty range = 159-234) per 100 000 live births. Thirty-eight per cent of maternal deaths occurred on the day of delivery and 6% on one day post-delivery. Nineteen per cent of the maternal deaths occurred at home, another 19% in-transit, almost half (49%) in a public facility, and 13% in a private hospital. Haemorrhage contributed to 31% and eclampsia to 23% of the maternal deaths. Twenty-one per cent of the maternal deaths occurred due to indirect causes. Ninety-two per cent sought care before dying, of which 7% sought care from home. Thirty-three per cent of women who died due to maternal causes sought care from three or more different places, indicating they were substantially shuttled between facilities. Eighty per cent of the deceased women who delivered in a public facility also died in a public facility. Conclusions: Two major causes accounted for around half of all maternal deaths, and almost half occurred during childbirth and by two days of birth. Interventions to address these two causes should be prioritised to improve the provision and experience of care during childbirth. Significant investments are required for facilitating emergency transportation and ensuring accountability in the overall referral practices.JA-23-295 D4I
Levels, trends, causes, place and time of, care-seeking for, and barriers in preventing indirect maternal deaths in Bangladesh: An analysis of national-level household surveysM Moinuddin Haider, Abu Bakkar Siddique, Sabrina Jabeen, Aniqa Tasnim Hossain, Shusmita Khan, Md Mahabubur Rahman, Fatema Tuz Zohora, Nitai Chakraborty, Quamrun Nahar, Ahmed Ehsanur Rahman, Kanta Jamil, Shams El Arifeen2023English, , Background: Eclampsia, haemorrhage, and other direct causes are the primary burden of maternal mortality in Bangladesh, often reducing attention given to indirect maternal deaths (IMDs). However, Sustainable Development Goals may not be achieved without actions to prevent IMDs. We examined the levels, trends, specific causes, timing, place, and care-seeking, and explored the barriers to IMD prevention. Methods: We used three nationally representative surveys conducted in 2001, 2010, and 2016 to examine levels and trends in IMDs. The analysis of specific causes, timing, and place of IMDs, and care-seeking before the deaths was based on 37 IMDs captured in the 2016 survey. Finally, we used thematic content analysis of the open history from the 2016 survey verbal autopsy (VA) questionnaire to explore barriers to IMD prevention. Results: After increasing from 51 deaths per 100 000 live births in 2001 to 71 in 2010, the indirect maternal mortality ratio (IMMR) dropped to 38 deaths per 100 000 live births in 2016. In 2016, the indirect causes shared one-fifth of the maternal deaths in Bangladesh. Stroke, cancer, heart disease, and asthma accounted for 80% of the IMDs. IMDs were concentrated in the first trimester of pregnancy (27%) and day 8-42 after delivery (32%). Public health facilities were the main places for care-seeking (48%) and death (49%). Thirty-four (92%) women who died from IMDs sought care from a health facility at least once during their terminal illness. However, most women experienced at least one of the “three delays” of health care. Other barriers were financial insolvency, care-seeking from unqualified providers, lack of health counselling, and the tendency of health facilities to avoid responsibilities. Conclusions: IMMR remained unchanged at a high level during the last two decades. The high concentration of IMDs in pregnancy and the large share due to chronic health conditions indicate the need for preconception health check-ups. Awareness of maternal complications, proper care-seeking, and healthy reproductive practices may benefit. Improving regular and emergency maternal service readiness is essential.JA-23-294 D4I
Counter-Trafficking in Persons (C-TIP) Monitoring and Evaluation Capacity Assessment Report for ArmeniaData for Impact2023English, , , The United States Agency for International Development (USAID) Data for Impact (D4I) project is working to strengthen the Government of Armenia’s (GOAM) capacity and systems to support efforts in counter-trafficking and forced labor. The counter-trafficking in persons (C-TIP) and exploitation of persons monitoring, and evaluation (M&E) system capacity assessment was conducted to ascertain and document current capacity at the organizational and individual levels in the Ministry of Labor and Social Affairs (MOLSA) Division of Anti-Trafficking and Women’s Issues and inform the development of a capacity strengthening plan. This report outlines the assessment methodology used, the results discovered, and the action plan developed based on the assessment.TR-23-504 D4I
Nigeria HPN Multi-Activity Evaluation Most Significant Change: Methods BriefData for Impact2023English, , In collaboration with local research partner Data Research and Mapping Consult Ltd., Data for Impact conducted two-day Most Significant Change (MSC) workshops in Ebonyi, Kebbi, and Zamfara states in July and August 2022 as part of the HPN Multi-Activity evaluation. This brief focuses on methods.SR-23-177c D4I
Nigeria HPN Multi-Activity Evaluation Findings from a Most Significant Change (MSC) Workshop in KebbiData for Impact2023English, , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria HPN activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (e.g., malaria). D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd. (DRMC), conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara in July/August 2022. This short report shares the results from Kebbi.SR-23-177f D4I
Nigeria HPN Multi-Activity Evaluation: Findings from a Most Significant Change (MSC) Workshop in EbonyiData for Impact2023English, , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria HPN activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (e.g., malaria). D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd., conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara in July/August 2022. This brief shares findings from the workshop in Ebonyi.SR-23-177e D4I
Nigeria HPN Multi-Activity Evaluation: Findings from Most Significant Change Workshops in Ebonyi, Kebbi, and ZamfaraData for Impact2023English, , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria HPN activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (e.g., malaria). D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd., conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara in July/August 2022. This brief shares findings from the workshops.SR-23-177b D4I
Nigeria HPN Multi-Activity Evaluation: Findings from a Most Significant Change (MSC) Workshop in ZamfaraData for Impact2023English, , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria HPN activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (e.g., malaria). D4I, in collaboration with local research partner Data Research and Mapping Consult Ltd., conducted two-day MSC workshops in Ebonyi, Kebbi, and Zamfara in July/August 2022. This brief shares findings from the workshop in Zamfara.SR-23-177h D4I
USAID Integrated Health Program Evaluation Report: Year 3 Impact Evaluation ResultsMatt Worges, PhD; David Hotchkiss, PhD; Janna Wisniewski, PhD; Paul-Samson Lusamba-Dikassa, MD, PhD; Lauren Blum, PhD; Eva Silvestre, PhD2023English, , This report presents results from an impact evaluation conducted by Data for Impact (D4I) following three years of implementation of the United States Agency for International Development (USAID) Integrated Health Program (IHP) in nine provinces of the Democratic Republic of the Congo (DRC). The IHP focuses, in part, on increasing the use of health facility-based maternal and child healthcare and family planning services. The impact evaluation investigated the extent to which changes in healthy behaviors and health outcomes were attributable to the USAID IHP.TRE-23-36 D4I
Assessment of the USAID Multi-Sectoral Nutrition Strategy: Second Periodic AssessmentData for Impact2023English, The 2014–2025 United States Agency for International Development (USAID) Multi-Sectoral Nutrition Strategy (MSNS) provides guidance to USAID Missions and USAID implementing partners on multi-sector nutrition (MSN) programming. It has been used by USAID as its strategy to meet the Sustainable Development Goals and the World Health Assembly Global Nutrition Targets. To take stock of the progress in addressing the causes of malnutrition through MSN programming, USAID developed the MSNS Monitoring and Learning (M&L) Plan and planned three assessments of the MSNS. The first assessment was conducted in 2018. USAID asked Data for Impact (D4I) to conduct the second assessment to assess the current progress of MSN programming in USAID-supported countries using a case study approach focused on five countries: Bangladesh, Mali, Nepal, Rwanda, and Uganda. The assessment included case studies for each focus country in addition to the overall assessment report, which synthesized the findings for MSN programming across these countries as well as a broader set of USAID-supported countries. The results of this assessment will be used by USAID/Washington to inform the next iteration of the MSNS and to further assist USAID/Washington, USAID Missions, and partner organizations with MSN programming design, implementation, and reaching set goals and targets. TR-23-514 D4I
High Impact Practices (HIPs) in Family Planning (FP): A qualitative assessment of quality and scale of implementation for three service delivery HIPs in Bangladesh and TanzaniaSusan Pietrzyk, Athena Pantazis, Joyanta Roy, Catherine Kahabuka2023English, , , , , High impact practices (HIPs) in family planning (FP) are a collection of evidence-based practices identified by global experts that have demonstrated impact on contraceptive uptake and other related outcomes in varied settings. This assessment focused on the extent that three HIPs are implemented and monitored across several United States Agency for International Development (USAID)-funded health service delivery projects in Bangladesh and Tanzania. The specific HIPs covered in this assessment relate to community health workers, mobile outreach service delivery, and immediate postpartum family planning. Prior to this assessment, no implementation standards for HIPs had been established beyond the HIP technical briefs. As such, HIP core components were developed for this assessment with core components referring to an established standard for implementation. Data collection included the administration of core component checklists to rank individual core component implementation using a scale of 1 (limited) to 4 (foundational) and key informant interviews. A total of 156 individuals (83 male and 73 female) participated in data collection. The results from the two data collection activities are, to an extent, the opposite. The self-assessed ranking through the core component checklists suggests that the projects are implementing the core components and thus, the HIPs. However, the interviews with the project staff and district FP experts point to challenges around implementing what is laid out in the core components. The results of this assessment indicate the need for USAID to further clarify how HIPs implementation is defined as part of laying the groundwork to establish a HIPs measurement framework. Additional Resources: High Impact Practices (HIPs) in Family Planning Summary Brief: Assessing HIP Core Components High Impact Practices (HIPs) in Family Planning: Methodological Brief on Monitoring HIPs Implementation with Core Components High Impact Practices (HIPs) in Family Planning: Measuring and Monitoring HIP Implementation with Core Components: Example HIP Core Component ChecklistsTR-23-515 D4I
Monitoring and Evaluation Plan for the Rwandan National Child Development Agency Operational Plan (2022/3-2024/5)Rwandan National Child Development Agency2023EnglishThe goal of this monitoring and evaluation plan is to facilitate the collection of quality data that will be used to monitor and evaluate the implementation of the Rwandan National Child Development Agency's operational plan (2022/3–2024/5) and inform decision-making processes. The plan outlines the processes that will be applied to determine the extent to which the strategic objectives of the operational plan are met. It defines the data needed and how the data will be collected, and their quality ensured, analyzed, and utilized for decision-making at all levels.SR-23-182 D4I
Study Visit Report: Madagascar Exchange Visit to EthiopiaData for Impact2023English, , From March 26, 2023, to April 1, 2023, a delegation composed of policy makers and healthcare professionals from Madagascar visited Ethiopia as part of an exchange visit to learn about the country’s primary healthcare system (PHC) and community health program. The learning exchange visit was organized by the Data for Impact (D4I) project in close collaboration with the International Institute for Primary Health Care – Ethiopia (IPHC-E), John Snow Inc. (JSI), and its country offices in Ethiopia and Madagascar. The delegation was led by Madagascar’s Secretary General of Public Health and included the Secretary General of the Ministry of the Economy and Finance, the Director General of the Ministry of the Interior and Decentralization, as well as personnel from each level of the Ministry of Public Health (MOPH), representatives from The United States Agency for International Development’s (USAID) Accessible Continuum of Care and Essential Services (ACCESS) project/Management Sciences for Health (MSH), and USAID Madagascar. This report describes the objectives and main activities of the visit and highlights select observations and areas of interest expressed by the delegation which may be applied to strengthen Madagascar’s PHC and community health program. The report is also available in French. SR-23-180 D4I
Activité IMPACT Madagascar : dossier d’évaluation à mi-parcours2023French, , , Le programme IMPACT (Improving Market Partnerships and Access to Commodities Together, améliorons ensemble les partenariats de marchés et d’accès aux produits de base) est financé à hauteur de 30 millions de dollars sur cinq ans par l’Agence des États-Unis pour le développement international (USAID). Ce programme a pour but de consolider la chaîne d’approvisionnement du secteur de la santé à Madagascar et d’augmenter son efficacité en favorisant une approche globale des marchés (AGM). IMPACT vise à remédier à la faible disponibilité des produits de santé due à la mauvaise coordination et à l’inefficacité des marchés, en particulier dans les domaines de la santé maternelle et infantile, la planification familiale et le paludisme. IMPACT est mis en œuvre dans 13 des 22 régions de Madagascar par Population Services International (PSI), avec comme partenaires PATH, Management Sciences for Health, Banyan Global, et la fondation Axian de 2018 à 2024. Data for Impact (D4I) a mené l’évaluation à mi-parcours en vue de fournir des informations à l’USAID et aux partenaires de mise en œuvre d’IMPACT qui serviront à l’apprentissage et à la correction de trajectoire. Les objectifs de cette évaluation étaient d’examiner l’efficacité du programme IMPACT et les progrès réalisés jusqu’à ce jour, d’identifier ce qui fonctionne et ce qui ne fonctionne pas, ainsi que de proposer des solutions ou des domaines d’intervention pour les années restantes.FS-23-624-FR D4I
Strengthening Capacity for Monitoring, Evaluation, and Data Use in Rwanda: A Case StudyData for Impact2023English, , , The United States Agency for International Development- (USAID) funded Data for Impact (D4I) project works with countries to increase capacity for evaluation and data use by engaging with local actors as essential collaborators and learning partners. We plan and implement diverse capacity strengthening approaches, design our efforts around local priorities, and work to measure improvements in capacity and performance resulting from these efforts. This case study highlights D4I’s partnership with Rwanda’s National Child Development (NCD) Agency to strengthen local capacity for monitoring and evaluation, detailing D4I’s intentional, partner-centered approach aligned with the principles for effective programming and equitable partnerships detailed in USAID’s Local Capacity Strengthening (LCS) Policy.FS-23-626 D4I
Review of CTC Analytics Data Use at Site Level in TanzaniaData for Impact2023English, , The Data for Impact (D4I) project in Tanzania, supported by the United States Agency for International Development (USAID), has been leading efforts in conducting site-level intensive monitoring visits for HIV and TB service delivery to determine if sites are meeting service quality standards and to make recommendations for corrective action at the site level based on the assessments. Despite significant investments in this quality improvement process, performance challenges persist in key HIV focus areas, such as under target service delivery, inadequate follow-up, and lack of documentation. These gaps can be attributed to a lack of accountability mechanisms to track implementation of prioritized action items, stakeholders’ inability to triangulate information across multiple information systems, and a lack of access to real-time analyses and visualizations at the site level. Recognizing these performance limiting factors, the D4I team has proposed to enhance accountability mechanisms by facilitating the use of data and demand creation through supporting facility staff in reviewing the data, developing data guidance tools for site-level data use and analytics, and strengthening capacity of the site Quality Improvement Teams. Empowering facility staff to understand and utilize data to inform decisions will help to improve performance. Recently, USAID/Tanzania engaged the University of California, San Francisco to develop a new platform to help sites to better view their performance data via an online platform called Care and Treatment Center (CTC) Analytics. According to the user’s manual, this is a “web-based system whose main objective is to facilitate timely reporting, analysis, and use of HIV Continuous Quality Improvement (CQI) indicators to improve service delivery at the care and treatment clinic. The system was built to analyze and generate reports using two streams of data: (1) data uploaded by users, and (2) data analyzed by CTC Analytics, which are read from the CTC 2 Export for Analysis file.” To better understand the application of the CTC Analytics platform to data use strategies at the site level, a trip was conducted by the D4I field team and a consultant to assess data use at the site level in discussion with facility staff during site monitoring visits. This report summarizes the outcomes from these assessments. The information obtained during the activity was used to develop a set of recommendations aimed at increasing the availability and use of real-time site-level data to improve the quality-of-service provision.TR-23-519 D4I
Experiences and Lessons Learned: Implementing the Organizational Network Analysis MethodData for Impact2023English, , , Public health organizations and projects can better understand their network and leverage the resources within it for the benefit of their clients by using the systematic approach known as Organizational Network Analysis (ONA). In ONA, networks can be represented by measures such as density (number of links among organizations as a proportion of all possible links), betweenness centrality (the roles that individual organizations and exchange relationships play within the larger network), reciprocity (the proportion of mutual ties), efficiency (the effectiveness of a network at distributing information and resources to all organizations), in-degree connections (e.g., referrals received) and out-degree connections (e.g., referrals sent). This document shares Data for Impact’s (D4I) experiences and lessons learned in implementation of ONA in projects in Botswana and Nigeria.FS-23-617 D4I
Madagascar IMPACT Activity: Midterm Evaluation BriefData for Impact2023English, , Improving Market Partnerships and Access to Commodities Together (IMPACT) is a five-year, $30 million activity funded by the United States Agency for International Development (USAID) that promotes a total market approach (TMA) to strengthen and increase the efficiency of the health sector supply chain in Madagascar. IMPACT seeks to address the low availability of health commodities due to poor market coordination and inefficiencies, especially for maternal and child health, family planning, and malaria. IMPACT is implemented in 13 of 22 regions of Madagascar by Population Services International (PSI), with partners PATH, Management Sciences for Health, Banyan Global, and the Axian Foundation from 2018 through 2024. Data for Impact (D4I) facilitated the midterm evaluation to provide information to USAID and the IMPACT implementing partners for learning and course correction. The evaluation sought to examine the IMPACT program’s progress and performance to date, identify what is working and what is not working, and offer solutions or areas of focus for the remaining program years.FS-23-624 D4I
Neonatal Mortality Estimates and Associated Risk Factors in Nine Counties in KenyaAnn Wanjiru Mwangi, Faith Hilda Yego2023English, , , Addressing neonatal mortality remains a key priority globally. In Kenya, the neonatal mortality rate (NMR) estimated by the United Nations Interagency Group for Child Mortality Estimation (UN-IGME) was 20 per 1000 live births in 2020, which demonstrates suboptimal decline. Although more still needs to be done, the Government of Kenya and its stakeholders have put strategies in place to achieve Sustainable Development Goal 3 to ensure healthy lives and promote well-being for all ages and have targeted ending preventable deaths of newborns and children. Although risk factors associated with neonatal mortality are known, there is a paucity of data when it comes to disaggregation by counties and projected estimates to support planning and implementation of interventions. The overall goal of this project was to conduct a secondary analysis to provide quality and easily accessible estimates of neonatal mortality in nine counties in Kenya for decision-making purposes, and to improve program planning, implementation, and policies. This report shares more on the study and findings.SR-22-169-D4I
Gender Competency Tool Module A: Gender Sensitive CommunicationKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Gender sensitive communication refers to the provider’s ability to transmit information through verbal and non-verbal communication in a way that recognizes unequal power structures and promotes equality for all clients. It is client-centered. This document contains "Module A: Gender Sensitive Communication" of the "Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services." This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103b D4I
Gender Competency Tool Module B: Promoting Individual AgencyKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Promoting individual agency refers to the provider’s capacity to support an individual client’s voluntary and informed decisions about whether, when, and how often to reproduce, without pressure to conform to gender and cultural norms. This document contains "Module B: Promoting Individual Agency" of the "Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services." This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103c D4I
Gender Competency Tool Module C: Supporting Legal Rights and Status Related to Family PlanningKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Supporting legal rights and status related to family planning refers to the provider’s ability to provide information and services to clients in accordance with rights and local laws and without interference of personal bias. This document contains "Module C: Supporting Legal Rights and Status Related to Family Planning" of the "Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services." This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103d D4I
Gender Competency Tool Module D: Engaging Men and Boys as PartnersKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Engaging men and boys as partners refers to the provider’s recognition of men and boys as supportive partners to women and as potential users of family planning. It can be demonstrated with male or female clients and couples. It should be anchored in women’s preferences and consent. This document contains "Module D: Engaging Men and Boys as Partners" of the "Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services." This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103e D4I
Gender Competency Tool Module E: Facilitating Positive Couples’ Communication and Cooperative Decision MakingKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Facilitating positive couples’ communication and decision making refers to the provider’s capacity to help clients articulate, discuss, and come to an agreement on reproductive intentions and to make joint reproductive decisions as a couple. This document contains “Module E: Facilitating Positive Couples’ Communication and Cooperative Decision Making” of the “Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services.” This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103f D4I
Gender Competency Tool Module F: Addressing Gender-Based ViolenceKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Addressing gender-based violence refers to the provider’s ability to understand and recognize gender-based violence, incorporate principles of do no harm into family planning services, provide appropriate referrals and reinforce the right to be treated with respect and live without violence. This document contains "Module F: Addressing Gender-Based Violence" of the "Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services." This is one of six modules (A–F), each of which are related to one domain of gender competency. In each module, providers respond to statements that represent knowledge, attitudes, and skills in the domain. For each statement, providers indicate if they “Strongly Agree, Agree, Disagree, or Strongly Disagree” with the statement. Select modules can be administered on their own, or as part of a holistic assessment. Access additional "A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning Services" resources: TL-23-103g D4I
A Provider Self-Assessment Tool to Measure Gender Competency for Family Planning ServicesKatherine Andrinopoulos, Courtney McGuire, Eve Namisango, Phyllis Dako-Gyeke, Taylor Reisz, Janna Wisniewski2023English, , , Family planning (FP) providers can play an important role in ensuring that their clients reach their reproductive health goals despite barriers they may face because of their gender. Gender competency is the knowledge, attitudes, and skills that can help providers reduce gender-related barriers for their clients. With increased gender competency, providers can be more responsive to the diverse needs of their clients and deliver high-quality FP services. The Gender Competency Self-Assessment Tool for Family Planning Providers presented in this document provides a method for measuring the knowledge, attitudes, and skills of individual providers in six domains of gender competency. By completing this self-assessment, providers can determine their current level of gender competency, and thereby identify areas of strength and weakness in each domain. Each module of the tool includes a response form, a scoring form, and a discussion guide. Access tool modules: This self-assessment tool is part of a larger toolkit to increase the gender competency of FP providers developed by USAID’s Office of Population and Reproductive Health. Providers who would like to increase their gender competency based on their self-assessment may choose to complete the eLearning course available here.TL-23-103a D4I
Investment for the Sustainability of Digital Health Systems in BangladeshData for Impact2023English, , , , The Ministry of Health and Family Welfare (MOHFW) in Bangladesh has introduced digital tools to improve the routine health information system (HIS) and streamline management of information. These efforts have been supported to a great extent by development partners (DPs). Sustaining these tools requires investment from the organizations using these tools. This brief examines the issues of investment to ensure sustainability of digital systems in Bangladesh.fs-23-613 D4I
Ministry of Labor and Social Affairs (MOLSA) Monitoring and Evaluation Capacity Strengthening Action PlanData for Impact2023English, , , , This monitoring and evaluation (M&E) Capacity Strengthening Action Plan outlines a response to the key M&E capacity gaps identified among MOLSA divisions. The recommendations from a capacity assessment with multiple components were used to propose activities that MOLSA and its partners may wish to undertake to improve the M&E capacities of MOLSA staff and the two divisions that support monitoring and evaluation of Counter-Trafficking in Persons (C-TIP) interventions. The two divisions are the Division of Anti-Trafficking and Women’s Issues and the Division of Monitoring and Evaluation.SR-23-173 D4I
Mapped newborn data availability in routine Health Information Systems EN-MINI mapping tool results: BangladeshData for Impact2023English, , This report provides background information and shares results from the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) mapping tool in Bangladesh.TL-23-104 D4I
Haemorrhage-related maternal mortality in Bangladesh: Levels, trends, time of death, and care-seeking practices based on nationally representative population-based surveysSabrina Jabeen, Abu Bakkar Siddique, Aniqa Tasnim Hossain, Shusmita Khan, M Moinuddin Haider, Tazeen Tahsina, Anisuddin Ahmed, Shafiqul Ameen, Nitai Chakraborty, Quamrun Nahar, Kanta Jamil, Shams El Arifeen, Ahmed Ehsanur Rahman2023English, ,
Background: Haemorrhage is a major cause of maternal deaths globally, most of which are preventable and predominantly happen in low and middle-income countries, including Bangladesh. We examine the current levels, trends, time of death, and care-seeking practices for haemorrhage-related maternal deaths in Bangladesh. Methods: We conducted a secondary analysis with data from the nationally representative 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys (BMMS). The cause of death information was collected through verbal autopsy (VA) interviews using a country-adapted version of the standard World Health Organization VA questionnaire. Trained physicians reviewed the VA questionnaire and assigned the cause of death using the International Classification of Diseases (ICD) codes. Results: Haemorrhage accounted for 31% (95% confidence interval (CI)=24-38) of all maternal deaths in 2016 BMMS, which was 31% (95% CI=25-41) in 2010 BMMS and 29% (95% CI=23-36) in 2001 BMMS. The haemorrhage-specific mortality rate remained unchanged between 2010 BMMS (60 per 100000 live births, uncertainty range (UR)=37-82) and 2016 BMMS (53 per 100000 live births, UR=36-71). Around 70% of haemorrhage-related maternal deaths took place within 24 hours of delivery. Of those who died, 24% did not seek health care outside the home and 15% sought care from more than three places. Approximately two-thirds of the mothers who died due to haemorrhage gave birth at home. Conclusions: Postpartum haemorrhage remains the primary cause of maternal mortality in Bangladesh. To reduce these preventable deaths, the Government of Bangladesh and stakeholders should take steps to ensure community awareness about care-seeking during delivery
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Échelle d’autonomisation reproductiveData for Impact2023French, , , En vue d’améliorer la mesure de l’autonomisation reproductive chez les femmes d’Afrique subsaharienne, Data for Impact – avec le soutien financier de l’Agence des États-Unis pour le développement international (USAID) – a développé et validé une échelle multidimensionnelle pouvant être intégrée dans les outils d’enquête. L’échelle d’autonomisation reproductive est composée de cinq brèves sous-échelles qui mesurent : (1) la communication des femmes avec les prestataires de soins ; (2) la communication des femmes avec leur partenaire ; (3) la prise de décisions des femmes en matière de santé reproductive (SR) ; (4) le soutien social dont les femmes bénéficient en matière de SR ; et (5) les normes sociales en lien avec la SR et la fertilité des femmes. Rapport (en anglais)FS-23-605 FR D4I
Data for Impact Year 4 HighlightsData for Impact2023EnglishData for Impact (D4I) works with country partners to strengthen capacity to generate and use high-quality data, investigate program effectiveness, and learn from evidence. This brief shares highlights from D4I's work in Year 4 of the project.FS-22-612 D4I
Factors that provide protection against intimate partner physical violence among married adolescents in BangladeshMizanur Rahman, Kanta Jamil, Quamrun Nahar, Nitai Chakraborty, M. Moinuddin Haider, and Shusmita Khan2023English, , ,

Background: Intimate partner violence (IPV), and especially intimate partner physical violence (IPPV), perpetrated by husbands, and within adolescence marriage are pervasive in Bangladesh. Younger women are more vulnerable to IPPV.

Objectives: We examined factors associated with IPPV experienced by married adolescents ages 15–19 and tested four hypotheses: (1) adolescent girls married to relatively older husbands, (2) adolescents living in extended families with parents or parents-in-law, (3) adolescents who are minimally controlled by husbands, and (4) adolescents who have a child after marriage are protective of IPPV.

Methods: We analyzed IPPV data from 1,846 married girls ages 15–19 obtained from a national adolescent survey conducted in 2019–20. IPPV is defined as the respondent having physical violence perpetrated by her husband at least once in the last 12 months. We implemented logistic regression models to test our hypotheses.

Results: Sixteen percent of married adolescent girls experienced IPPV. Girls living with parents-in-law or parents had adjusted odds ratio (AOR) of 0.56 (p < 0.001) of IPPV compared to those girls who lived with husband alone. Girls with husbands ages 21–25 years and 26 years or older had AORs of 0.45 (p < 0.001) and 0.33 (p < 0.001) of IPPV compared to those girls with their husband ages 20 and younger. Married adolescent girls who did not own a mobile phone (an indicator of spousal power dynamics) had an AOR of 1.39 (p < 0.05) compared to those girls who had a phone. IPPV risk increases with an increased duration of marriage for those with no living children (p < 0.001) but not for those with at least one living child; the risk was higher among those who had a child within the 1st year of marriage than those who had not yet had a child. At a duration of 4 years and longer, IPPV risk was higher among those with no living children than those with children.

Discussion: Findings related to those living with parents-in-law or parents, girls married to relatively older boys/men, having the ability to communicate with outside world, and having a child are protective of IPPV in Bangladesh are new, to our knowledge. Strictly adhering to the law that requires men waiting until the age of 21 to marry can reduce married girls' risk of IPPV. Raising girls' legal marriage age can minimize adolescents' IPPV and other health risks associated with adolescent childbearing.

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What shapes attitudes on gender roles among adolescents in BangladeshAvita J. Streatfield, Md Mahabubur Rahman, Shusmita Khan, M. Moinuddin Haider, Mizanur Rahman, Quamrun Nahar, and Kanta Jamil2023English, , ,

Background: In Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes.

Objective: The aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes.

Methods: The paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15–19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles.

Results: Unmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6–7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels.

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Tools and Resources to Support Local Capacity StrengtheningData for Impact2023English, In working to meet Data for Impact’s (D4I) project objective of increased capacity for evaluation and data use, D4I has developed several tools and resources to support the capacity strengthening process. The table in this brief describes tools and resources developed by D4I, as well as tools created under MEASURE Evaluation, that are available on the D4I project website.FS-23-622b D4I
Data for Impact’s Approach to Individual and Institutional Capacity StrengtheningData for Impact2023EnglishThe objective of Data for Impact (D4I) is to increase capacity for rigorous evaluation. D4I works in partnership with local institutions to generate evidence, ensure data quality, integrate gender, and promote data use. D4I works to ensure that its capacity strengthening approach is aligned with USAID’s Local Capacity Strengthening Policy. Wherever possible, the project incorporates intentional, demand-driven processes that start with understanding local systems and the roles that local actors play. This brief shares more on D4I's approach to individual and institutional capacity strengthening.FS-23-622a D4I
Strengthening Capacity in Nigeria: A Case StudyData for Impact2023English, , , The USAID-funded Data for Impact (D4I) project works with countries to increase capacity for rigorous evaluation by engaging with local institutions and evaluators as essential collaborators, systems actors, and learning partners. We plan and implement diverse capacity strengthening approaches, design our efforts around local priorities, and work to measure improvements in capacity and performance resulting from these efforts. This case study highlights D4I’s partnership with the Nigeria-based Data Research and Mapping Consult, Ltd. (DRMC) and how D4I strives to practice the principles for effective programming and equitable partnerships outlined in USAID’s Local Capacity Strengthening (LCS) Policy through an intentional, partner-centered approach.FS-23-616 D4I
Strengthening Evaluation Capacity in the Democratic Republic of the CongoData for Impact2023English, , , , The USAID-funded Data for Impact (D4I) project works with countries to increase capacity for rigorous evaluation by engaging with local institutions and evaluators as essential collaborators, systems actors, and learning partners. We strive to reflect the principles for effective programming and equitable partnerships detailed in USAID’s Local Capacity Strengthening (LCS) Policy by designing our efforts around local priorities, planning and implementing diverse capacity strengthening approaches, and envisioning and measuring the changes in performance that result from these efforts. This case study highlights D4I’s partnership with the Kinshasa School of Public Health (KSPH) in the Democratic Republic of the Congo (DRC). D4I is partnering with KSPH to evaluate the USAID-funded Integrated Health Program (IHP), focused on strengthening the DRC’s health system. In addition to learning via collaborative implementation of the evaluation, with D4I’s support KSPH is implementing a coordinated set of capacity strengthening interventions selected following a baseline needs assessment. This case study highlights how LCS Policy principles were put into practice, and how interventions were designed with sustainability and the local system in mind.fs-23-610 D4I
Use of Group-Based Trajectory Modeling to Understand Trends in Modern Contraceptive Prevalence in Low- and Lower Middle-Income CountriesElizabeth Simmons, MPH; Janine Barden-O’Fallon, PhD; Heather Luz Reyes-McNaughton, PhD; Bamikale Feyisetan, PhD; Baker Maggwa, MD, MS2023English, , Global estimates of modern contraceptive prevalence (MCP) have been increasing over time. However, heterogeneity surfaces across countries in the rate of change of MCP over time. Group-based trajectory modeling is a statistical model that identifies distinct subgroups in trajectories of an outcome over time, as well as predictors of variability both between and within groups. We assessed trajectories of MCP for 76 low- and lower-middle income countries from 1990–2020. To select a final model, we compared indicators of statistical fit between models with a varying number of groups and differing polynomial types to describe group trajectories. Five types of predictor variables (national family planning policy, Unites States government support for family planning, access to family planning services, desired fertility and women’s empowerment) were operationalized as both time-stable (averaged) and time-varying and included in separate models as predictors of between- and within-group variability in contraceptive prevalence. A two-group model with quadratic polynomials to describe group trajectories best fit the data and was selected as a final model. In models assessing time-stable predictors of trajectory membership, countries that on average had a higher demand for family planning satisfied across 1990–2020 were more likely to belong to the higher MCP group than the lower MCP group. In models assessing time-varying effects of predictors, findings suggest that in the lower MCP group when scores on all predictor variables were higher, MCP was also higher. In the higher MCP group, this finding also held, but only for a subset of predictors (the percent of population residing in urban areas, demand for family planning satisfied by any method, secondary school enrollment among females, and GDI). This analysis shows there are two distinct groups of higher and lower modern contraceptive prevalence trajectories among low- and lower-middle income countries and suggests different programmatic focuses for each group. To request a copy of this report, please contact Janine Barden-O'Fallon.TR-23-512 D4I
Strengthening Local Research Capacity through Small GrantsData for Impact2023English, , , , , , Data for Impact awarded small grants to universities and nongovernmental organizations in USAID priority countries to conduct family planning-focused research projects. The research topics were developed by the subgrantee applicants based on local information needs. The overall goal of the program was to address FP information gaps at the subnational, national, or regional level and strengthen the research capacity of local researchers. This brief provides an overview of the small grants program and the experiences of the subgrantees.FS-23-618 D4I
Use of Combined Oral Contraceptive Pills among Women with Elevated Blood Pressure in BangladeshData for Impact2023English, , , , This technical brief examines the prevalence of elevated blood pressure (BP) among currently married women ages 18-49 (CMWA18-49) by their family planning method use: (a) combined oral contraceptive (COC) pills, (b) other modern methods, and (c) those who do not use any methods or use traditional methods. The brief also estimates the total number of CMWA18-49 who use COCs and have elevated BP.fs-23-609-d4i
Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators EN-MINI-PRISM Tools for Routine Health Information Systems: Tanzania Pilot Study ReportData for Impact2023English, , , , , This report provides background information and shares results from the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) pilot study in Tanzania.tl-21-94i-d4i
Facility Readiness and Service Provision in Mother and Child Welfare Centers (MCWCs) in Bangladesh: Where Do We Stand?Mizanur Rahman, D4I; Shusmita Khan, D4I; Md. Moinuddin Haider, D4I; Muhibbul Abrar, MaMoni MNCSP; Ali Ahmed, icddr,b2023English, , , , The government of Bangladesh (GOB) established Mother and Child Welfare Centers (MCWCs) in 1975 to provide specialized maternal, child health, and family planning (FP) services and to prevent complications during pregnancy and childbirth. The MCWCs are mandated to be equipped with emergency medicine, instruments, and trained and skilled staff. The MCWCs are located at the district, upazila, and union levels. The level of service provision and care is not the same at all levels due to differences in trained skilled staff, infrastructure (i.e., how many beds are allocated for service delivery), supplies, and equipment. MCWCs at the district level have more staff, equipment, and essential and emergency drugs for rendering comprehensive services to mothers and children than those at the upazila and union levels. There are, however, some common services available across all levels of MCWCs. At present, 96 MCWCs are functioning and providing reproductive health-emergency obstetric care (RH-EOC) services throughout the country under the leadership of the Directorate General of Family Planning (DGFP). In 2019, the Mother and Child Health (MCH) unit of the DGFP requested assistance from MEASURE Evaluation/Data for Impact (D4I) and MaMoni MNCSP, Save the Children in development of a database on MCWCs readiness to provide health services based on the 2017 Bangladesh Health Facility Survey (BHFS) findings. The database to be developed would provide MCWC managers with up-to-date information on MCWC readiness to provide services, assist with estimating staff and logistic needs, and improve the raising of requisitions for depleted products and supplies. Managers at regional and central levels would be able to categorize the readiness status of MCWCs and use the categorizations to make management planning decisions for service improvements in the MCWC system. The 2017 BHFS dataset was provided by the National Institute of Population Research and Training (NIPORT) and analysis support was provided by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).   The objectives of the assignment were to:
  1. map the MCWCs (i.e., matching the DGFP listed MCWCs with those included in the 2017 BHFS dataset);
  2. produce a readiness inventory of required staff service provision guidelines, equipment and supplies, and medications, as per the range of services provided by an MCWC;
  3. categorize the MCWCs based on their readiness statistics; and
  4. identify gaps for each of the MCWCs based on specific services.
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2022 Sustainability Assessment Results: Nigeria Health, Population, and Nutrition Multi-Activity EvaluationHuyen Vu, Jessica Fehringer, Tory Tayor, Samson Adebayo, Emmanuel Adegbe, and Siân Curtis2023English, , , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria HPN Activities, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). Evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. The sustainability assessment component of the evaluation seeks to answer the following broad evaluation question related to health programming effectiveness: Did relevant commitment/engagement and capacity outcomes improve more from baseline to endline in LGAs/states where an integrated approach (IHP) was implemented, a disease-focused approach (PMI-S) was implemented, or a combination of the two? All four HPN Activities are engaging with state teams and structures through capacity strengthening activities to improve health planning, management, and coordination at the state and community levels. Through this engagement and capacity building they expect to gain support and commitment of stakeholders and gradually sustain the changes achieved. This report presents an overview of the methods used to evaluate sustainability of HPN programming approaches and the baseline results of the assessment. The sustainability assessment was part of the second round of evaluation process monitoring conducted in early 2022. The first round of process monitoring in 2021 focused on coordination and collaboration among the Activities. Access additional resources at https://www.data4impactproject.org/countries/nigeria.TR-22-496 D4I
Nigeria Health, Population, and Nutrition Multi-Activity EvaluationData for Impact2023English, , , , Data for Impact (D4I) is conducting a mixed-methods, portfolio-level evaluation of four USAID/Nigeria Health, Population and Nutrition (HPN) Activities with a focus on comparing the strengths and challenges of an integrated health programming approach with a disease-focused approach (e.g., malaria). This brief provides an overview of the evaluation. Access additional resources at https://www.data4impactproject.org/countries/nigeria.FS-23-614e D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Baseline Health Facility Assessment Results TablesData for Impact2023English, , , , , , Data for Impact (D4I) is conducting a prospective mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). D4I conducted a health facility assessment (HFA) as part of the evaluation to gather information on health facilities’ service availability and readiness to provide services both generally and specifically for malaria, family planning, and antenatal care service domains. This document shares the baseline HFA results tables, and additional resources can be found at https://www.data4impactproject.org/countries/nigeria.FS-23-614b D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Baseline Health Facility Assessment Indicator MatrixData for Impact2023English, , , , , Data for Impact (D4I) is conducting a prospective mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). D4I conducted a health facility assessment (HFA) as part of the evaluation to gather information on health facilities’ service availability and readiness to provide services both generally and specifically for malaria, family planning, and antenatal care service domains. This is the baseline HFA indicator matrix, and additional resources can be found at https://www.data4impactproject.org/countries/nigeria.FS-23-614c D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Baseline Health Facility Assessment Methodology NoteData for Impact2023English, , , , , , Data for Impact (D4I) is conducting a prospective mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). D4I conducted a health facility assessment (HFA) as part of the evaluation to gather information on health facilities’ service availability and readiness to provide services both generally and specifically for malaria, family planning, and antenatal care service domains. Health facility service availability and readiness are assessed using specific services such as diagnosis and treatment of malaria, and general support services such as stockout rates and health information system reporting practices. The purpose of this methodology note is to describe the methods used in conducting and analyzing the baseline HFA. Additional information for the baseline HFA, including a results brief, full results tables, the indicator matrix, and D4I’s Zamfara HFA data collection instrument are available https://www.data4impactproject.org/countries/nigeria.FS-23-614a D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Zamfara Health Facility Assessment ToolData for Impact2023English, , , , , , Data for Impact (D4I) is conducting a prospective mixed methods portfolio-level outcome evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). D4I conducted a health facility assessment (HFA) as part of the evaluation to gather information on health facilities’ service availability and readiness to provide services both generally and specifically for malaria, family planning, and antenatal care service domains. This is the Zamfara HFA Tool, and additional resources can be found at https://www.data4impactproject.org/countries/nigeria.FS-23-614d D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation 2021 Provider Survey ToolData for Impact2023English, , , , This tool was created for the health provider survey conducted by Data for Impact (D4I) as one component of a mixed methods outcome evaluation of four United States Agency for International Development (USAID)/Nigeria Health, Population, and Nutrition (HPN) activities. The four activities are the Integrated Health Project (IHP), the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION - Nigeria (BA-N), and the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM). The objective of the health provider survey evaluation component is to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). Access a report sharing survey results.TR-23-503b-D4I
2021 Provider Survey Results: Nigeria Health, Population, and Nutrition Multi-Activity EvaluationKristen Brugh, PhD; Sian Curtis, PhD; Emmanuel Adegbe, PhD; Jessica Fehringer, PhD; Milissa Markiewicz, MPH; Brian Luckett, PhD2023English, , , , , This report presents the results of a health provider survey conducted by Data for Impact (D4I) as one component of a mixed methods outcome evaluation of four United States Agency for International Development (USAID)/Nigeria Health, Population, and Nutrition (HPN) activities. The four activities are the Integrated Health Project (IHP), the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION - Nigeria (BA-N), and the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM). The objective of the health provider survey evaluation component is to provide evidence for health programming, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). An integrated approach (led by IHP) implements a fully integrated set of reproductive, maternal, newborn, and child health plus nutrition and malaria (RMNCH+NM) interventions as well as health system strengthening interventions. A disease-focused approach (led by PMI-S) addresses one health area only (malaria) and includes health system strengthening focused on that health area. In each state, both approaches also include demand creation (led by BA-N) and commodity procurement and distribution interventions (led by GHSC-PSM). The evaluation is being implemented in three case study states—Kebbi (integrated approach), Zamfara (disease-focused approach), and Ebonyi (combined approach with both IHP and PMI-S implementing). The purpose of the survey, which will be conducted again at endline in 2025, is to assess whether provider knowledge, attitudes, and self-reported practices improve over time and whether that improvement varies depending on whether the focus of provider training is disease-focused (fever/malaria management) or more integrated (RMNCH+NM). The provider survey contributes to answering the evaluation question: Did malaria and other health and service delivery outcomes improve more from baseline to endline in local government authorities (LGAs)/states where an integrated (IHP) approach was implemented, a disease-focused (PMI-S) approach was implemented, or a combination of the two? Provider outcomes in malaria, child health, antenatal care, and family planning service areas were assessed. Non-malaria service areas serve as ‘comparison’ services for the purposes of the evaluation to allow examination of depth versus breadth in the changes in outcome levels by service areas seen in the two programming approaches.TR-23-503-D4I
Collaboration and Coordination in Nigeria’s Multi-Activity ProgramData for Impact2023English, , , FS-23-615 D4I
Collaboration and Coordination in Nigeria’s Multi-Activity Program Findings from an Organizational Network AnalysisDevin J. Cornell, MA; Tory M. Taylor, MPH; Siân L. Curtis, PhD2023English, , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health-programming approach with a disease-focused approach (malaria). As part of this evaluation, we conducted an organizational network analysis (ONA) to better understand collaboration and coordination through structural aspects of resource, information, and funding exchange in Ebonyi, Kebbi, and Zamfara where different combinations of activities are being employed: Integrated approach: The Integrated Health Project (IHP) implements a fully integrated set of reproductive, maternal, newborn, and child health plus nutrition and malaria and health system strengthening interventions. This approach is being used in Ebonyi and Kebbi. Disease-focused approach: The President’s Malaria Initiative for States (PMI-S) focuses on malaria health programming and health system strengthening. This disease-focused approach is being used in both Ebonyi and Zamfara. In all three states, demand creation is led by Breakthrough ACTION-Nigeria (BA-N), and commodity procurement and distribution is led by the Global Health Supply Chain Program[1]Procurement and Supply Management (GHSC-PSM). In this analysis, we evaluated the potential effects of the integrated, disease-focused, and combination approaches on three types of sharing networks constructed from a survey of organizations in these states: non-monetary resource sharing, information sharing, and funding sharing. Selected findings from a sustainability assessment that included a structured survey and key informant interviews among HPN activity stakeholders were also considered alongside the ONA results for additional context and triangulation. This report shares more. Access a related brief and learn more about Data for Impact's work in Nigeria.TR-23-510 D4I
Exploring Education, Health, and Child Protection Support Penetration (Explorarea Gradului de Penetrare a Suportului în Domeniul Educației, Sănătății și Protecției Copilului)Jonathan Friedman, Camelia Gheorghe, Isaac Kamber2023English, , , , A web application was developed allowing for the exploration of various scenarios in the field of education, health, and child protection. The application offers a platform for analysis of historical trends and patterns using a combination of open data and proprietary data shared by the Government of Moldova. Extrapolation of these trends and patterns could form a baseline scenario for the allocation of resources and improvement of child outcomes displayed through the web application. Through it, users can adjust these assumptions and respond to hypothetical shocks to consider how best to optimize outcomes for children under different scenarios.fs-23-608-d4i
Executive Summary: 2022 Nigeria HPN Multi-Activity Sustainability Assessment ResultsData for Impact2022English, , , , Data for Impact (D4I) is conducting a prospective mixed methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) Activities comparing an integrated health programming approach with a disease-focused approach. The sustainability assessment explores how the Activities are contributing to the sustainability of health systems and health outcomes in Ebonyi, Kebbi, and Zamfara states by seeking to answer the question: Did relevant commitment/engagement and capacity outcomes improve more from baseline to end line in LGAs/states where an integrated approach was implemented, a disease-focused approach was implemented, or a combination of the two? This brief shares more on the sustainability assessment results.fs-23-606-d4i
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation Baseline: DHIS2 Service Utilization Results BriefData for Impact2023English, , , , , , Data for Impact is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). Evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. The evaluation is being implemented in three case study states. The purpose of this brief is to summarize initial findings from descriptive analysis of select malaria, antenatal care, and family planning service provision outcomes in the district health information system (DHIS2). Current results differ from preliminary analyses presented in June 2022 due to refinement in the handling of missing values, particularly for the percentage of facilities reporting for each service in the analysis; substantive divergence from previous results is where applicable.fs-23-611-d4i
Madagascar ACCESS Activity (Accessible Continuum of Care and Essential Services Sustained): Midterm Evaluation ReportSusan Bergson, Dr. Lwendo Moonzwe, Prof. Julio Rakotonirina, Balkissa Jacobs, Rebekah Koch2023English, , , , This midterm evaluation examined the progress of the Accessible Continuum of Care and Essential Services Sustained (ACCESS) program to identify promising approaches, ongoing challenges, and recommendations. The evaluation focused on five questions:
  1. To what extent has Access improved the quality of health services and the continuum of care?
  2. To what extent did ACCESS implement a capacity building approach and how effective has it been?
  3. To what extent have the ACCESS social and behavior change initiatives been implemented?
  4. How effective is the program’s approach to supportive supervision and monitoring, while building Ministry of Public Health (MOPH) leadership and capacity to conduct these efforts on its own?
  5. What are recommendations across all questions that will reinforce and strengthen ACCESS activities and initiatives for the duration of the program?
The evaluation used a mixed methods approach, including primary data collection through key informant interviews and focus group discussions; secondary review of program documents; and analysis of existing program and MOPH District Health Information Software data. The data suggested that ACCESS is achieving its intended objectives. These objectives include improving health service quality and the continuum of care, developing a capacity building approach at the subnational level, and promoting healthy behaviors and supportive supervision. Work towards these objectives contributed to health systems strengthening. The data also indicated continuing challenges around lack of health seeking behavior, preferences for seeking services from private providers or traditional healers, poor infrastructure at community and basic health center levels, and programmatic delays with capacity building and quality improvement. The COVID-19 pandemic has exacerbated these challenges, particularly in relation to capacity building and quality improvement. Key recommendations include improved planning/coordination of joint supportive supervision activities; meeting equipment/infrastructure needs; and acceleration of the district graduation approach rollout and certification process.		TR-22-493 D4I
Nigeria Health, Population, and Nutrition Multi-Activity Evaluation: Baseline Health Facility Assessment Results BriefData for Impact2022English, , , , , , , Data for Impact (D4I) is conducting a prospective mixed-methods portfolio evaluation of four USAID/Nigeria Health, Population, and Nutrition (HPN) activities, with a focus on comparing an integrated health programming approach with a disease-focused approach (malaria). Evaluation results will inform adaptive program implementation and support USAID/Nigeria’s investment strategy prioritization to improve health outcomes. The purpose of this brief is to summarize evaluation baseline health facility assessment (HFA) findings with a focus on service delivery outcomes related to facility readiness to provide services.fs-22-585-d4i
Malawi Secondary Education Expansion for Development (SEED) Impact Evaluation: Baseline ReportGustavo Angeles, Chrissie Thakwalakwa, Kristen Brugh, Jessica Fehringer, Esme Kadzamira, Tawonga Mwase-Vuma, Dadirai Mkombe, Milissa Markiewicz, Liz Millar, Mat Mainwaring, Becky Wilkes, and Ting Chen2022English, , , , The Malawi Secondary Education Expansion for Development (SEED) activity is a $90,000,000 commitment from USAID and PEPFAR for urban expansion and rural construction of Community Day Secondary Schools (CDSSs). Data for Impact (D4I) is conducting an evaluation of the SEED activity to understand whether there is an impact on communities where SEED is conducting expansion and construction of CDSSs. This mixed methods impact evaluation covers a broad range of development outcomes, including the impact of SEED for children enrolled in Standard 7 in primary schools at baseline in rural SEED CDSS catchment areas on educational outcomes; sexual behaviors; water, sanitation, and hygiene behaviors; and child safety and violence. We recruited Standard 7 students (n=761) from 32 rural primary treatment schools that will feed into new rural CDSSs, as well as from 32 rural comparison primary schools outside the catchment area of new CDSSs. To measure the pre-intervention primary to secondary school transition rate, we surveyed a retrospective cohort of students (n=599) enrolled in Standard 8. In rural and urban areas, focus group discussions (FGDs) were held with students and caregivers and key informant interviews (KIIs) with community leaders. We also conducted in depth interviews with students and KIIs with teachers in urban areas. We found acceptable balance in 94.9 percent of assessed quantitative variables. Rural qualitative findings mirrored those from the quantitative survey. Urban findings showed perceived positive outcomes resulting from SEED urban, including a conducive learning environment, and reduced absenteeism among girls. Some unintended outcomes were noted by urban respondents, such as expanded enrollment and increased teacher workloads. Access a related summary report and graphic briefs.tre-23-34-d4i
Reproductive Empowerment ScaleData for Impact2023English, , , To strengthen the measurement of reproductive empowerment among women in sub-Saharan Africa, Data for Impact—funded by the United States Agency for International Development—developed and validated a multidimensional scale that can be incorporated into survey instruments. The Reproductive Empowerment Scale consists of five short subscales that measure women’s: (1) communication with healthcare providers, (2) communication with partners, (3) reproductive health (RH) decision making, (4) social support for RH, and (5) social norms related to women’s RH and fertility. This brief shares more. Also available in French.FS-23-506-D4I
Evaluating Family Planning & Reproductive Health Program Transition from Donor Support: A Proposed FrameworkData for Impact2024English, , , , , This brief introduces a family planning (FP) transition framework intended to guide donors and local stakeholders in pre- and post-transition assessments and to support the development and monitoring and evaluation (M&E) of FP transition plans. The framework was developed by Data for Impact (D4I), a project funded by the United States Agency for International Development (USAID). This brief describes the FP transition framework, which was based on a comprehensive literature review and a pilot of a post-transition evaluation of four countries—Honduras, Indonesia, Morocco, and Peru. The literature review included 147 published and unpublished articles and documents, including grey literature, reports, and presentations shared by USAID staff. The D4I team adapted the framework and domains proposed by Bao et al. (2015) for monitoring and evaluating the transition of global health programs. The pilot assessment consisted of reviews of existing survey data and semi-structured, in-depth interviews of key informants who were heavily involved in FP programs in these four countries.SR-22-167-D4I
Analysis of the 2018 Afghanistan Household Survey: Understanding Regional Variations in Family Planning UseManizha Faqir Ibrahim, MD, MPH; Qudratullah Nasrat, MD, MPH2022English, , , , , Understanding unmet need for family planning (FP) has been central to international FP efforts for decades. Addressing this need is essential to FP program strategies in developing countries, including in Afghanistan. This study aimed to determine the factors affecting unmet need for modern contraceptive use across all regions of Afghanistan. To do this, the authors conducted a secondary analysis of data from the 2018 Afghanistan Household Survey, which was implemented in 34 provinces. The research provided an estimate of the level of unmet need provincially and regionally. This report shares more on the study, including findings and recommendations.WP-22-261-D4I
10 Ways to Increase the Use of Evaluation FindingsData for Impact2022English, , , How can your organization increase the use of evaluation findings by decision makers? This infographic shares 10 evidence-based approaches. Access a related report and brief, and watch a recording of a related webinar.GR-22-132-D4I
Applying Behavioral Insights to Increase the Use of Evaluation Findings at USAIDData for Impact2022English, , , USAID’s Data for Impact (D4I) project conducted a study that applied a behavioral perspective to understanding barriers to, and enablers of, the use of evaluation findings in USAID global health programs. The study consisted of a literature review on evidence-informed decision making, as well as interviews with individuals involved with USAID evaluations of global health programs and with professionals who are active in the promotion of evidence use. The team then proposed promising strategies for increasing the use of evaluation findings. Strategy design relied on a review of evidence from behavioral sciences, including behavioral economics, psychology, and sociology. This brief summarizes the study’s findings on barriers and enablers to the use of evaluation findings at USAID. It then outlines approaches that can help address these barriers and build on the enablers. Access a related report and infographic, and watch a recording of a related webinar.FS-22-588-D4I
2021 Process Monitoring Summary Results: EbonyiData for Impact2021English, , , , , Data for Impact (D4I) is conducting a mixed methods, portfolio-level evaluation of four United States Agency for International Development (USAID) Health, Population, and Nutrition programs in the Nigerian States of Ebonyi, Kebbi, and Zamfara. The programs are the Integrated Health Project, the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION-Nigeria (BA-N), and the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM, henceforth PSM). The evaluation includes a process monitoring component designed to help answer evaluation questions, monitor the implementation of activities, provide contextual information, and explore the validity of critical implementation assumptions identified during the development of a portfolio-level theory of change (TOC). The first round of process monitoring focused on coordination among Activities, work planning, and areas of joint implementation to describe coordination processes and to determine whether assumptions made about how the activities work together to achieve desired outcomes were accurate. This brief shares the results from Ebonyi where all four Activities are implementing. Access related presentations from December 2021 and July 2022 to learn more.FS-21-518-D4I
2021 Process Monitoring Summary Results: ZamfaraData for Impact2021English, , , , , Data for Impact (D4I) is conducting a mixed methods, portfolio-level evaluation of four United States Agency for International Development (USAID) Health, Population, and Nutrition programs in the Nigerian States of Ebonyi, Kebbi, and Zamfara. The programs are the Integrated Health Project, the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION-Nigeria (BA-N), and the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM, henceforth PSM). The evaluation includes a process monitoring component designed to help answer evaluation questions, monitor the implementation of activities, provide contextual information, and explore the validity of critical implementation assumptions identified during the development of a portfolio-level theory of change (TOC). The first round of process monitoring focused on coordination among Activities, work planning, and areas of joint implementation to describe coordination processes and to determine whether assumptions made about how the activities work together to achieve desired outcomes were accurate. This brief shares the preliminary results from Zamfara where PMI-S, BA-N, and PSM are active. Access related presentations from December 2021 and July 2022 to learn more.FS-21-523-D4I
2021 Process Monitoring Summary Results: KebbiData for Impact2021English, , , , , Data for Impact (D4I) is conducting a mixed methods, portfolio-level evaluation of four United States Agency for International Development (USAID) Health, Population, and Nutrition Activities in the Nigerian States of Ebonyi, Zamfara, and Kebbi. The activities are the Integrated Health Project (IHP), the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION-Nigeria (BA-N), and the Global Health Supply Chain Program – Procurement and Suppl Management (GHSC-PSM, henceforth PSM). The evaluation includes a process monitoring component designed to help answer evaluation questions, monitor the implementation of activities, provide contextual information, and explore the validity of critical implementation assumptions identified during the development of a portfolio-level theory of change (TOC). The first round of process monitoring focused on coordination among Activities, work planning, and areas of joint implementation to describe coordination processes and to determine whether assumptions made about how the activities work together to achieve desired outcomes were accurate. This brief shares the preliminary results from Kebbi where IHP, BA-N, and PSM are active. Access related presentations from December 2021 and July 2022 to learn more.FS-21-521-D4I
2021 Nigeria HPN Evaluation Process Monitoring Results: Round 1Data for Impact2021English, , , , Data for Impact is conducting a mixed methods, portfolio-level evaluation of four USAID Health, Population and Nutrition programs—the Integrated Health Project (IHP), the President’s Malaria Initiative for States (PMI-S), Breakthrough ACTION-Nigeria (BA-N), and the Global Health Supply Chain ProgramProcurement and Supply Management (GHSC-PSM, henceforth PSM)—in Ebonyi, Zamfara, and Kebbi. The evaluation includes a process monitoring component designed to help answer evaluation questions, monitor implementation activities, provide contextual information, and explore the validity of critical implementation assumptions identified during the development of a portfolio-level theory of change (TOC). The first round of process monitoring focused on coordination among implementing partners (IPs), work planning, and areas of joint implementation to describe coordination processes and determine if assumptions made about how the activities work together to achieve desired outcomes are accurate. This brief shares round 1 results. Access a related presentation to learn more.FS-21-529-D4I
Nigeria HPN Multi-Activity Evaluation Annual Review MeetingData for Impact2022English, , , This collection of presentations was shared at the June 2022 annual review meeting for the Nigeria health, population, and nutrition (HPN) multi-activity evaluation.
Obstetric fistula in Bangladesh: Estimates from a national survey with clinical validation correctionSaifuddin Ahmed, Sian Louise Curtis, Kanta Jamil, Quamrun Nahar, Mizanur Rahman, SK Nazmul Huda, Imteaz Ibne Mannan, Shusmita Khan, Anadil Alam, Emily H Weaver, Shams El Arifeen2022English, , , Background Obstetric fistula, which develops after a prolonged or obstructed labour, is preventable and treatable. However, many women are still afflicted with the condition and remain untreated in low-income and middle-income countries. Concerns have also been raised that an increasing trend of caesarean sections is increasing the risk and share of iatrogenic obstetric fistula in these countries. The true prevalence of this condition is not known, which makes it difficult for health planners and policy makers to develop appropriate national health strategies to address the problem. The estimation of obstetric fistula with surveys is difficult because self-reporting of incontinence symptoms is subject to misclassification bias. In this study, we aimed to estimate the prevalence and burden of obstetric fistula in Bangladesh. Methods For a valid estimation addressing misclassification bias, we implemented the study in two steps. First, we did the Maternal Morbidity Validation Study (MMVS) among a population of 65 740 women in Sylhet, Bangladesh, to assess the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values of the survey questions. This was done through confirmation of the diagnosis with clinical examinations of suspected cases by female physicians; a sample of women who screened positive for pelvic organ prolapse and other urinary incontinence symptoms were also examined and used as controls for clinical diagnosis confirmation. Second, we used the estimated diagnostic test values, after correcting for verification bias, to adjust the reported prevalence in the nationally representative Bangladesh Maternal Mortality and Health Care Survey 2016 for the unbiased estimation of obstetric fistula prevalence in Bangladesh. Findings The MMVS, done from Aug 3 to Dec 9, 2016, identified 67 potential cases of obstetric fistula; of them, 57 (85%) women completed the clinical examination, and 19 were confirmed as obstetric fistula cases. The adjusted sensitivity of the self-reports of obstetric fistula was 100% (95% uncertainty interval [UI] 99·8–100) and the observed specificity was 99·9% (95% UI 99·9–100) among women aged 15–49 years. However, the PPV was low, at 31·6% (95% UI 19·2–46·2), suggesting that almost two thirds of the self-reported cases were not true obstetric fistula cases. We estimated an adjusted obstetric fistula prevalence rate of 38 (90% UI 25–58) per 100 000 women aged 15–49 years in Bangladesh. Nationally, we estimated about 13 376 (90% UI 8686–20 112) women of reproductive age living with obstetric fistula. Additionally, we estimated 4081 (1773–8790) women aged 50–64 years to be living with obstetric fistula in Bangladesh; overall, we estimated that there are 17 457 (10 459–28 902) women aged 15–64 years in Bangladesh with obstetric fistula. Interpretation The burden of obstetric fistula is still high in Bangladesh. Prevention and provision of surgical treatment to so many women will need coordinated efforts, planning, allocation of resources, and training of surgeons.JA-22-290-D4I
Behavioral Interventions for the Use of Evaluation Findings: Final ReportAgata Slota, Cassandra Ake, and Lucinda Jones2022English, , , To date, significant investments have been made in research studies, evaluations, and collection of routine data to understand successes in global health programs and to identify opportunities for improvement. USAID’s 2020 Evaluation Policy, for example, notes that “to fulfill its responsibilities, USAID bases policy and investment decisions on the best available empirical evidence, and uses the opportunities afforded by program implementation to generate new knowledge for the wider community.” While there have been efforts and frameworks to link research and evaluation findings to country-level action and promote the uptake and impact of research findings on health policy and programming, challenges remain in putting that evidence into practice in real-world settings. It is estimated that 85% of health research is not being used internationally (Stewart et al. 2019). More specifically, evaluation findings are not always used to inform decisions on global health programs. This study applied a behavioral perspective to understanding barriers to, and enablers of, the use of evaluation findings in USAID global health programs. The researchers proposed promising strategies for increasing evaluation findings use that incorporated insights from behavioral sciences. Access a related brief and infographic, and watch a recording of a related webinar.tr-22-497-d4i
Potential for further fertility decline in Bangladesh and the implications for the National Family Planning ProgramData for Impact2022English, , , Bangladesh is one of the most densely populated countries in the world and is vulnerable to population pressures and climate change (United Nations [UN], 2022). The UN projects an increase from Bangladesh’s 2019 population of 163 million to 200 million by 2050; however, this projection assumes that fertility will decline to 1.7 births per woman by 2030 (UN, 2022). In its fourth Health, Population, and Nutrition Sector Program (HPNSP), the Ministry of Health and Family Welfare (MOHFW) set a goal to achieve a total fertility rate (TFR) of 2.0 by 2022 (MOHFW, 2017), below the replacement TFR of 2.1. The HPNSP also aimed for a contraceptive prevalence rate (CPR) among married women of 75 percent in 2022 to reach the TFR goal (MOHFW, 2017). The TFR in Bangladesh was 2.3 and the CPR among married women was 62 percent according to the 2017/18 Bangladesh Demographic and Health Survey (BDHS) (National Institute of Population Research and Training [NIPORT] & ICF, 2020). Fertility will need to decline to well below replacement levels to align with UN projections and national health goals. What are the prospects for such a decline in Bangladesh? This brief shares more.FS-22-587-D4I
Taking measures before opportunities bleed away: Current knowledge and policy gaps in menstrual hygiene management among adolescent girls in BangladeshShusmita Khan, Data for Impact (D4I), University of North Carolina at Chapel Hill, Kanta Jamil, IAP World Services, Quamrun Nahar, RDM, icddr,b, Anadil Alam, RDM, icddr,b2022English, , The objective of this technical brief is to examine the status of various indicators related to Menstrual Hygiene Management (MHM) among adolescent girls (ever-married and unmarried) ages 15–19 years. The authors conducted a review of national documents to identify current programs that address MHM. The authors also performed a national policies landscape to identify responses, roadmaps, and potential gaps. This brief provides recommendations for appropriate strategies for stakeholders and decision makers to ensure appropriate MHM roadmaps for adolescent girls in Bangladesh.fs-22-586-d4i
Malawi Secondary Education Expansion for Development (SEED) Impact Evaluation: Baseline Report SummaryData for Impact2022English, , The Malawi Secondary Education Expansion for Development (SEED) activity is funded by USAID and PEPFAR and includes urban expansion and rural construction of Community Day Secondary Schools (CDSSs). Data for Impact (D4I) is conducting an impact evaluation of the SEED activity to help understand whether there is a change or impact on communities where SEED is carrying out expansion and construction of CDSSs. This summary report shares an overview of baseline findings.SR-22-160 D4I
Planting the SEEDs for Education: Theory of Change BriefData for Impact2022English, , , , Data for Impact (D4I) was tasked with conducting an impact evaluation of the Malawi Secondary Education Expansion for Development (SEED) program and collected baseline data in 2019. This brief presents the SEED theory of change and underlying hypotheses. Page two highlights baseline data related to the hypotheses. Access a related baseline report, summary report, and additional graphic briefs.fs-22-576-d4i
Understanding Financial Barriers to Secondary Education in Rural Malawi: Results from the Malawi SEED Impact Evaluation Baseline SurveyData for Impact2022English, , In 2021, Data for Impact (D4I), with funding from USAID, began a mixed-methods impact evaluation to assess the impact of the Malawi Secondary Education Expansion for Development (SEED) activity. This brief presents data triangulated from baseline quantitative and qualitative interviews with rural students, their caregivers, and head teachers about actual and perceived barriers to educational achievement, including the financial costs of sending children to school. Access a related baseline report, summary report, and additional graphic briefs.fs-22-577-d4i
Malawi SEED Urban School Expansion: Qualitative BriefData for Impact2022English, , The Malawi Secondary Education Expansion for Development (SEED) activity worked to improve urban secondary school facilities, including new classroom blocks, boy and girl latrine blocks, and changing rooms for girls. This brief shares related findings from an impact evaluation by Data for Impact. Access a related baseline report, summary report, and additional graphic briefs.fs-22-575-d4i
Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive HealthBridgit Adamou2020English, , , , Adolescents and youth are a key population for reproductive health (RH) interventions, because young people suffer disproportionately from negative RH outcomes, including acquisition of HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancy; unsafe abortion; and gender-based violence. Effective monitoring and evaluation (M&E) of RH interventions designed for adolescents and youth is essential to determine their success and impact and show where improvement is needed. MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this report to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories.tr-20-394
Guidelines on the Use of Data Warehouses in Child Care and Protection Information Management and AnalyticsData for Impact2022English, , , , , These guidelines were developed to support governments and other childcare and protection stakeholders in the conceptualization, development, and use of data warehouses to manage and analyze information from multiple sources for more efficient and informed decision making and improved services and outcomes for children and families. It provides a technical overview of the options available for developing analytical solutions to integrate data using a data warehouse approach. For any level of complexity and budget, there are suitable solutions available; these guidelines aim to empower stakeholders with the key information needed for selecting the most appropriate one. Although many sections in the guidelines are intended for audiences with a monitoring and evaluation or information technology background, the document can also foster discussion among leadership and policy makers about data integration possibilities and goals for the future of childcare and protection information management and analytics.MS-22-212 D4I
Digital Skills Assessment GuideData for Impact2022English, , , , This guide is intended to provide a general roadmap for the development and implementation of a custom digital skills assessment within a child protection government agency or organization. Given the ever-increasing significance of digital skills for all work, especially work requiring collection and use of sensitive data related to children in precarious situations, assessing and improving digital skills among the child protection workforce is of utmost importance. Watch a webinar introducing the guide.MS-22-211 D4I
Counter-Trafficking in Persons (C-TIP) Expert Assessment ReportData for Impact2022English, , , The Ministry of Labor and Social Affairs (MOLSA) with support from the United States Agency for International Development (USAID) Data for Impact (D4I) project assessed progress of counter-trafficking in persons (C-TIP) aspects of the 2020–2022 National Action Plan (NAP). The report provides evidence-based recommendations to improve C-TIP programming and to better monitor implementation through standardized indicators and performance measures. As part of the assessment, MOLSA and D4I completed a review of the C-TIP monitoring and evaluation system capacity. The assessment established the types of human trafficking cases in Armenia and categorized them, evaluated the series of steps performed by the counter-trafficking person and exploitation of person actors engaged in C-TIP in Armenia (also known as business processes) as envisioned by the NAP, outlined the current steps and practices, and recommended the ideal process. This report outlines the status of the activities described under each chapter of the NAP and highlights the gaps and challenges to be addressed.TR-22-487-D4I
Madagascar IMPACT Activity (Improving Market Partnerships and Access to Commodities Together) Midterm Evaluation ReportBergson, S., Indriamihaja, O.C., Moonzwe, L., Koch, R., Mohamed, N.S., & Tarrant, A.2022English, , , This midterm evaluation examined the progress of the Improving Market Partnerships and Access to Commodities Together (IMPACT) program to identify promising approaches and ongoing challenges, and to provide recommendations for the remainder of the program implementation period. The evaluation focused on three questions: 1. What is the effect of IMPACT’s total market approach (TMA) on improving the availability and accessibility of quality health products to the Malagasy people? 2. Which of the IMPACT implementation approaches and activities appear to be the most promising and should be prioritized in the final two years of promoting the TMA? For those that are not showing promise, what alternatives or complementary options should be considered? 3. To what extent is there national ownership/stewardship of the TMA? How has the IMPACT program contributed to this degree of national ownership? The evaluation used a mixed methods approach, including primary data collection through an online survey, key informant interviews, and focus group discussions; secondary review of program documents; and secondary analysis of existing data collected from program documents and routine monitoring activities. The data suggested that IMPACT was achieving its intended objectives and intermediate results related to enhanced coordination, strengthened capacity, and expanded engagement. The data also indicated that logistics, logistics management information system, and supply chain management issues continued to plague the program, resulting in continued and harmful stockouts or stock mismanagement issues, thereby inhibiting the potential success of innovative demand creation activities and, ultimately, bringing limited access to health products. Key recommendations include prioritizing the transition of stewardship and responsibility, renewing the understanding of a TMA approach with stakeholders, improving engagement of the private sector, transitioning social marketing activities, and increasing demand for health products.TR-22-489-D4I
Appraisal of Family Planning Commodities Management during the COVID-19 Crisis in Gandaki Province, NepalIsha Karmacharya, MPH; Santosh Khadka, MPH; Laxmi Adhikari, MPH; Maheshor Kaphle, MPH2022English, , , , Background: Family planning (FP) is an integral part of the Government of Nepal’s (GoN) national health strategy and Ministry of Health and Population (MoHP) programs. The MoHP’s Family Health Division is committed to implementing targeted strategies and interventions that enable the country to continue to increase access to and use of rights-based, high-quality FP information and services, with a particular focus on serving the poor, vulnerable, and marginalized populations. However, the COVID-19 threats followed by a nationwide lockdown have weakened all aspects of Nepal’s health system, including access to FP commodities and services. Study Objective: The main objective of this study was to assess FP commodities procurement, supply chain and stock management at Gandaki Province and local levels during the COVID-19 pandemic emergency to determine if there were any variations in FP commodities procurement, supply chain, stock management, and service delivery. Methods: The study was conducted in Gandaki Province, employing quantitative and qualitative methods. For the quantitative part of the study, we obtained secondary data from the Provincial Health Logistic Management Center (PHLMC) and Provincial Health Directorate for all 11 districts of the province on FP commodities and stock management from mid-January to mid-April 2020 (before the COVID-19 crisis) and mid-April to mid-July 2020 (during the COVID-19 crisis). We conducted 17 key informant interviews (KIIs) to obtain qualitative data from central, provincial, district, and local government health staff. We performed descriptive data analysis to assess FP procurement, supply chain, and stock management changes due to the COVID-19 crisis. Results: The process of procuring FP commodities was the sole responsibility of the central level government. The commodities that were previously overstocked, such as male condoms, COCs, and injectables, were understocked during the pandemic. The most-preferred FP methods during the pandemic were short-acting methods like condoms and combined oral contraceptive pills (COCs) because of less personal interaction involved in accessing the methods. At the same time, there was a reduction in new users of modern methods (COCs, implant, intrauterine contraceptive device [IUCD], and permanent methods), aside from injectables, which had slightly increased. The quantity of male condoms supplied also decreased. No specific strategies for FP commodities management were formulated at the provincial level. However, district-level governments attempted to address FP challenges caused by the pandemic by installing mobile and satellite clinics, augmenting human resources, sending FP commodities with the vehicles that transported COVID-19 safety commodities, and shifting the use of long-acting methods to short-acting methods. Professionals working in the FP sector felt the need to maintain a proper stock of FP commodities and strengthen their monitoring, documentation, and system management. The central level, with the U.S. Agency for International Development’s (USAID) support, performed monitoring that helped the provinces keep track of the commodities supply and stock. Conclusion: FP commodities management and service utilization were affected by the COVID-19 pandemic. Accessing difficult-to-reach places with FP commodities was coordinated via the supporting organizations in those areas. Regular rapid assessments and enforcement of remedial measures are needed for the health supply chain, procurement system, and stock management.WP-22-257 D4I
État de préparation des services Évaluation de mi-parcours du programme de santé intégré de l’USAID: Résultats des enquêtes de 2019 et 2021 sur les établissements de santéData for Impact2022French, , , , L’objectif du programme de santé intégré (PROSANI) de l’USAID est de renforcer la capacité des institutions et des communautés congolaises à fournir des services de santé intégrés de haute qualité afin d’améliorer durablement l’état de santé de la population du pays. Dans le cadre des efforts de suivi du PROSANI USAID, l’équipe Data for Impact (D4I) de l’Université de Tulane a réalisé une évaluation indépendante de la performance et de l’impact du PROSANI de l’USAID sur les principaux résultats liés au système de santé, notamment l’utilisation des services de planification familiale et de soins de santé, le fonctionnement des systèmes de santé et l’adoption de comportements sains. Ce dossier présente les conclusions et les progrès réalisés de 2019 à 2021, pour l’un des indicateurs clés, la préparation des services. L’état de préparation des services est la capacité globale des établissements de santé à fournir des services de santé généraux et la disponibilité des éléments nécessaires à la prestation de ces services.WP-22-256d D4I FR
Prestation de services Évaluation de mi-parcours du programme de santé intégré de l’USAID: Résultats des enquêtes de 2019 et 2021 sur les établissements de santéData for Impact2022French, , , , , Le programme de santé intégré de l’USAID (PROSANI) vise à renforcer la capacité des institutions et des communautés congolaises à fournir des services de santé intégrés de haute qualité afin d’améliorer durablement l’état de santé de la population du pays. Dans le cadre des efforts de suivi du PROSANI USAID, l’équipe Data for Impact (D4I) de l’Université de Tulane a réalisé une évaluation indépendante de la performance et de l’impact du PROSANI USAID sur les principaux résultats liés au système de santé, notamment l’utilisation des services de planification familiale et de soins de santé, le fonctionnement des systèmes de santé et l’adoption de comportements sains. Ce mémoire présente les conclusions sur les différents aspects de la prestation de services et les progrès réalisés de 2019 à 2021.WP-22-256c D4I FR
Leadership et gouvernance Évaluation de mi-parcours du programme de santé intégré de l’USAID: Résultats des enquêtes de 2019 et 2021 sur les établissements de santéData for Impact2022French, , , Le programme de santé intégré PROSANI de l’USAID vise à renforcer la capacité des institutions et des communautés congolaises à fournir des services de santé intégrés de haute qualité afin d’améliorer durablement l’état de santé de la population du pays. Dans le cadre des efforts de suivi du PROSANI USAID, l’équipe Data for Impact (D4I) de l’Université de Tulane a procédé à une évaluation indépendante de la performance et de l’impact du PROSANI USAID sur les principaux résultats liés au système de santé, notamment l’utilisation des services de planification familiale et de soins de santé, le fonctionnement des systèmes de santé et l’adoption de comportements sains. Ce mémoire présente les conclusions relatives aux progrès accomplis sur les indicateurs de leadership et de gouvernance mesurés en 2019 et 2021. WP-22-256b D4I FR
Impact de la pandémie de COVID-19 Évaluation de mi-parcours du programme de santé intégré de l’USAID: Résultats des enquêtes de 2019 et 2021 sur les établissements de santéData for Impact2022French, , , , La propagation du coronavirus (COVID-19), une infection virale hautement transmissible, a provoqué une pandémie mondiale qui a entraîné des pertes de vies humaines dans le monde entier, notamment en République Démocratique du Congo (RDC). Avant la pandémie, en 2018, le programme de santé intégré du PROSANI USAID a été lancé pour améliorer les résultats sanitaires en RDC. Plus précisément, l’objectif du PROSANI USAID est de renforcer la capacité des institutions et des communautés congolaises à fournir des services de santé intégrés de haute qualité pour améliorer durablement l’état de santé de la population du pays. Dans le cadre des efforts de suivi de l’USAID, l’équipe Data for Impact (D4I) de l’Université de Tulane a réalisé une évaluation indépendante de la performance et de l’impact du PROSANI USAID sur les principaux résultats liés au système de santé, notamment l’utilisation des services de planification familiale et de soins de santé, le fonctionnement des systèmes de santé et l’adoption de comportements sains. L’équipe de recherche a recueilli des données qualitatives pour évaluer l’impact de la pandémie de COVID-19 sur le PROSANI USAID et le système de santé en RDC. Les résultats de l’impact de la pandémie de COVID-19 sont présentés dans ce dossier.WP-22-256a D4I FR
Impact of vacancies at the community level: Insights from digital toolsData for Impact2022English, , , , The Ministry of Health and Family Welfare operates through two large organizations to provide primary healthcare to the citizens of Bangladesh. One of those is the Directorate General of Family Planning (DGFP). DGFP employs a large pool of community level health and family planning workers predominantly in rural areas who provide services through home visits and at health facilities. However, many positions remain vacant. Digital tools such as those used by the electronic management information system at the grassroots level provide opportunities to examine the impact of these vacancies on health service delivery in real-time. This policy brief examines vacancies of one category of community level worker, Family Welfare Assistants, and suggests recommendations for DGFP to staff the vacancies expeditiously.fs-22-580-d4i
The double burden of malnutrition among Bangladeshi women: Rethinking the country’s maternal and child health programs and policiesData for Impact2022English, , , , , , This brief discusses malnutrition among ever-married women ages 15–49 in Bangladesh and draws on data from the Bangladesh Demographic and Health Surveys in 2007 and 2017–2018.fs-22-578-d4i
Republica Moldova: Copiii beneficiari ai serviciilor sociale în 2021: Buletin statisticData for Impact2022Romanian, , Acest buletin statistic a fost realizat de către Agenția Națională Asistență Socială (ANAS) cu suportul proiectului ”Date pentru impact: Valorificarea puterii datelor în beneficiul copilului” (D4I), finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională (USAID). Proiectul are drept obiectiv general consolidarea capacității guvernului și a partenerilor săi, la nivel național și local, de colectare, analiză și utilizare a datelor pentru a genera un impact pozitiv asupra copiilor aflați în dificultate. Prezentul buletin statistic prezintă un rezumat al datelor colectate de structurile teritoriale de asistență socială (STAS) cu referire la copiii beneficiari ai serviciilor sociale (primare, specializate și cu specializare înaltă) în anul 2021, în conformitate cu Programul de lucrări statistice pentru anul 2022 aprobat prin Hotărârea Guvernului (HG) nr. 441/2021 și a Nomenclatorului serviciilor sociale aprobat prin Ordinul Ministrului Muncii, Protecției Sociale și Familiei nr. 353/2011. Colectarea, verificarea, centralizarea și analiza datelor au avut loc în perioada ianuarie – mai 2022.
Situația copiilor în sistemul de servicii sociale din raionul Rîșcani, 2019-2021: Buletin informativ
Situația copiilor în sistemul de servicii sociale din raionul Sîngerei, 2019-2021: Buletin informativ
Situația copiilor în sistemul de servicii sociale din raionul Fălești, 2019-2021: Buletin informativ
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Situația copiilor în sistemul de servicii sociale din raionul Rîșcani, 2019-2021: Buletin informativData for Impact2022Romanian, Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din raionul Rîșcani în perioada 2019-2021, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel raional pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Asistență Socială și Protecție a Familiei din raionul Rîșcani pe parcursul celor trei ani. Republica Moldova: Copiii beneficiari ai serviciilor sociale în 2021: Buletin statistictr-22-490c-d4i-ro
Situația copiilor în sistemul de servicii sociale din raionul Sîngerei, 2019-2021: Buletin informativData for Impact2022Romanian, Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din raionul Sîngerei în perioada 2019-2021, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel raional pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Asistență Socială și Protecție a Familiei din raionul Sîngerei pe parcursul celor trei ani. Republica Moldova: Copiii beneficiari ai serviciilor sociale în 2021: Buletin statistictr-22-490b-d4i-ro
Situația copiilor în sistemul de servicii sociale din raionul Fălești, 2019-2021: Buletin informativData for Impact2022Romanian, Acest buletin informativ prezintă o analiză succintă a situației copiilor aflați în situație de risc și a copiilor separați de părinți din raionul Fălești în perioada 2019-2021, progresele înregistrate și acțiunile întreprinse sau care urmează a fi întreprinse la nivel raional pentru o mai bună abordare a necesităților copiilor, reducerea vulnerabilității acestora în fața diferitelor forme de risc social și îmbunătățirea calității vieții lor. În analiză s-au folosit datele colectate de Direcția Generală Asistență Socială, Protecție a Familiei și Copilului (DGASPFC) din raionul Fălești pe parcursul celor trei ani. Republica Moldova: Copiii beneficiari ai serviciilor sociale în 2021: Buletin statisticTR-22-490d-D4I-RO
Pilot experiences: Using RECAP to build capacity for research and evaluation of health programsData for Impact2022English, , , The Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP) supports local organizations to rapidly assess their technical and management capacity for conducting research and evaluations. As part of the RECAP development process, three evaluation and research organizations from different backgrounds conducted a self-assessment using RECAP. Feedback from each workshop was incorporated into the final version of the RECAP package. Results from each assessment workshop are anonymously presented as an example of the information that RECAP can generate. Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206h-d4i
USAID Integrated Health Program Evaluation Report: Year 2 Impact Evaluation ResultsDavid Hotchkiss, Matt Worges, Janna Wisniewski, Paul-Samson Lusamba-Dikassa, Lauren Blum, Eva Silvestre, Gael Compta, Francine Wood2022English, , , , , , This report presents results from an impact evaluation conducted by Data for Impact (D4I) following two years of the United States Agency for International Development (USAID) Integrated Health Program’s (IHP) implementation in nine provinces of the Democratic Republic of the Congo (DRC). The IHP focuses, in part, on increasing utilization of health facility-based maternal and child healthcare and family planning services. The impact evaluation investigates the extent to which changes in healthy behaviors and health outcomes are attributable to the USAID IHP.tr-21-453-d4i
Mapped newborn data availability in routine Health Information Systems: EN-MINI mapping tool results: Tanzania – June 2022Data for Impact2023English, , , , , This report provides background information and shares results from the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) mapping tool in Tanzania.tl-21-94j-d4i
Monitoring and Evaluation Capacity Strengthening Plan: RwandaData for Impact2022English, , , , , , USAID Data for Impact (D4I) and National Child Development Agency (NCDA) collaborated and conducted a five-day Child Protection Management Information System (CPMIS) stakeholder workshop to gain a better understanding of Rwanda’s care reform landscape, identify areas and opportunities for monitoring and evaluation (M&E) capacity strengthening, assess existing management information systems for child protection and care, and to identify priorities and requirements for integrated and reliable information management systems. A monitoring and evaluation (M&E) Capacity Strengthening Plan was then developed to respond to key M&E gaps identified and recommendations as per the capacity areas documented in the assessment report. This brief provides an overview of the plan.fs-22-567-d4i
Landscape Assessment of Child Protection Digital Information Systems in Rwanda: May – June 2021Data for Impact2022English, , , To better understand the current digital information systems and data in the child protection sector, D4I conducted a high-level landscape assessment of the child protection digital information systems assessing aspects such as governance, indicators captured, users, architecture, and visualization tools. The assessment seeks to understand the context and environment in which the various child protection related systems operate and identify the gaps and opportunities for an integrated national child protection monitoring and information management system. The landscape assessment workshop aimed to understand the roles of those stakeholders working in care reform—specifically, their experience in assessing, monitoring, and using information about child protection and care, as well as noting any information gaps in the current system. The goal was to highlight the various data and information systems currently used in Rwanda for child protection and care services. This report shares more.tr-22-470-d4i
Child Protection and Care Reform in Rwanda: Monitoring and Evaluation Capacity Assessment ReportData for Impact2022English, , , , , , , Over the last decade, Rwanda has taken several measures to ensure appropriate care for children without parental care with particular attention to preventing unnecessary separation of children from their families and ensuring the provision of alternative care for children deprived of parental care. As part of the care system reforms, the Government of Rwanda and its partners have identified the need to strengthen the administrative data collection and reporting systems to improve availability and use of data, including the need to develop an integrated monitoring and information management system for children involved in the child protection system and use of existing and new data for policy and programmatic decision making. Data for Impact and Rwanda's National Child Development Agency worked together to organize a five-day Child Protection Management Information System stakeholder workshop to gain a better understanding of Rwanda’s care reform landscape, identify areas and opportunities for monitoring and evaluation (M&E) capacity strengthening, assess existing management information systems for child protection and care, and to identify priorities and requirements for integrated and reliable information management systems. This report shares more.tr-22-466-d4i
Research and Evaluation Capacity Assessment Tool and Resource Package: Institutional Strengthening ResourcesData for Impact2022English, This document is part of the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP) and shares institutional strengthening resources. Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206d-d4i
Research and Evaluation Capacity Assessment Tool and Package (RECAP): Facilitator PresentationData for Impact2022English, , This facilitator PowerPoint presentation is part of the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP). Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206g-d4i;
Research and Evaluation Capacity Assessment Tool and Resource Package: Assessment WorkbookData for Impact2022English, , , This Excel assessment workbook is part of the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP). Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206f-d4i
Research and Evaluation Capacity Assessment Tool and Resource Package: Tool SummaryData for Impact2022English, , This resource provides a summary overview of the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP) tool. Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206e-d4i
Brief: Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP)Data for Impact2022English, , With increasing demand for accountability and rigorous research and evaluations of health programs, the Data for Impact (D4I) project developed the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP) to support local organizations to rapidly assess their technical and management capacity for conducting research and evaluations. This brief provides a one-page overview of RECAP. Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206c
Frequently Asked Questions: The Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP)Data for Impact2022English, This frequently asked questions (FAQ) resource provides answers to common questions on the Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP). Access additional RECAP resources at https://www.data4impactproject.org/resources/recap/.ms-21-206b-d4i
Research and Evaluation Capacity Assessment Tool and Resource Package: User GuideLuben, E., Fehringer, J., Brugh, K., Strahley, A., Pietrzyk, S., & Millar, L.2022English, , , The Research and Evaluation Capacity Assessment Tool and Resource Package (RECAP) has been designed to support local organizations to rapidly assess their technical and management capacity for conducting research and evaluations. RECAP supports users in creating actionable plans for institutional strengthening, with the goal of improving country and organizational capacity to address local health information gaps and have the capacity to receive direct awards from the United States Agency for International Development and other funders. Additional RECAP Resources Assessment Workbook Tool Summary Facilitator Presentation Institutional Strengthening Resources Frequently Asked Questions One-page RECAP Briefms-21-206-d4i
Identifying Innovative Approaches to Increase Domestic Resource Mobilization and Financing Contributions for Family Planning in NigeriaChinyere Mbachu, Ifunanya Agu, Chinazom Ekwueme, Irene Eze, Chinonso Obayi, Obinna Onwujekwe2022English, , , Background: Improving domestic resource mobilization (DRM) for family planning (FP) can contribute to improving and sustaining maternal health outcomes, especially in such places as Ebonyi State, Nigeria, which has one of the highest unmet needs for FP in the country. This study explored the prospects for increasing government spending on FP in the short-to-medium term in view of the well-defined needs for improved FP service delivery and stocks of contraceptive commodities. Methods: A fiscal space assessment was conducted in Ebonyi State. We applied the Roadmap for Assessing Fiscal Space for Health (Tandon & Cashin, 2010) to identify the need for additional funding for FP services in Ebonyi State and assessed the potential and feasibility of increasing funding for FP through DRM. Data collection entailed a document review and two key informant interviews. We performed descriptive trend analysis of financial data to determine change over time and to make assumptions (of increases or declines in the fiscal space) for the short-to-medium term (2016–2020). For the qualitative data, we performed a manual thematic analysis then triangulated the narratives with the quantitative data. Findings: Statutory allocation constituted a considerably high proportion of the total revenue in Ebonyi State but there has been a downward trend since 2018. With the exclusion of the 2020 budget, the budgetary allocation to health in the past five years has been very poor, ranging from 2.7 percent to 3.2 percent, which is far less than the Abuja Declaration recommendation of 15 percent. The main sources of funding for FP in the past five years were the federal government’s earmarked funds under the Saving One Million Lives Program for Results and donor contributions, specifically from the United Nations Fund for Population Activities. Although budgetary allocations for FP were made in the state government’s budget in the past five years (2016–2020), releases were only made in 2016 and 2017, albeit very paltry sums. Therefore, in the past three years, FP services have been funded from external sources. Conclusion: The fiscal space for FP services and contraceptives is very poor in Ebonyi State. It could be improved if the state government honors its commitment to allocate 15 percent of its budget to the health sector and if a proportion of the Basic Health Care Provision Fund is earmarked for FP services.wp-22-253-d4i
EN-MINI Tools: Training ManualThe London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , This manual is intended to support the use of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems. The training manual is for both facilitators and participants and explains how to conduct the training sessions using the complementary training slides. Learn more and access additional resources on the EN-MINI Tools site.TL-23-102
EN-MINI Tools: Training PresentationThe London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This training PowerPoint is intended for use with the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Learn more and access additional resources on the EN-MINI Tools site.pr-
Examinarea și utilizarea datelor pentru luarea deciziilor în beneficiul copiluluiViorica Toartă, Camelia Gheorghe2022Romanian, , , , Obiectivul proiectului ”Date pentru Impact (D4I): Valorificarea puterii datelor în beneficiul copilului”, finanțat de Agenția Statelor Unite pentru Dezvoltare Internațională (USAID) și implementat de Palladium în Republica Moldova, este de a consolida capacitatea guvernului și a partenerilor săi la nivel național și local de a colecta date de bună calitate, a le analiza și utiliza pentru a genera un impact pozitiv asupra copiilor aflați în dificultate.wp-22-252-D4I-RO
Evaluation of the FUTURES Project: Baseline ReportMitiku, F., Barden-O’Fallon, J., Hiruy, H., Millar, E., & Gerbaba, M.2022English, , , , The FUTURES—My Forest, My Livelihood, My Family program (FUTURES) serves communities in the Yayu Coffee Forest Biosphere Reserve (YCFBR) located in Southwestern Ethiopia, in Oromia Regional State. The YCFBR encompasses the Hurumu, Yayo, Bilo Nopa, Alge-Sachi, and Doreni woredas of Illu-Abba Bora zone and Chora woreda of Buno Bedele zone and includes protected forest area as well as designated areas for economic activities like coffee and spice production, commercial forest plantations and eco-tourism, and areas where many traditional and modern agricultural practices take place. Households in the area depend on a combination of small-scale agricultural and forest management systems dominated by traditional agronomic practices and characterized by a lack of crop diversity and low productivity. Deforestation, degradation, and increased loss of biodiversity are major concerns for sustainable agricultural and livelihood practice in the region. Social, gender, and cultural barriers have historically limited women’s and youth’s engagement in agricultural and economic sectors. High rates of early and forced marriage, and limited availability of reproductive health and family planning services, especially youth-friendly services, may further limit women and youth from participating meaningfully in agricultural practice and livelihood generation. Government services and local civil society organizations in the area operate at a limited capacity, and their offices are male-dominated and do not meaningfully incorporate a gendered approach to their work (Gebrehanna and Seyoum, 2020). The three-year FUTURES project was launched in April 2021 to address many of the health, environment, and livelihood concerns of the YCFBR region. The project is implemented by CARE Ethiopia and its three local partners, Oromia Development Association (ODA), Environment and Coffee Forest Forum (ECFF), and Kulich Youth Reproductive Health and Development Organization (KYRHDO). The FUTURES project evaluation, funded by USAID, and led by Data for Impact (D4I), aims to understand the impact of the FUTURES project on key health, agricultural, and livelihood and conservation behavioral outcomes, and to contribute to knowledge about the implementation of cross-sectoral programs, including monitoring, evaluations, and learning (MEL) of such programs.tre-22-31
Using Routine Data in Combination with Population Surveys to Understand Patterns of Contraceptive Use: A Case Study of MalawiMai Do, MD, DrPH; Bhavita Kumari, MD, MPH; Janine Barden-O’Fallon, PhD; Amani Selim, MA; Wezi Munthali, MPH; Bertha Migodi, MScCHN2022English, , , , Routine data have often been underutilized in family planning (FP) program monitoring and evaluation and in decision making at local and national levels. This presents a critical need for a greater use of these data sources for health outcome monitoring and decision making. The overall goal of this exercise was to test the feasibility of using existing routine data in combination with non-routine data to monitor and explain contraceptive use behaviors among populations in need, while also assisting districts to better understand supply chain challenges and plan for commodity procurement. We aimed to achieve two specific objectives: 1. Assess patterns of modern contraceptive use and discontinuation for method related reasons among women of reproductive age 2. Compare modern contraceptive supply data among districts with different levels of contraceptive use and discontinuation for method related reasons to identify potential supply challenges and recommendations Malawi was the focus country of this activity. Non-routine information on contraceptive behaviors among representative samples of women of reproductive age came from the last Malawi Demographic and Health Survey (DHS) in 2015–16 (National Statistical Office [NSO/Malawi] and ICF, 2017). Sources for routine data included District Health Information System 2 (DHIS2) and OpenLMIS, which have been integrated into the health management information system of the Ministry of Health. We focused on data related to the current use and discontinuation of injectables and implants (from the DHS), and their supply data from the HMIS. Supply data included indicators related to stockout, stock on hand, and quantities received and used. The analysis was implemented in two phases. Phase I was the analysis contraceptive use and discontinuation among Malawian women using the DHS data. The intent of Phase II was to assess supply indicators for each of the eleven USAID priority districts. The key outcome of the exercise was to produce a simple analytical approach that could be replicable in other settings. The exercise highlighted the critical need for data consistency and quality for this type of analysis to produce useful findings that could benefit decision making around commodity supplies. We propose certain recommendations to improve the usability of commodity supply data and enhance the feasibility and usefulness of this exercise. First, it is important to establish clear criteria with regard to what service delivery points and health facilities need to report on what indicators, and how. These criteria also need to clearly distinguish different community distribution mechanisms, i.e. facility-based versus community-based, depending on the specific method. Second, there needs to be an established feedback mechanism for the district and central levels to review and incorporate such data into commodity procurement and disbursement decision making. Such a feedback mechanism should allow sufficient time for the district and central levels to review data and take actions to enhance data quality.tr-22-472-D4I
Assessment of Journalist Training in Family Planning and Reproductive HealthData for Impact2022English, , , This is the final report of an assessment for trainings of journalists and youth advocates in family planning and reproductive health (FP/RH) conducted by projects funded by the United States Agency for International Development (USAID) Office of Population and Reproductive Health (PRH) 2014–2020. D4I assessed recent journalist trainings to better understand how future training initiatives should adapt to stay current within the continuously changing communication and media landscapes. The Population Reference Bureau (PRB) conducted most of the PRH-funded journalist trainings through their flagship Women’s Edition workshops and their Youth Multimedia trainings. ICF International also delivered PRH-funded journalist training under The Demographic and Health Surveys Program (DHS). Women’s Edition trainings targeted women journalists from all professional levels interested in covering health and development stories and representing diverse media in developing countries. Youth Multimedia trainings targeted youth advocates within youth-led organizations who were passionate about population dynamics and reproductive health. DHS trainings targeted journalists interested in reporting on DHS surveys. This assessment aimed to provide programmatic recommendations based on a complete view of the trainings from the perspective of the implementing organizations and trainees.sr-21-153-d4i
Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and PracticesMEASURE Evaluation2020English,

Health organizations around the globe regularly make evidence-based decisions for effective health programming. Qualitative evaluation fulfills an important role in rigorous evaluation of programs. The strength of qualitative evaluation is its ability to provide valuable insight into complex issues, which quantitative methods may not provide. Qualitative data sources can answer the “why” behind program successes or challenges. Additionally, qualitative data illuminate the uniquely human side of health programming and bring to light important contextual factors, such as culture, gender, or societal norms. Qualitative evaluation may be used to complement quantitative data, answer a question not accessible quantitatively, or provide a cost-effective data source when one would not otherwise be available.

This curriculum covers a training that is meant to assist health professionals in using qualitative evaluation skills in sound and rigorous evaluation of their program. The course is meant to assist health professionals in using qualitative evaluation skills in sound and rigorous evaluation of their programs. The sessions go beyond basic concepts to explore important considerations of qualitative methods in the context of rigorous evaluation. Through session content and participatory exercises, participants will gain basic skills in rigorous qualitative data collection, analysis, and use.

MEASURE Evaluation's Qualitative Methods in Evaluation of Public Health Programs Curriculum resources include:
  • Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Syllabus
  • Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Facilitators’ Guide
  • Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Participants’ Guide
  • PowerPoint presentations for each of the 12 course training workshop sessions
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EN-MINI-PRISM Analysis ToolThe London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , The EN-MINI-PRISM Analysis Tool is an accompanying data analysis tool for the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Learn more and access additional resources on the EN-MINI Tools site.EN-MINI-PAT
EN-MINI Tool 02022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 0
Our Work: Year 3 HighlightsData for Impact2022English, , , , This graphic shares highlights from Data for Impact's work during Year 3 of the project.gr-22-125-d4i
Use of Routine Health Information System Data to Monitor and Improve Quality of CareD4I2022EnglishTo reduce maternal and neonatal mortality substantially and move towards eliminating preventable causes of maternal and newborn death, increased coverage of services should be accompanied by improved quality throughout the continuum of care. Data enable practitioners to accurately identify quality of care (QOC) problems, prioritize quality improvement initiatives, and objectively assess whether QOC change and improvement has occurred. Collecting and analyzing data are therefore central to the function of quality improvement in any health service. The World Health Organization (WHO), with support from various global partners, has developed QOC standards for improving maternal and newborn care, child and young adolescent care, care for small and sick newborns, and a monitoring framework and measures. This study, funded by the United States Agency for International Development’s (USAID) Bureau for Global Health through the Data for Impact (D4I) project, used the WHO framework with some adaptations to assess how practitioners and government officials use the QOC indicators to inform reproductive, maternal, newborn, and child health (RMNCH) decision making in Bangladesh. Study objectives included: 1. To document what routine health information systems, data elements, and indicators referenced in the WHO framework are available and used in Bangladesh for quality improvement. 2. To document who the RHIS data users are and their perception and experience of using RHIS for QOC improvement efforts.FS-21-530
Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators EN-MINI-PRISM Tools for Routine Health Information SystemsThe London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Learn more and access additional resources on the EN-MINI Tools site. The tools were updated in February 2023.TL-23-102 D4I
EN-MINI Tool 6The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Download the related scoring guide. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 6
EN-MINI Tool 5The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 5
EN-MINI Tool 4The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 4
EN-MINI Tool 3The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 3
EN-MINI Tool 2The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 2
EN-MINI Tool 1The London School of Hygiene & Tropical Medicine UK, Ifakara Health Institute Tanzania, icddr,b Bangladesh, and D4I2022English, , , , , , This resource is part of the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Tools for Routine Health Information Systems collection. Access updated versions of the EN-MINI tools and find additional resources on the EN-MINI Tools site.EN-MINI Tool 1
Privacy and Confidentiality of Personal Health Data in BangladeshD4I2022EnglishMaintaining the privacy and confidentiality of health data is a global issue. With or without knowing it, people share several types of personal data during their interactions with health care service providers and health facilities. As digital systems now record and store this data, issues relating to privacy and confidentiality assume a much greater importance. Health data is sensitive and reveal personal details; it is therefore critical to institute measures to avoid unauthorized access and use of it. This policy brief examines the generation and use of personal health data in Bangladesh and explains why the government should enact appropriate laws and adopt measures for protecting privacy and confidentiality of personal health data within the national digital health infrastructure.WP-21-250
Brief: Considerations for the Use of Routine Data for Evaluation of Public Health ProgramsMeasure Evaluation2020English, , , , A routine health information system (RHIS) collects and provides data about standard health and vital events at regular intervals to support the decision-making process at each level of the health system. Use of data from RHIS for evaluation has grown as more resources are dedicated to improving these systems. Secondary data, including routine data, are not collected by the data user but have appealing advantages over primary data collected for specific research. They are typically collected more frequently or over a longer period; boast greater cost efficiency, in some cases; and may be available more quickly.1–2 However, routine data are not appropriate for all evaluation questions or all contexts. Evaluators must carefully consider aspects such as data quality, usability, and accessibility before deciding to use these data. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has used RHIS data in numerous evaluations over the past 20 years. This brief shares field experiences from this work and key considerations for the use of RHIS data in evaluation.FS-20-418
Armenia’s Counter-Trafficking Situation and Response: Landscape Assessment ReportD4I2021English, , SR-21-154 D4I
Supporting Countries to Measure Progress and Outcomes of National Care Reforms Development Care System Reform Logic Model and Indicator Mapping ActivityData for Impact2021, , Globally, countries are striving to reform their child protection and care systems to ensure appropriate care for children without or at risk of losing parental care. The reforms are also informed by growing evidence illustrating the benefits of family-based care on children’s development and the negative impacts of residential care. However, there is a lack of a shared conceptual and measurement framework to guide planning and enable decision makers to accurately track progress and performance in strengthening national care systems, evaluate impact, and ensure accountability at country and global levels. Because of this, the D4I team has undertaken a review of existing measurement frameworks and tools and has developed a draft logic model and mapped global and national indicators to the model. The logic model draws heavily on existing guidance and research evidence on care reform. The logic model and indicators are expected to inform efforts to measure the progress and outcomes of reforming care systems. The D4I team elicited feedback on the draft logic model and indicators from key stakeholders including representatives from U.S. Agency for International Development (USAID), United Nations Children’s Fund (UNICEF), the Better Care Network (BCN), and the Global Social Service Workforce Alliance (GSSWA). In addition, it was presented to and revised based on feedback from the Evidence for Impact Working Group. This group, chaired by representatives of the Better Care Network and Lumos Foundation, brings together researchers, measurement experts, and practitioners working on establishing data systems on children’s care to foster a strategic and well-coordinated approach to research and data in the sector, with a focus on generating and applying “evidence for impact” on policy, systems, and practice globally. D4I has worked closely with this working group to advance the overall measurement framework by capturing existing indicators and data sources and collectively identifying gaps.TR-21-450 D4I
Dhaka Tribune Op-Ed: Born Too Early: Preterm Births in Bangladesh Shusmita Khan and Ahmed Ehsanur Rahman2021English
Current practices on data review and data use to inform supportive supervision in child protection in MoldovaD4I2021English, , WP-21-249
USAID Integrated Health Program Midline Evaluation: Results from the 2019 and 2021 health facility surveysDavid Hotchkiss, PhD; Janna Wisniewski, PhD; Matt Worges, PhD; Paul-Samson Lusamba-Dikassa, MD, PhD; Lauren Blum, PhD; Eva Silvestre, PhD; Gael Compta, MS; Francine Wood, MPH2021English, , , , , , , , , This report presents results from Data for Impact’s baseline and midline health facility surveys, administered in 2019 and 2021 as part of the performance evaluation of the Integrated Health Program in the Democratic Republic of the Congo. Performance relative to key indicators was compared between 2019 and 2021, both overall and disaggregated by province, when appropriate. Data were also collected at the community level in 2021 only. In general, performance on indicators of leadership and governance was stronger than on indicators of quality; however, some quality indicators were found to be significantly improved between baseline and midline. A full evaluation report that includes results from qualitative analyses is forthcoming. See a report on the baseline evaluation.TR-21-447
OP-ED: Let’s not Ignore Blood Pressure and Diabetes2020EnglishOp ed on hypertension & diabetes
Measurement of Full Method Choice: Assessment of method availability in BangladeshData for Impact2021English, , , TR-21-445 D4I
OP-ED: Fighting to Breathe2020EnglishOp Ed on childhood pneumonia
Dhaka Tribune Op-Ed: Increasing Choices for Family Planning2021English, Op ed on increasing FP choices
The United Republic of Tanzania’s National Guidelines for Supportive Supervision of Most Vulnerable Children ProgramsTanzania Ministry of Health, Community Development, Gender, Elderly and Children2021English, , , Most vulnerable children (MVC) are defined in Tanzania as children under the age of 18 years living under extreme conditions, characterized by severe deprivation that endangers health, well-being, and long-term development. The exact number of MVC in Tanzania is unknown, but it has been estimated that up to 71 percent of children in Tanzania suffer two or more instances of severe deprivations of their basic needs. Children’s vulnerability is intertwined with social, cultural, and economic factors, plus the effects of the HIV epidemic. Developing appropriate responses to assist MVC requires information on their numbers as well as reach, coverage, and effectiveness of existing services. The vision of the United Republic of Tanzania is to ensure that MVC receive the care, protection, and support required to reach their full potential. In line with this vision, the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), through the Department of Social Welfare (DSW), developed the National Costed Plan of Action for Most Vulnerable Children 2013–2017 (NCPA II). NCPA II outlined activities to enhance the well-being of MVC by protecting their rights and preventing and reducing the incidence or effects of economic hardship and health risks.ms-21-204
A Guide for Conducting Alternative Care Data Review Meetings in UgandaData for Impact2021English, , , , , , As part of ongoing care reforms in Uganda, the Ministry of Gender, Labour and Social Development (MGLSD) has been working to improve data collection, information management, and reporting systems for children living without parental care. In 2019, in collaboration with the MEASURE Evaluation project, which is funded by the United States Agency for International Development (USAID), the MGLSD developed priority indicators for routine monitoring of alternative care, including indicator reference sheets and automated tools for capturing and reporting data required for indicators. The National Guidelines for Routine Monitoring of Formal Alternative Care were also developed to provide standardized guidance on how to collect and report data on children in formal alternative care, including best practices for data analysis and visualization to facilitate the use of data in decision making for alternative care. Published in 2019, the national guidelines present a range of indicators for alternative care, sources of information, the frequency of reporting on alternative care, and monitoring and review structures. The guidelines emphasize the need for regular data review meetings that are aligned with other strategic planning and budget review meetings at district and national levels. Data review meetings are intended to provide a platform to: 1. Review progress made, based on the full array of available data in line with the prioritized indicators. 2. Review and provide feedback on the quality of data. 3. Generate concrete follow-up actions to improve data quality and outcomes for children. This guide is intended for monitoring and evaluation and technical staff in the MGLSD who are responsible for oversight and coordination of child protection and care system reforms, and district-level probation and social welfare officers. It aims to support the application of the national guidelines by providing detailed guidance for planning and facilitating data review meetings on alternative care at national and district levels. It also provides standardized tools and templates for use during review meetings, and highlights best practices for conducting data review meetings.ms-21-202-d4i
Case Management Information Systems Assessment (Excel)Data for Impact2021English, , , , , The Case Management Information Systems (CMIS) Assessment and Planning Toolkit is a comprehensive toolkit designed to improve the capacity of governments to evaluate digital systems to support child protection and care case management activities and assess their potential for scaling up and achieving long-term sustainability. It provides a thorough guide for government agencies to identify the gaps and needs of case management systems through an organizational self-assessment, followed by a set of questionnaires to evaluate solutions. The toolkit provides a starting point for the thinking behind the implementation or selection of a CMIS platform. This Excel file provides an interactive version of the CMIS Assessment.tl-21-93
Case Management Information System Governance Maturity Model ToolkitData for Impact2021English, , , The case management information system (CMIS) maturity model is a tool that helps countries to assess their current maturity levels in CMIS governance. It also supports figuring out CMIS governance components that countries need to acquire next in order to improve their performance. The gaps identified should be used to inform development of country-level roadmaps towards improved maturity. This maturity model toolkit can be used by decision makers and departmental leads from the country agency responsible for child protection and/or the established coordination mechanism at the national or sub-national level, through a consensus building process, and within a meeting setup. It is advisable to only apply this toolkit with, and after country teams have garnered sufficient understanding of the CMIS Governance Guidelines that forms the basis of the metrics referred to in this toolkit. Access the related CMIS Assessment Toolkit.tl-21-92-d4i
Case Management Information Systems Assessment ToolkitData for Impact2021English, , , , , , , The Case Management Information Systems (CMIS) Assessment and Planning Toolkit is a comprehensive toolkit designed to improve the capacity of governments to evaluate digital systems to support child protection and care case management activities and assess their potential for scaling up and achieving long-term sustainability. It provides a thorough guide for government agencies to identify the gaps and needs of case management systems through an organizational self-assessment, followed by a set of questionnaires to evaluate solutions. The toolkit provides a starting point for the thinking behind the implementation or selection of a CMIS platform. The toolkit can also be used by NGOs and donor organizations who would seek to understand the utility and functionality of existing CMIS solutions in a specific context. The outcomes of the self-assessment process will help project teams to determine if the technology or CMIS platform(s) being evaluated aligns with the country’s priorities, resources, and local context in order to plan their next steps. Access the related CMIS Governance Guidelines and an interactive Excel version of the CMIS Assessment. Watch a webinar on the toolkit.tl-21-91-D4I
Case Management Information Systems Governance GuidelinesNyaboga, J., Onyango, F., Nzyoka, R., and Cannon, M. 2021English, , , , , Increased demand for timely and accurate child protection data by decision makers and social workers has created an urgency and a great opportunity to build impactful case management information systems (CMIS) implementation. The sensitive and dynamic nature of child protection activities has necessitated the need to not only automate service delivery but also to build strong systems that comply to technological and ethical standards while promoting innovation and best practices. Successful implementation not only requires the highest safety and security standards, government ownership, and well-defined accountability mechanisms, but it also underlines the need for a strong policy and regulatory base. Countries are at different levels with implementation of CMIS, and these systems are evolving from paper-based generation, transmission, and storage to web-based systems. A concerted effort is necessary to safeguard the gains by strengthening governance for these information systems. Data for Impact (D4I) is supporting the development of a global governance guidance document for implementation and oversight of CMIS. This guidance document is part of the larger governance activity by D4I in development of a CMIS Assessment and Planning Toolkit designed to improve the capacity of governments in evaluating digital systems to support child protection and care and to assess their potential for scale-up and long-term sustainability. Access a related Excel tool and the CMIS Assessment Toolkit. Watch a webinar on these resources.ms-21-203-d4i
FUTURES Project Theory of ChangeData for Impact2021English, , , , , The FUTURES project, situated in the Yayu Biosphere Reserve of Southwest Ethiopia, aims to achieve sustainable forest biodiversity and improved reproductive health (RH) and livelihoods of women and young people in the region. The project is funded by the Packard Foundation and is implemented by CARE Ethiopia and its three local partners: Oromia Development Association (ODA), Environment and Coffee Forest Forum (ECFF), and Kulich Youth Reproductive Health and Development Organization (KYRDA). The Data for Impact (D4I) project, funded by the United States Agency for International Development (USAID), is collaborating with the FUTURES project to develop and implement a rigorous monitoring and evaluation system to generate evidence for integrated programming. As a first step in this work, the partners worked together to articulate and design a Theory of Change (TOC). The TOC is a graphic representation of how the project will work to achieve its goal through gender transformative interventions across RH, livelihood, and ecological activities. The TOC depicts the context in which the project operates and illustrates pathways in which the project expects to accomplish its outcomes and goal. This brief shares more.fs-21-532-d4i
D4I Armenia promotes access and use of data on children in adversity by community social workersData for Impact2021English, , , , , , , This brief shares information on Data for Impact's activities to promote and advocate for community social workers (CSWs) in Armenia to have access to the Manuk information system, which is used for registration and tracking of children in adversity, and their increased involvement in the child protection system. These efforts took two directions: (1) advocate for the use of CSWs to identify children who were out of school following the deinstitutionalization of care institutions and special schools between 2018 and 2020; and (2) contribute to the working group established by the Ministry of Labor and Social Affairs for clarifying the roles and responsibilities of CSWs by making relevant amendments to existing legislation. Download the brief to learn more.fs-21-531-d4i
HIS Mapping: An Inventory of Digital Tools in Use by the Ministry of Health and Family Welfare in BangladeshMd. Humayun Kabir, Mohammad Kibria2021English, , , , , , The Government of Bangladesh has formulated a Digital Bangladesh vision for the country. The Ministry of Health and Family Welfare (MOHFW) is translating this vision through different eHealth/Health Information System (HIS) tools. Over the years, many different tools have been developed and used by different organizations or units within the MOHFW. This document presents a list of all major or important systems in use by the different organizations under the MOHFW. This brief also examines policy implications resulting from the listing exercise.fs-21-525-d4i
Estimating the Effects of COVID-19 on Immunization Services Use in BangladeshGustavo Angeles, Hannah Silverstein, Karar Zunaid Ahsan, Mohammad Kibria, Nibras Ar Rakib, Gabriela Escudero2021English, , , Using information available through routine health information systems (RHIS), Data for Impact (D4I) assessed the effects of COVID-19 on health service use in Bangladesh more than a year into the pandemic. The study examined national usage patterns for selected child immunization services, before and during the COVID-19 pandemic. We used data from the pre-pandemic period to develop models to replicate the trajectories of total and average health service utilization, as well as the number of facilities reporting such services, over time. These models were then used to estimate what the child immunization service utilization would have been in the absence of COVID-19 during the first full year of the pandemic (from March 2020 to April 2021). This brief shares more. We are grateful to the Directorate General of Health Services (DGHS) and, in particular, Dr. Md. Shamsul Haque, Line Director of Maternal, Newborn, Child and Adolescent Health (MNCAH), and Dr. Md. Tanvir Hossen, Deputy Program Manager, EPI & Surveillance. We also thank Bill Weiss at USAID for providing suggestions and technical support to this work.fs-21-528-d4i
Estimating the Effects of COVID-19 on Health Service Utilization in UgandaGustavo Angeles, Hannah Silverstein, Kavita Singh, Jamiru Mpiima, and Elizabeth Simmons2021English, , , , , Using information available through routine health information systems, Data for Impact (D4I) assessed the effects of COVID-19 on health service use in Uganda more than a year into the pandemic. The study examined national usage patterns for selected health services, before and during the COVID-19 pandemic. We used data from the pre-pandemic period to develop models to replicate the trajectories of total and average health service utilization over time. These models were then used to estimate what health service utilization would have been in the absence of COVID-19 during the full year and 3 months of the pandemic (from March 2020 to May 2021). This brief shares more. Access supplemental figures for the Kampala metropolitan area. We are grateful to Bill Weiss at USAID for providing valuable suggestions and support to this activity.fs-21-527-d4i
Estimating National and Area-Specific COVID-19 Effects on Health Service Use in the Democratic Republic of the CongoGustavo Angeles, Hannah Silverstein, Matthew Worges, David Hotchkiss, and Janna Wisniewski2021English, , , , , Using information available through routine health information systems (RHIS), Data for Impact (D4I) assessed the effects of COVID-19 on health service use in the Democratic Republic of the Congo (DRC) twelve months into the pandemic. The study examined national and area-specific usage patterns for selected basic health services, before and during the COVID-19 pandemic. We used data from the pre-pandemic period to develop models to replicate the trajectories of total and average health service utilization, as well as the number of facilities reporting such services, over time. These models were then used to estimate what health service utilization would have been in the absence of COVID-19 during the first full year of the pandemic (from March 2020 to March 2021). This brief shares more. We are grateful to Paul Lusamba, Country Director of Research at the Tulane International LLC Office in Kinshasa, and to Bill Weiss at USAID for providing valuable suggestions and support to this activity.fs-21-526-d4i
Hypertension and Diabetes in Bangladesh: Findings from the Bangladesh Demographic and Health Survey (BDHS) 2017-18 and Policy ImplicationsPeter Kim Streatfield, Karar Zunaid Ahsan, Afrin Iqbal, Kanta Jamil, M. Moinuddin Haider, Shusmita Khan2021English, , , , In Bangladesh, non-communicable diseases (NCDs) now account for two out of three deaths annually, up from one in ten several decades ago. The reasons for this increase include, among others, that deaths due to communicable diseases have decreased and the decline in fertility and improving life expectancy have shifted the population age structure to older age groups where NCDs are more prominent. This policy brief shares Bangladesh Demographic and Health Survey findings for two of the major NCDs in Bangladesh, hypertension and diabetes, and discusses policy implications.wp-21-247-d4i
Pilotarea indicatorilor de îngrijire alternativă a copilului în MoldovaData for Impact2021Romanian, , , , , , Pilotarea indicatorilor de îngrijire alternativă a avut loc în cadrul proiectului D4I. Proiectul își propune să consolideze capacitatea guvernului și a partenerilor săi la nivel național și local de colectare, analiză și utilizare a datelor pentru a genera un impact pozitiv asupra copiilor din Republica Moldova aflați în dificultate. Anexa 5. Seturi de date Access the report in English.tr-21-436-d4i-ro
Pilot Test of Alternative Childcare Indicators in MoldovaData for Impact2021English, , , , , The alternative childcare indicators and related electronic tools were pilot tested under the Data for Impact (D4I) project to assess their utility for increasing the efficiency of the data collection and reporting processes, and for evidence-based decision making, with the ultimate goal of scaling them up at the national level. This report presents the objective of the pilot test, its purpose, location and duration, the pilot test process, findings, conclusions, and recommendations. Download Appendix 5. D4I aims to strengthen the capacity of the government and its national and local partners to collect, analyze, and use data to generate a positive impact on children in adversity in the Republic of Moldova. Access this publication in Romanian.tr-21-436-d4i
Improving Private Health Care Data Collection in BangladeshMd. Humayun Kabir2021English, , Health care is data intensive. Each transaction between a service-seeker and a health care provider generates data as a by-product. Routinely collected health data from the public and private sectors are essential for understanding health trends. Decision-makers need these data to develop appropriate health policies, allocate resources, and prioritize interventions. The recent COVID-19 pandemic exposed health systems to new challenges illustrating the need and relevance of timely and accurate data from all sectors to make informed decisions (WHO, 2020). While government agencies responsible for managing health care collect routine public health data on a regular basis, there is often a lack of systematic and regulated mechanisms for collecting data from the private sector, even though the private sector plays an important and often dominant role in health service delivery in many lower- and middle-income countries. This brief focuses on the need for data collection from the private sector and nongovernmental organizations within a comprehensive national health information system in Bangladesh and offers recommendations to achieve this.fs-21-517-d4i
Estimating the effect of COVID-19 on utilization of health services in the DRC and Bangladesh: Technical noteData for Impact2021English, , , , Using information available through routine health information systems (RHIS), Data for Impact (D4I) conducted a study to examine the effects of COVID-19 on the utilization of health services in the Democratic Republic of the Congo (DRC) and Bangladesh. The study sought to examine patterns for the use of selected non-COVID-19 related health services, including maternal and child health (MCH), family planning (FP), outpatient visits, and immunizations, before and during the COVID-19 pandemic in both countries. We used routine data from the pre-pandemic period to develop models to replicate the average and total health service utilization over time. These models were then used to estimate what health service utilization would have been in the absence of COVID-19 during the months of the pandemic (since March 2020). The study aimed to investigate two key questions: 1. Did COVID-19 affect reporting of health service delivery over time? 2. Did COVID-19 affect the utilization of basic health services? Access related briefs: Estimating National and Area-Specific COVID-19 Effects on Health Service Use in the Democratic Republic of the Congo Estimating the Effects of COVID-19 on Health Service Utilization in Uganda Estimating the Effect of COVID-19 on Total Utilization of Health Services in Bangladeshfs-20-516-d4i
Moldova Longitudinal Case Management Information System for Child Protection: Three-Year Implementation RoadmapData for Impact2021English, , , , , Data for Impact (D4I) will support the Ministry of Health, Labour and Social Protection (MOHLSP) to develop a case management information system and strengthen its capacity to use data to address the needs of vulnerable children and generate reliable longitudinal data and indicators needed to plan reform initiatives and support decision-making processes. The Case Management Information System for Child Protection (hereinafter called CMIS) will help community and rayon social assistants and the MOHLSP manage data for children-at-risk, with digital tools that facilitate case management and longitudinal tracking. In addition to the CMIS, in year three, an analytical module that will integrate data from different data sources will be developed. The analytical module will produce indicators for case management performance, violence against children, and alternative care, based on availability and existence of the required data sources to produce the indicators and agreements with relevant stakeholders. Unlike manual reporting processes using paper-based forms or file sharing through Excel, a digitized, web-based process will streamline and integrate vertical information from the community levels up to the rayon and national levels. The CMIS will also facilitate horizontal integration of service delivery/case management data from rayons and local communities. During the three-year development of the CMIS, D4I will conduct several cycles of validation with final users and stakeholders to ensure that the system meets their requirements and needs while delivering rapid results. Success of this approach is subject to availability of the main stakeholders to validate the system. Activities in years two and three will be dependent on funding received by the United States Agency for International Development (USAID).sr-21-152-d4i
Training Curriculum for the Integrated Approach to Family Planning Data Quality AssessmentData for Impact2021English, , , This curriculum document out lines training sessions for using the Service Statistics to Estimated Modern Use (SS to EMU) and the Routine Data Quality Assessment (RDQA) tool integrated approach to assess and monitor family planning data quality performance. Access the full curriculum collection, which is also available in French.ms-20-198-d4i
User Guidelines for the Integrated Approach to Family Planning Data Quality AssessmentData for Impact2021English, , , , The purpose of this document is to provide guidance to Track20 monitoring and evaluation (M&E) officers, family planning (FP) data managers, and M&E officers on how to use the Service Statistics to Estimated Modern Use (SS to EMU) and the Routine Data Quality Assessment tool integrated approach to assess and monitor FP data quality performance. Access the full curriculum collection, which is also available in French. ms-21-199-d4i
End Line Evaluation of the Private Health Sector Project in Ethiopia: Executive SummaryData for Impact2021English, , , In 2020, USAID/Ethiopia asked Data for Impact (D4I) to evaluate the Private Health Sector Project's achievements, challenges, and sustainability to inform future investments in strengthening the private health sector. This report presents the methodology, findings, and recommendations from the D4I end line evaluation.tr-20-434a-d4i
Bangladesh Adolescent Health and Wellbeing Survey 2019-20: Summary FindingsNational Institute of Population Research and Training (NIPORT), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and Data for Impact2021English, , The primary objective of the Bangladesh Adolescent Health and Wellbeing Survey 2019-20 was to describe the state of health and wellbeing of Bangladeshi male and female adolescents ages 15-19 years. This brief summarizes the survey findings.fs-20-514-d4i
Bangladesh Adolescent Health and Wellbeing Survey 2019-20: Final ReportNational Institute of Population Research and Training (NIPORT), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and Data for Impac2021English, , , , The primary objective of the Bangladesh Adolescent Health and Wellbeing Survey (BAHWS) 2019-20 was to examine and better understand the state of health and wellbeing of male and female adolescents ages 15-19 years in the country. This report shares details on the study and its findings. Access resources from a dissemination event.tr-20-432-d4i
Estimating the effect of COVID-19 on total utilization of health services in BangladeshData for Impact2021English, , , , , , The COVID-19 pandemic has led to widespread stay-at-home orders, fears of going to health facilities where COVID-19 patients are treated, economic hardship due to job loss or interruption, and a variety of other changes that pose significant challenges to patient access and use of other health services. It is important to understand whether and how pandemics such as COVID-19 affect the utilization of essential health services so that policy and decision-makers can better plan and adapt programs as needed in the face of pandemics. Using information available through routine health information systems (RHIS), Data for Impact (D4I) conducted a study to examine the effects of COVID-19 on the utilization of health services in Bangladesh. The study sought to examine patterns in use of selected non-COVID-19-related health services, including maternal and child health (MCH), family planning (FP), outpatient visits, and immunizations, before and during the COVID-19 pandemic in Bangladesh. D4I researchers used routine data from the pre-pandemic period to develop a model to predict total health service utilization over time, including estimating what the levels of health service utilization would have been in the absence of COVID-19. This brief shares more.fs-20-513-d4i
Seminar on Strengthening the Routine Health Information System of the Ministry of Health and Family Welfare in BangladeshKabir H, Chowdhury SK2015English, ,

The U.S. Agency for International Development (USAID) and its implementing partners are collaborating with the Bangladesh Ministry of Health and Family Welfare (MOHFW) to help develop a routine health information system (RHIS) in the country. A seminar held January 13, 2015 as part of the next phase of activities for strengthening the RHIS was organized by USAID partners implementing the RHIS in Bangladesh.

Among issues that emerged from the seminar are the following:

  • There is a need for bringing collection of data and their use for health service delivery into a regulatory framework so as to ensure the privacy of sensitive personal data and to stop misuse.
  • Strengthening RHIS is urgently needed to ensure comprehensive, quality routine data and use of information for decision making at different levels, from local to central.
  • There should be a strong coordination mechanism in order to avoid duplication of work among different stakeholders.
  • Providing a unique health ID to track all service recipients should be explored.
  • Focus should be given to a common web-based platform to ensure interoperability and avoid duplication of efforts.
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Using DHIS 2 Software to Collect Health Data in BangladeshTahmina Begum, Shaan Muberra Khan, Jannatul Ferdous, Muhammad Masud Parvez, Aminur Rahman, Feroza Akhter Kumkum, and Iqbal Anwar2019English, , , , Accurate and high-quality data are important for improving program effectiveness and informing policy. As part of Bangladeshs district health information system, which allows data to be entered at the community level and analyzed at the central, state, and district levels, the country adopted the web-based platform DHIS 2 in 2009. In Bangladesh, real-time health service use data, with particular attention to reproductive, maternal, newborn, child, and adolescent health (RMNCAH), are available from the community level to the tertiary hospital level. However, health data are being underused for health planning purposes, because of poor data quality and reporting. The main objective of this study was to understand the users perceptions of and experiences with using DHIS 2 to collect and analyze RMNCAH data in Bangladesh and to identify facilitators and barriers to using these data at different levels of the healthcare system. The study used three qualitative research methods. Insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and, ultimately, the design of a responsive health management information system in Bangladesh.wp-19-226
Feasibility of Integrating Social Service and Community Health Data in DHIS 2Dawne Walker2017English, , , , Governments require information about the health and social service needs of their populations to enable effective policymaking and resource allocation. Most governments have health information systems to track critical health indicators, and these data are often captured in the district health information system software known as DHIS 2. However, these systems are not often linked to the data systems used by social and community services, where people often access care. As a result, the systems are fragmented and unable to provide holistic information for decision making on health and social services. Could DHIS 2 offer the answer? Here we present what we learned from a literature review and key informant interviews about using DHIS 2 as a platform for managing non-health social service and community health data, experiences integrating these data streams in the DHIS 1 and 2 platforms, recommendations for implementation, and whether the systems should be integrated or merely made interoperable. We present a list of prerequisites for an integrated community healthy and social service data system to collect reliable data for decision making.wp-17-185-en
Impact Evaluations of Large-Scale Public Health Interventions: Experiences from the FieldSkiles MP, Hattori A, Curtis SL2014English

Agencies are articulating the need to causally attribute health outcomes to investments in an era of shrinking resources and increasingly complex development environments.The opportunity to uncover essential information for program planning and resource allocation is a strong motivation for impact evaluations.Findings from large-scale impact evaluations (IEs) can be instrumental for decision making, yet they are not without challenges and costs.

In this paper, we share field experiences from a number of evaluation studies undertaken during MEASURE Evaluation Phases II and III.A series of case studies highlight design and implementation challenges that required creative solutions to move forward; plus analysis across studies revealed common reoccurring themes and valuable lessons. Examples of these cross-cutting themes presented include: challenges with identification and selection of program beneficiaries, random assignment in complex environments, identification of a robust comparison or control group for estimating the counterfactual, heterogeneity of program impacts, timing of baseline data collection, and absence of baseline data and a counterfactual.

Field experiences from MEASURE Evaluation project demonstrate the need for transparency and collaboration among the key partners, the inevitable balancing of technical requirements with programmatic priorities, and the flexibility required to adapt designs in order to answer the most valuable evaluation questions. Interest in accountability of funding of public health interventions continues to grow, promising continued interest in IEs. Evaluators, implementers, and funders can share in these learnings as we move forward with expanding our understanding of the costs and benefits for rigorous evaluations.

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Existing Gap between Preferred and Actual Birth Intervals in Bangladesh: Relation to Fertility and Child Health. Analysis from the Bangladesh Demographic and Health Survey 2011Fuad MH, Khan SH, Jahan FA, Talukder SH, Shakhider MAH2014English, , , This paperlooks into the existing gap between actual and preferred birth intervals in Bangladesh. The paper also examines the degree to which the interval varies in different geographical locations namely urban and rural. For this the respondents who already had a live birth and observed the time interval to the second birth were considered. The survival probability of the preceding birth interval (time) and different explanatory variables were examined in this process. The 2011 Bangladesh Demographic and Health Survey dataset was utilized for this paper. A secondary analysis found that the overall length for actual birth intervals in urban and rural areas are 64.87 months and 57.57 months, respectively. These lengths are significantly higher than the mean lengths of the previous intervals (41.54 in urban areas and 39.53 in rural areas). However, for intervals less than 24 months the difference between actual and preferred birth interval is not significant. That means there is a group of people in both urban and rural areas who prefer to have more children within a short interval. Based on the secondary analysis, the interval of the preceding birth to conception is strongly associated with neonatal mortality as well as under-five mortality, even after controlling for a host of potentially confounding factors.wp-14-145
Comparing Alternative Measures of Poverty: Assets-Based Wealth Index vs. Expenditures-Based Poverty ScoreForeit KGF, Schreiner M2011English, How comparable are different measures of poverty?  In the economic literature, poverty is often measured by income or expenditures. National health surveys, such as a Demographic and Health Survey (DHS), do not routinely collect data on household expenditures but rather estimate relative wealth by analyzing household assets and housing characteristics. This paper assesses the predictive validity of using DHS data to assign expenditures-based poverty rankings to households and individuals, using countries for which there are contemporaneous expenditures surveys and a DHS.  The estimates come from a three-step method. First, potential poverty indicators are matched between the expenditures survey and the DHS. Second, a poverty scorecard is constructed based on data from the expenditures survey, using only indicators that appear in both that survey and the DHS. Third, the scorecard is applied to the DHS to produce estimates of expenditures-based poverty. Three countries were analyzed: Bangladesh, Ethiopia, and Malawi. After matching items between DHS and expenditures surveys, the estimated proportions of people living below the poverty line of $1.25 a day purchasing power parity (PPP) were comparable between the DHS and the expenditures surveys. When we compared individuals assets-based wealth quintile with their expenditure-based poverty scorecard quintile, the assets-based wealth quintiles correlated positively with expenditures-based poverty scores.  Marked differences between countries were also found.  Appreciable mismatch between the two poverty measures could be seen, most notably in the case of Ethiopia where more than a third of the individuals in each assets-based wealth index quintile were ranked two or more quintiles above or below that quintile on the expenditures-based poverty scorecard. We conclude that assets-based wealth indices do not consistently track well against expenditure-based measures of poverty and should not be used to identify individuals or households living below consumption- or expenditures-based poverty thresholds.  We also recommend that future DHS country surveys harmonize the selection, wording and response categories of questions on household assets and dwelling characteristics with national expenditure surveys, and vice-versa.wp-11-123
Effect of an Expansion in Private Sector Provision of Contraceptive Supplies on Horizontal Inequity in Modern Contraceptive Use: Evidence from Africa and AsiaHotchkiss D, Godha D, Do M2010English, , , One strategic approach available to policy makers to improve the availability of contraceptive supplies as well as the sustainability of family planning programs is to expand the role of the private sector in providing access to contraceptive supplies. However, critics of this approach argue that increased reliance on the private sector will not serve the needs of the poor, and could lead to increases in socio-economic disparities in the use of modern contraceptive methods. The purpose of this study is to investigate whether the expansion of the role of private providers in the provision of modern contraceptive supplies is associated with increased horizontal inequity in modern contraceptive use.  The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives.  The methodology involves estimating concentration indices to assess the degree of inequity in contraceptive use by wealth groups across time.  In order to measure modern contraceptive prevalence rate (MCPR) inequity, the study controls for differences in the need for family planning services in relation to household wealth. Overall, the results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased MCPR inequity.  In fact, in three of the four study countries (Nigeria, Uganda, and Indonesia), MCPR inequity actually decreased over time; while in the fourth study country (Bangladesh), MCPR inequity fluctuated.  Overall, the results offer support to the premise that government strategies that promote the role of the private commercial sector can help facilitate the achievement of equity objectives.wp-10-114
Measuring and Interpreting Urban Fertility and Family Planning Indicators by Wealth in Two South Asian CountriesSpeizer IS, Luseno W2010English, , As the population of the world becomes increasingly urban, there is a need to examine the fertility and family planning needs of urban populations, particularly among the urban poor. While it is often assumed that urban residents are better off than their rural counterparts, the reality in many settings is that the urban poor are equally disadvantaged because of over-crowding, high demand for limited resources, increased cost of services in urban settings, and lack of access to clean water and sanitation. The definition and measurement of poverty in a population has become increasingly important as reduction of poverty is identified as the first Millennium Development Goal. This study applies new approaches proposed by the MEASURE Evaluation project to classify wealth using nationally-representative surveys, such as the Demographic and Health Surveys (DHS). These approaches are particularly important in cases where identifying and targeting of services to the urban poor are of interest. Applying these new approaches to DHS data from Bangladesh and Pakistan, this paper demonstrates that the standard DHS wealth measures under-estimate the percent of the urban population that is poor and demonstrates that, using the re-classified wealth indices, women in the lowest quintiles remain worse off on fertility and family planning indicators. Even in Bangladesh, where family planning services are easily available, distinctions are still found between the urban poor and non-poor in terms of family planning method use and sources of methods. Larger differences are found in Pakistan, where programmatic efforts have been less widespread. Without reclassification of standard DHS wealth measures, programs risk misrepresenting the urban poor and may miss some of the women and households most in need of family planning services. Ensuring access to family planning among all women, men, and households, but particularly among the urban poor who lack access to some of the urban advantages available to their better-off counterparts, will lead to improved health outcomes for women and children, especially in concentrated urban areas.wp-10-113
On reuse of clusters in repeated studiesKolenikov S, Angeles G2005EnglishSuppose data for a survey with multistage design is to be collected in two periods of time. This paper assesses the relative merits of keeping the same clusters in the sample vs. sampling new clusters, under differential statistical (correlation between clusters and overtime) and logistical (costs of survey) scenarios. The design effect of reusing the same clusters from the master sample over time is of the form 1 − Aρπ/n where ρ is intertemporal correlation of the cluster totals, n is the number of clusters, π is the proportion of clusters retained from the previous round, and A > 0 is a fixed constant. As long as the efficiency gains appear to be minor, the value of the designs that reuse the clusters comes from the logistical (cost of the survey) considerations. Empirical demonstrations that use Demographic and Health Survey (DHS) data for Bangladesh, 1996 and 2000, and a Monte Carlo simulation, are provided.wp-05-87
Impact Evaluation of the Mayer Hashi II Project in BangladeshRahman, M., Curtis, S., E-Ijdi, R., Haider, M., Imam, A., Ahmed, A., Bloom, S.2019English, , , , , The USAID-supported Mayer Hashi Phase II (MH-II) project, implemented during October 2013 through September 2018 aimed to increase the use of effective family planning (FP) and reproductive health services, with a focus on the informed and voluntary use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). This external impact evaluation was conducted by MEASURE Evaluation to determine the impact of the MH-II project on LARC and PM use at the population level. The evaluation used household, provider, and facility surveys conducted in 2015 and 2017 in early (Phase I) and late (Phase III) implementation districts supplemented by qualitative interviews with district family planning managers in 2017 to contextualize results. There were no increases in LARC and PM use or in intention to use LARCs and PMs at the population level in Mayer Hashi Phase I or Phase III program areas by 2017. The percentage of providers who were trained in LARCs and PMs and PPFP increased notably in both Phase I and Phase III areas, but changes in intermediate outcomes hypothesized along the program pathway were not realized. Contextual analysis identified chronic system weaknesses in provision of LARCs and PMs outside of the scope of the MH-II project and persistent low demand for LARCs and PMs as impediments to widespread increases in the use of LARCs and PMs. Future programs focusing on LARCs and PMs need to consider these larger system constraints in their design and in setting their expected outcomes. They also need to further engage the private sector given its growing role in health care.tre-19-18
Impact of the Bangladesh Nongovernmental Organization Health Service Delivery ProjectSin Curtis, Mizanur Rahman, Sharad Barkataki, Nitai Chakraborty2019English, , , , The Nongovernmental Organization Health Service Delivery Project (NHSDP) was a flagship health service delivery project in Bangladesh funded by the United States Agency for International Development. NHSDP supported the delivery of an essential service package of reproductive, maternal, and child health services through a network of local nongovernmental organization (NGO) clinics that primarily targeted the poor and underserved in rural and urban areas. The purpose of this evaluation was to monitor project outcomes and determine the impact of the NHSDP intervention on selected family planning and maternal and newborn health outcomes. The findings of this impact evaluation will inform the design and implementation of the next phase of the NGO service delivery program.tre-18-15
The Sustainability of the Electronic Management Information System of Bangladesh’s Directorate General of Family PlanningKabir, M.H.2020English, , , , This report addresses the sustainability issues of the electronic management information system (eMIS) that has been implemented in the Directorate General of Family Planning (DGFP) under the Ministry of Health and Family Welfare (MOHFW) of Bangladesh. The pilot implementation of the eMIS began in January 2015 in two districts (Tangail and Habiganj), with support from the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, in partnership with icddr,b and the Mamoni Maternal and Newborn Care Strengthening (MNCSP) project. The eMIS was scaled up in 2018 and reached 32 districts, either partially or in full, by December 2019. At the field level, the tools are being used by more than 10,000 users. The eMIS aimed to automate the business processes of community health and family planning workers, their supervisors, and providers working in first-line facilities (called Union Health and Family Welfare Center), based on mobile technologies. Web-based tools were also developed for managers at the subdistrict and district levels and for decision makers at the central level. The eMIS tools help users and managers of the DGFP gain the benefits of digitization, as well as enable the DGFP to become a data-driven organization. The eMIS reached a milestone with the declaration of a paperless Tangail on March 1, 2020 by the minister for health and family welfare. The implementation of the eMIS was supported within a project framework, and carrying it forward requires internalizing it within the DGFP and making it sustainable. Key issues related to sustainability, such as the acquisition of hardware, software maintenance and development, capacity building (human resource development, skills, training), implementation mechanisms, and the use of data for decision making are discussed in this report, and relevant recommendations are provided, along with an action plan.tr-20-411
Assessment of the MaMoni Health Systems Strengthening Project in BangladeshBarkataki, S., Billah, M., Chakraborty, N., Haider, M. M., Imam, M. A., Khan, S., Priyanka, S. S., Rahman, M, Rahman, M, & Al-Sabir, A.2020English, , , , , The United States Agency for International Development (USAID)-supported MaMoni Health Systems Strengthening (MaMoni HSS) project sought to improve the use of integrated family planning (FP), maternal, newborn, and child health (MNCH), and nutrition services in six low-performing districts of Bangladesh from September 2013 to September 2017. Save the Children in Bangladesh implemented the project. The MaMoni HSS project pursued a multipronged strategy to ensure service delivery at the different types of health facilities in the six districts. At the union-level facilities, it focused on ensuring primary-level outpatient care and increasing skilled birth attendance and round-the-clock delivery care. At the district and upazila levels, MaMoni HSS focused on referrals for maternal and newborn care, including caesarean section services, management of preeclampsia/eclampsia, care for newborns at specialized units, and management of severe acute malnutrition. Although the MaMoni HSS project followed this multipronged strategy, its primary purpose was to strengthen the delivery of services at the union-level facilities. Moreover, although the project worked with community clinics (CCs) for growth monitoring and promotion, counseling, and antenatal care (ANC), the CCs were not a focus area of the intervention.tr-20-401
An Assessment of the Advancing Adolescent Health Program in BangladeshQuamrun Nahar, Anadil Alam, Sadia Afrin, Sharad Barkataki, Shusmita Khan, Ali Ahmed, Iffat Sharmin, Musarrat Rubina Mannan, and Mizanur Rahman2020English, , , , , The Advancing Adolescent Health (A2H) program was funded by the United States Agency for International Development (USAID) and implemented by Plan International in Rangpur District, Bangladesh, from January 2016 to January 2019. Plan International collaborated with two local nongovernmental organizations to implement A2H: The Eco-Social Development Organization and World Mission Prayer Leagues LAMB Hospitalpopularly known as LAMB Hospital. The goal of A2H was to improve adolescent sexual and reproductive health and family planning knowledge and access and use of related services for married and unmarried adolescents. To assess the program, the USAID-funded projects Research for Decision Makers, based at the International Centre for Diarrhoeal Diseases Research, Bangladesh, and MEASURE Evaluation, based at the University of North Carolina at Chapel Hill (USA), conducted a household survey from JulySeptember 2018 among 8,501 girls ages 1519 years from the two selected program areas and 3,005 similar girls from a comparison area. This report presents findings from an analysis of this survey.tr-20-400
Bangladesh District Level Socio-demographic and Health Care Utilization Indicators2019English, , , The purpose of this report is to present health care utilization and socio-demographic indicators at the district level. The data from this report comes from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS). The objectives of the 2016 BMMS were to a) estimate the national level Maternal Mortality Ratio (MMR); b) identify the specific causes of maternal and nonmaternal deaths among adult women; c) assess the pattern of antenatal, delivery, and postnatal care practices; d) assess maternal complications experience and careseeking; e) estimate childhood mortality rates; f) measure the level of selected maternal morbidities (obstetric fistula and pelvic organ prolapse); and g) provide district-level socioeconomic, demographic, family planning, and health care utilization indicators.tr-20-395
Improving Nutrition through Community-Based Approaches in BangladeshGustavo Angeles, Shusmita Khan, Mizanur Rahman, Nitai Chakraborty, Sharad Bartaki, & Gabriela Escudero2019English, , , This document is the baseline survey report for the evaluation of the United States Agency for International Development (USAID)/Bangladeshs Improving Nutrition through Community-Based Approaches (INCA) activity. The evaluation is being conducted by the USAID-funded MEASURE Evaluation project at the request of USAID/Bangladesh, and is part of a larger set of monitoring and evaluation activities for the INCA project. INCA is a three-year effort to improve the nutritional status of women and children under age two in rural areas of 11 priority upazilas in the districts of Bhola, Laxmipur, and Noakhali. Caritas Bangladesh and United Purpose are implementing the project. It started in May 2017 and will be active through April 2020. Total funding is approximately USD$4.4 million. The 2017 baseline survey is the first of two surveys to assess the performance and impact of INCA. The overall objectives of this external evaluation are (1) to inform USAID and other stakeholders about project achievements in terms of changes in key outcomes and impact at the target population level; (2) to learn about the effectiveness of the specific INCA intervention for eventual replication in other areas of the country; and (3) to inform the follow-up of the project. The evaluation is based on a prospective, quasi-experimental, difference-in-differences (DID) design to assess project impact using data collected through representative household surveys in INCA intervention and comparison areas in this baseline survey, and a follow-up end line survey that will be implemented by the end of 2019. MEASURE Evaluation also conducted a short community survey during this baseline assessment and will repeat it in the end line survey to assess changes in health and nutrition service availability.tr-19-388
Effective Access to Long-Acting Reversible Contraceptives and Permanent Methods in BangladeshM. Moinuddin Haider, Sharad Barkataki, Ali Ahmed, Quamrun Nahar, Mizanur Rahman2019English, , , , , This report presents the results of an analysis to determine the effective accessibility of health facilities designated to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception to Bangladeshi couples. We define LARC and PM services as effectively accessible to consumers if facilities that are designated to offer LARCs and PMs do indeed offer these types of contraception and if those facilities are ready to provide an appropriate quality of services. Bangladesh has an extensive health infrastructure that delivers preventive and curative services, including family planning. However, compared to global rates, Bangladesh has a relatively low prevalence of LARCs and PMs. This analysis is based on data collected from 963 facilities during the Bangladesh Health Facility Survey 2014 (National Institute of Population Research and Training, Associates for Community and Population Research, and ICF International, 2016).tr-19-387
Postpartum Family Planning in Bangladesh: A Situation Analysis and Way ForwardBarkataki, S., Huda, F., Nahar, Q., Rahman, M.2019English, , , , Postpartum family planning (PPFP) focuses on providing family planning (FP) counseling and services to women and couples in the first 12 months after birth. This publication reviews the policies, programs, and status of PPFP in Bangladesh and seeks to identify the need, gaps, and future focus areas for PPFP in the country.tr-19-386
Implementation of the Electronic Management Information System in Bangladesh: Experience and Lessons Learned2019English, , , In 2015, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh undertook an initiative to develop and implement an electronic management information system (eMIS) to benefit community health service delivery. The initiative was implemented through a collaborative partnership among the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), MaMoni Health Systems Strengthening (now MaMoni MNCSP), and SIAPS (now MTaPS) and was supported by USAID. The intent of the initiative was to replace cumbersome paper instruments, reduce data burden for health providers, improve data-driven service delivery and quality of care, and make management of health and family planning activities at the grassroots level more efficient and effective. The resultant eMIS provides comprehensive and interlinked electronic tools for use by community-level healthcare and family planning workers (health assistants [HAs] and family welfare assistants [FWAs]), union-level service providers (family welfare visitors [FWVs], sub-assistant community medical officers [SACMOs]), their supervisors (health inspectors [HIs], assistant health inspectors [AHIs], and family planning inspectors [FPIs]), and their managers at the upazila level. Data from eMIS get linked to the mainstream reporting system for use by managers, planners, and policymakers at the directorate and ministerial levels. All tools created for the eMIS were vetted and approved by the Directorate General of Family Planning (DGFP) and the Directorate General of Health Services (DGHS). The district and upazila managers had overall responsibility for implementing the eMIS, while technical assistance was provided by the eMIS initiative through software development, the provision of equipment, and capacity building. Systems for Improved Access to Pharmaceutical and Services (SIAPS), another USAID project (now MTaPS), contributed in the area of logistics management. This document describes in detail the information technology (IT) structure of the eMIS and the experience of implementing it across several upazilas and districts in Bangladesh.tr-19-380
Validating the Effectiveness of a Rapid Assessment Tool for Routine Health Information SystemsMEASURE Evaluation2018English, , , , , , , , The World Health Organization (WHO), with the United States Agency for International Development (USAID)-funded MEASURE Evaluation, has identified and harmonized standards for data management of Routine Health Information Systems (RHIS). Standards, or best practices, promote the production of timely, accurate data for use in program planning, monitoring, and evaluation. An assessment tool, the RHIS Rapid Assessment Tool, has been developed to help identify gaps and weaknesses (aspects of health facility and community information systems that do not reach the identified standard) and, thus, to strengthen RHIS and improve the data. The tool compares a country RHIS to the global standards, and indicates where resources should be invested to improve the system. The standards in the RHIS Rapid Assessment Tool were identified largely from expert meetings convened by MEASURE Evaluation and WHO in 20122014. In May 2012, MEASURE Evaluation hosted the International Workshop on Guidelines for Data Management Standards in Routine Health Information Systems, in Johannesburg, South Africa. RHIS experts gathered from around world to identify standards and best practices for RHIS, particularly for data management, the element of RHIS that had been identified as the most problematic globally following implementation of the Health Metrics Network (HMN) Country Assessment Tool in more than 85 countries (2008). The discussions were organized around four thematic areas: (1) users data and decision support needs; (2) data collection, processing, analysis, and dissemination of Information; (3) data integration and interoperability; and (4) governance of RHIS data management. The standards were field-tested in Nigeria and Bangladesh by MEASURE Evaluation in 2013-2014. In June 2014, WHO hosted the Technical Consultation on Monitoring Results with Health Facility Information Systems, which took place in Glion-sur-Montreux, Switzerland. The workshop output was developed into a toolkit according to an organizing framework for the key components of a country health facility information system. Those components were (1) governance, an overarching component; (2) data collection and management; (3) data quality and analysis; and (4) data dissemination and use. Within each section, key action steps are identified for countries and provided with examples of available tools and resources to support country action. A checklist of key items and attributes is provided to facilitate monitoring of progress toward defined standards. The checklist is also available as a separate spreadsheet. WHO and MEASURE Evaluation decided to harmonize the two resulting lists of standards, which then became the RHIS Rapid Assessment Tool. The two source documents are available at the following links: WHO Health Facility and Community Information System Toolkit MEASURE Evaluation Guidelines on Data Management Standards The RHIS Rapid Assessment Tool facilitates comparison of country RHIS with global standards, to identify gaps and weaknesses in the system as part of strategic planning for RHIS. The tool was tested in four country workshops (Madagascar, Malawi, Myanmar, and northern Syria) to validate its effectiveness. Workshop organizers then provided feedback and recommendations to help modify the tool to better meet the needs of users. The Republic of the Gambia provided feedback without testing the tool in a workshop setting. This document describes the validation process and its results.tr-18-298
Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016: Final Report2019English, , , , The Government of Bangladesh is committed to achieving its targets for Millennium Development Goal (MDG) 5: reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015 (United Nations Development Program [UNDP], 2015). The decline in MMR between 2001 and 2010 indicates remarkable progress. This progress is linked to fertility reduction, access to qualified maternal health care, and overall care-seeking during the antenatal period and during delivery (UNDP, 2015). By the end of the third sector program, a revised maternal health strategy and standard operating procedures (SOPs) for maternal and newborn health were finalized. With the MDGs phasing out and the Sustainable Development Goals (SDG) phasing in (United Nations, 2015), the Fourth Health, Population and Nutrition Sector Programme (4th HPNSP) 20172022 has set the target of reaching an MMR of 121 per 100,000 live births in 2022 (Ministry of Health and Family Welfare [MOHFW], 2017). Within this context, the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016 was carried out to assess how well the country is progressing toward these targets. The BMMS 2016 was an activity under the Operational Plan of Training, Research, and Development of the National Institute of Population Research and Training (NIPORT) under the Health, Population and Nutrition Sector Development Program (HPNSDP) 20112016 (MOHFW, 2014). The major objectives of the BMMS 2016 were 1) to provide a nationally representative estimate of the maternal mortality ratio (MMR) for three years preceding the survey (approximately 20142016); 2) to identify the causes of maternal deaths, and 3) to assess maternal healthseeking behavior indicators and compare them with the BMMS 2010 to assess how well the country is progressing toward national and global targets for maternal health since the 2010 survey.tr-18-297
Data Demand and Information Use in the Health Sector: Case Study SeriesMEASURE Evaluation2008English, , These data demand and use (DDU) case studies from a variety of settings give examples of how interventions have successfully facilitated data demand and changed how information is used. Examples are from Bangladesh, Cote d'Ivoire, Ghana, Kenya, Rwanda, Tanzania, and nine Caribbean countries. This publication is part of a series that includes a data demand and information use (DDIU) conceptual framework for evidence-based decision-making in the public health arena presented, and strategies and tools for taking concrete "next steps" in implementing DDIU or DDU activities.sr-08-44
Every Newborn-BIRTH protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and TanzaniaLouise T Day, Harriet Ruysen, et al.2019English, , , , , , , , , , Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focused on maternal recall surveys. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods: EN-BIRTH is an observational study including >20000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.ja-19-266
Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providersEunsoo Timothy Kim, Kavita Singh, and William Weiss2019English, , , Background The first 48 hours after birth is a critical window of time for the survival for both mothers and their newborns. Timely and adequate postnatal care (PNC) is being promoted as a strategy to reduce both maternal and newborn mortality. Whether or not a woman has received a postnatal check within 48 hours has been well studied, however, specific content and type of provider are also important for understanding the quality of the check. The objective of this paper is to understand who receives specific PNC interventions by type of provider in Bangladesh. Methods Data from the 2014 Bangladesh Demographic and Health Survey (DHS) were used to study receipt of specific PNC interventions breast exam, vaginal discharge exam, temperature check and counseling on danger signs within 2 days of birth. Descriptive bivariate analyses and regression analyses using generalized estimating equations (GEE) were used to understand if receipt of an intervention differed by socio-economic and health-related factors. A key factor studied was the type of provider of the PNC. Results The proportion of women receiving specific interventions during maternal PNC was mostly low (41.81% for breast exam, 39.72% for vaginal discharge, 82.22% for temperature check, 55.56% for counseling on danger signs and 16.95% for all four interventions). Findings from the regression analyses indicated that compared to having postnatal contact with formal providers (doctors, nurses, midwives and paramedics), having postnatal contact with village doctors was significantly associated with lower probabilities of receiving a breast exam, vaginal discharge exam and receiving all four interventions. PNC provided by NGO workers and other community attendants was significantly associated with a lower probability of receiving a vaginal discharge exam but a higher probability of receiving counseling on danger signs. Conclusions During PNC, women were much more likely to receive a temperature check than counseling on danger signs, breast exams or vaginal discharge exams. Very few women received all four interventions. In the situation where Bangladesh is experiencing a shortage of high-level providers, training more types of providers, particularly informal village doctors, may be an important strategy for improving the quality of PNC.ja-19-264
Postnatal care for newborns in Bangladesh: The importance of health-related factors and locationKavita Singh, Paul Brodish, Mahbub Elahi Chowdhury, Taposh Kumar Biswas, Eunsoo Timothy Kim, Christine Godwin, and Allisyn Moran2017English, , , , Background Bangladesh achieved Millennium Development Goal 4, a two thirds reduction in under-five mortality from 1990 to 2015. However neonatal mortality remains high, and neonatal deaths now account for 62% of under-five deaths in Bangladesh. The objective of this paper is to understand which newborns in Bangladesh are receiving postnatal care (PNC), a set of interventions with the potential to reduce neonatal mortality. Methods Using data from the Bangladesh Maternal Mortality Survey (BMMS) 2010 we conducted logistic regression analysis to understand what socio-economic and health-related factors were associated with early postnatal care (PNC) by day 2 and PNC by day 7. Key variables studied were maternal complications (during pregnancy, delivery or after delivery) and contact with the health care system (receipt of any antenatal care, place of delivery and type of delivery attendant). Using data from the BMMS 2010 and an Emergency Obstetric and Neonatal Care (EmONC) 2012 needs assessment, we also presented descriptive maps of PNC coverage overlaid with neonatal mortality rates. Results There were several significant findings from the regression analysis. Newborns of mothers having a skilled delivery were significantly more likely to receive PNC (Day 7: OR=2.16, 95% confidence interval (CI) 1.81, 2.58; Day 2: OR=2.11, 95% 95% CI 1.76). Newborns of mothers who reported a complication were also significantly more likely to receive PNC with odds ratios varying between 1.3 and 1.6 for complications at the different points along the continuum of care. Urban residence and greater wealth were also significantly associated with PNC. The maps provided visual images of wide variation in PNC coverage and indicated that districts with the highest PNC coverage, did not necessarily have the lowest neonatal mortality rates. Conclusion Newborns of mothers who had a skilled delivery or who experienced a complication were more likely to receive PNC than newborns of mothers with a home delivery or who did not report a complication. Given that the majority of women in Bangladesh have a home delivery, strategies are needed to reach their newborns with PNC. Greater focus is also needed to reach poor women in rural areas. Engaging community health workers to conduct home PNC visits may be an interim strategy as Bangladesh strives to increase skilled delivery coverage.ja-17-251
The importance of skin-to-skin contact for early initiation of breastfeeding in Nigeria and BangladeshKavita Singh, Shane M Khan, Liliana Carvajal-Aguirre, Paul Brodish, Agbessi Amouzou, and Allisyn Moran2017English, , ,

Background Skin-to-skin contact (SSC) between mother and newborn offers numerous protective effects, however it is an intervention that has been underutilized. Our objectives are to understand which newborns in Bangladesh and Nigeria receive SSC and whether SSC is associated with the early initiation of breastfeeding.

Methods Demographic and Health Survey (DHS) data were used to study the characteristics of newborns receiving SSC for non-facility births in Nigeria (DHS 2013) and for both facility and non-facility births in Bangladesh (DHS 2014). Multivariable logistic regression was used to study the association between SSC and early initiation of breastfeeding after controlling for key socio-demographic, maternal and newborn-related factors.

Results Only 10% of newborns in Nigeria and 26% of newborns in Bangladesh received SSC. In the regression models, SSC was significantly associated with the early initiation of breastfeeding in both countries (OR=1.42, 95% CI 1.151.76 for Nigeria; OR=1.27, 95% CI 1.041.55, for Bangladesh). Findings from the regression analysis for Bangladesh revealed that newborns born by Cesarean section had a 67% lower odds of early initiation of breastfeeding than those born by normal delivery (OR=0.33, 95% CI 0.260.43). Also in Bangladesh newborns born in a health facility had a 30% lower odds of early initiation of breastfeeding than those born in non-facility environments (OR=0.70, 95% CI 0.530.92). Early initiation of breastfeeding was significantly associated with parity, urban residence and wealth in Nigeria. Geographic area was significant in the regression analyses for both Bangladesh and Nigeria.

Conclusions Coverage of SSC is very low in the two countries, despite its benefits for newborns without complications. SSC has the potential to save newborn lives. There is a need to prioritize training of health providers on the implementation of essential newborn care including SSC. Community engagement is also needed to ensure that all women and their families regardless of residence, socio-economic status, place or type of delivery, understand the benefits of SSC and early initiation of breastfeeding.

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Developing Core Competencies for Monitoring and Evaluation Tracks in South Asian MPH ProgramsNegandhi H, Negandhi P, Tiwari R, Sharma A, Zodpey S, Kulatilaka H, Tikyani S2015English, , Background Monitoring and evaluation (M&E) provides vital information for decision-making and its structures, systems and processes are expected to be integrated throughout the life-cycle of public health programs. The acquisition of these skills should be developed in a structured manner and needs educational systems to identify core competencies in M&E teaching. This article presents our work on harmonizing M&E competencies for Masters-level programs in the South Asian context and undertaking the global review of M&E track/concentration offered in various Masters of Public Health (MPH) programs.

Methods Through an online search and snow-balling, we mapped institutions offering M&E tracks/concentrations in Masters of Public Health (MPH) programs globally. We obtained detailed information about their M&E curriculum from university websites and brochures. The data on curricular contents was extracted and compiled. We analyzed the curricular contents using the framework for core competencies developed by the Association of Schools of Public Health (ASPH); and the Millers triangle. This data was then used to inform a consultative exercise aimed at identifying core competencies for an M&E track/concentration in MPH programs in the South Asian context.

Results Our curricular review of M&E content within MPH programs globally showed that different domains or broad topic areas relating to M&E are covered differently across the programs. The quantitative sciences (Biostatistics and Epidemiology) and Health Policy and Management are covered in much greater depth than the other two domains (Social & Behavioral Sciences and Environmental Health Sciences). The identification of core competencies for an M&E track/concentration in the South Asian context was undertaken through a consultative group exercise involving representation from 11 institutions across Bangladesh, India, Nepal and Sri Lanka. During the consultation, the group engaged in a focused discussion to reach consensus on a set of 15 core competencies for an M&E track in South Asian MPH programs.

Conclusion This work presents an opportunity for institutions to identify and re-examine their M&E competencies as a part of their specialized tracks within MPH programs. Our curricular analysis approach has the potential for adaptation and further use in curriculum analysis across different academic specialties.

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Effects of individual, household and community characteristics on child nutritional status in the slums of urban BangladeshAhsan KZ, El Arifeen S, Al-Mamun A, Khan SH, Chakraborty N2017English, ,

Background Bangladesh urban population is expected to overtake rural population by 2040, and a significant part of the increase will be in slums. Wide disparities between urban slums and the rest of the country can potentially push country indicators off track unless the specific health and nutrition needs of the expanding slum communities are addressed. The study aims at describing the individual, household and community determinants of undernutrition status among children living in major urban strata, viz. City Corporation slums and non-slums, in order to understand the major drivers of childhood undernutrition in urban slum settings.

Methods Data are derived from Bangladesh Urban Health Survey conducted in 2013. This survey is a large-scale, nationally representative of urban areas, household survey designed specifically to provide health and nutrition status of women and children in urban Bangladesh.

Results Data showed that 50% of under-5 children in slums are stunted and 43% are underweight, whereas for non-slums these rates are 33 and 26% respectively. In terms of severity, proportion of under-5 children living in slums severely underweight or stunted are nearly double than the children living in non-slums. Logistic analyses indicate that mothers education, childs age, and households socio-economic status significantly affects stunting and underweight levels among children living in the urban slums. Logistic models also indicate that all individual-level characteristics, except exposure to mass media and mothers working outside home, significantly affect undernutrition levels among children living on non-slums. Among the household- and community-level characteristics, only households socioeconomic status remains significant for the non-slums.

Conclusions Poor nutritional status is a major concern in slum areas, particularly as this group is expected to grow rapidly in the next few years. The situation calls for specially designed and well targeted interventions that take into account that many of the mothers are poorer and less educated, which affects their ability to provide care to their children.

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Monitoring and Evaluating Progress towards Universal Health Coverage in BangladeshHuda T, Khan JAM, Ahsan KZ, Jamil K, Arifeen SE2014English, , , In the 42 years since independence, Bangladesh has made some substantial progress in the health sector, which is all the more remarkable when compared with other countries in the region. However, this achievement is not uniform across all health indicators. The coverage of many critical health services is still quite low. The country's health system is struggling to meet basic standards for quality of care because of a shortage of skilled health workers, the large number of unregulated private service providers, irregular supplies of drugs, inadequate public financing, high out-of-pocket expenses, and lack of proper monitoring and supervision mechanisms. Further complicating the situation is the increasing burden of non-communicable diseases, and the absence of any pre-payment risk pooling mechanisms. Bangladesh faces a daunting challenge in achieving the goal of universal health coverage.ja-14-185
Maternal Mortality in Bangladesh: A countdown to 2015 country case studyArifeen SE, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK2014English, , ,

Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.

We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.

The MMR fell from 322 deaths per 100000 livebirths (95% CI 253391) in 19982001 to 194 deaths per 100000 livebirths (149238) in 200710, an annual rate of decrease of 56%. This decrease rate is slightly higher than that required (55%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death.

The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh.

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Association Between Child Marriage and Reproductive Health Outcomes and Service Utilization: A Multi-Country Study From South AsiaGodha D, Hotchkiss DR, Gage AJ.2013English, , , , Purpose: Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs. The purpose of this study was to assess the association of child marriage with fertility, fertility control, and maternal health care use outcomes in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Methods: Data for the study come from the most recent Demographic and Health Surveys conducted in the study countries; we used a subsample of women aged 2024 years. Child marriage, defined as first marriage before 18 years of age, is categorized into two groups: first married at ages 1517 years and first married at age 14 years. We used multivariate logistic regression models. Results: The results of the study suggest that child marriage is significantly associated with a history of rapid repeat childbirth, current modern contraceptive use, female sterilization, not using contraception before first childbirth, pregnancy termination, unintended pregnancy, and inadequate use of maternal health services, although the associations are not always consistent across countries. Furthermore, women who married in early adolescence or childhood show a higher propensity toward most of the negative outcomes, compared with women who married in middle adolescence. Conclusions: Child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility-related outcomes, and low maternal health care use.ja-13-157
Estimating Expenditure-Based Poverty from the Bangladesh Demographic and Health SurveySchreiner, M2011English, It is widely believed that inequalities in health are related with poverty but formal analysis of the health-poverty nexus is hampered by data constraints. In particular, the most common measure of poverty compares expenditure with poverty lines, but expenditure surveys usually do not collect detailed health data. Conversely, the large repository of internationally comparable Demographic and Health Surveys has detailed health data but no expenditure data. This has led DHS researchers to control socio-economic status using an asset index defined in terms of housing characteristics and ownership of durable goods. While this may be a valid conception of poverty, it is difficult to compare the asset-based measure with the more common consumption based measure. This paper presents a simple poverty scorecard for Bangladesh that allows researchers to estimate the likelihood that expenditure is below a given poverty line using ten verifiable, inexpensive-to-collect indicators found in both Bangladeshs 2004 DHS and also in the 2005 Household Income and Expenditure Survey. The estimates of poverty from the scorecard are then compared with those of the DHS asset index.ja-13-155
Contraceptive discontinuation and unintended pregnancy: an imperfect relationshipCurtis S, Evens E, Sambisa W2011English, , CONTEXT: Contraceptive discontinuation is a common event that may be associated with low motivation to avoid pregnancy. If this is the case, a substantial proportion of pregnancies that follow discontinuation will be reported as intended. METHODS: Demographic and Health Survey data from six countries (Bangladesh, the Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe) over the period 19992003 were used to explore the proportions of pregnancies women reported as intended or unintended following various contraceptive behaviors. Multivariate logistic regression analysis was used to examine the characteristics of women who reported births as intended when they followed contraceptive failure or discontinuation for reasons other than a desire for pregnancy. RESULTS: The proportion of births reported as intended following contraceptive failure ranged from 16% in Bangladesh to 54% in Kazakhstan, and the proportion reported as intended following discontinuation for reasons other than a desire for pregnancy ranged from 37% in Kenya to 51% in Kazakhstan. In at least half the countries, associations were found between selected womens characteristics and their reports that births following either contraceptive failure or discontinuation were intended: Factors that were positively associated were womens age and the time elapsed between contraceptive discontinuation and the index conception; factors that were negatively - associated were increasing number of living children and reporting method failure as opposed to method discontinuation. CONCLUSION: These findings suggest that underlying variation in the motivation to avoid pregnancy is an important factor in contraceptive discontinuation.ja-11-129
Physical and sexual abuse of wives in urban Bangladesh: Husbands reportsSambisa W, Angeles G, Lance P, Naved R, and Curtis S2010English, , Using data from 8,320 husbands self reports for the 2006 Urban Health Survey, this article examines the prevalence of physical and sexual intimate partner violence (IPV) perpetrated by husbands against their wives in Bangladesh and identifies risk markers associated with such violence. Of the men included in the sample for this study, 55 percent reported perpetrating physical IPV against their wives at some point in their married lives, 23 percent reported perpetrating physical IPV in the past year, 20 percent reported ever perpetrating sexual IPV, and 60 percent reported ever perpetrating physical or sexual IPV. Bivariate analyses revealed that men residing in slums had a greater likelihood than those residing in nonslum areas and in district municipalities of perpetrating lifetime and past-year physical IPV, and any lifetime (physical or sexual) IPV. Lifetime sexual IPV prevalence, by contrast, was highest in district municipalities (26 percent), followed by slum (20 percent) and nonslum (17 percent) areas. Net of other factors, low socioeconomic levels were associated with mens increased likelihood of perpetrating IPV. Alcohol and drug use, sexually transmitted disease infection, poor mental health, and holding attitudes supportive of wife beating were predictive of IPV perpetration. These results suggest that IPV-prevention programs targeting men should consider spousal abuse, substance use, and sexual risk behaviors as social and public health problems and should also consider the sociocultural context within which men who abuse their partners are embedded.ja-10-116
Imbalances in the health labour force: an assessment using data from three national health facility surveysBarden-O'Fallon J, Gustavo A, Tsui A2006English, Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.ja-06-65
Creating a New Digital Health System in Bangladesh by Building Interoperability between the Country’s Family Planning Service Statistics System and the DHIS2Mohammad Golam Kibria, Nibras- Ar-Rakib, Md. Humayun Kabir, Gabriela Escudero2020English, , , The government of Bangladesh is prioritizing the management of comprehensive digital health information and is increasingly generating high-quality data for planning and decision-making purposes, which ultimately leads to better health outcomes. The Directorate General of Family Planning (DGFP), under the Ministry of Health and Family Welfare, has collected subdistrict-level family planning (FP) service statistics (SS) in electronic form for more than 10 years. However, this SS system lacked an interactive visual interface, which hindered data analysis and the use of data for decision making. To resolve this issue and maximize the effective use of the copious data collected through the SS system, with technical assistance from implementing partners (IPs), the DGFP created an innovative interoperability mechanism between the SS and the countrys District Health Information Software, version 2 (DHIS2) platform. This brief shares more.fs-20-433
Improved Reporting of Performance Data Supports Health Decision Making in BangladeshMEASURE Evaluation2019English, , , , , MEASURE Evaluation contributed to institutionalizing regular health-sector performance reviews by the Ministry of Health and Family Welfare of Bangladesh and helped promote data use for program and policy decisions. This brief shares more.fs-19-407
Discontinuation of Contraceptive Intrauterine Devices and Implants in BangladeshMEASURE Evaluation, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)2020English, , , Intrauterine devices (IUDs) provide effective contraception for 10 years and implants for three. These two family planning (FP) methods are known as long-acting reversible contraceptives (LARCs), and both are highly effective. Unfortunately, low rates of use and high rates of discontinuation of these methods have negative implications for programs seeking to achieve effective contraception in Bangladesh. The Bangladesh FP program has long sought to increase the rates of acceptance and continuation of LARCs. Bangladeshs Directorate General of Family Planning (DGFP) is responsible for mobilizing the resources necessary to promote the use of IUDs and implants, including procurement and supply of devices, training of service providers, and provision of insertion fees and client compensation. These investments are most costeffective when method acceptors continue to use LARCs throughout the effective life of the method. This brief presents an analysis of longitudinal data n IUD and implant discontinuation conducted by Research for Decision Makersan activity under the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)and MEASURE Evaluation. Both are funded by the United States Agency for International Development (USAID). We obtained longitudinal data from the Matlab Health and Demographic Surveillance System (HDSS)1 and compared the results of our analysis with those from the Bangladesh Demographic and Health Surveys (BDHS). The method discontinuation data collected by the BDHS (19942017) are nationally representative but suffer from small sample sizes. Exploring other reliable data sources, such as Matlab HDSS, can help generate evidence that will improve the rates of IUD and implant use.fs-19-404
Assessment of the Effectiveness of the MomConnect Helpdesk in Handling and Resolving ComplaintsMEASURE Evaluation2017English, , MomConnect, supported by the United States Presidents Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development(USAID), is a national scale ministerial mobile health initiative that employs cell phone technology to register pregnant women in South Africa and deliver to them stage-based maternal messages during pregnancy and after delivery. The effort aligns with USAID's and PEPFAR's global health goal to prevent child and maternal deaths. USAID supported early implementation and rollout of the initiative through the MEASURE Evaluation Strategic Information for South Africa (MEval-SIFSA) project. MomConnect has a helpdesk feature that allows mothers to ask maternal and child health-related questions and to provide feedback on services they receive at antenatal care clinics. This fact sheet outlines an assessment of the effectiveness of this helpdesk at handling and resolving complaints.fs-17-248
Bangladesh Maternal Mortality and Health Care Survey 2016: SummaryUnited States Agency for International Development, MEASURE Evaluation2017English, , Working to build on recent progress, Bangladesh's,fourth Health, Population, and Nutrition Sector Programme (4th HPNSP) for 20172022 aims to reach a maternal mortality ratio of 121 per 100,000 live births by 2022.The 2016 Bangladesh Maternal Mortality and Health Care Survey(BMMS 2016) assesses the recent progress in maternal health and establishes the baseline for HPNSP and Sustainable Development Goals. MEASURE Evaluation, funded by the United States Agency for International Development, produced this fact sheet to summarize the preliminary results of the BMMS 2016. See the full preliminary report here. Follow the link below for a version in Bengali.: FS-17-245-bafs-17-245-en
The Future of Long-Acting and Permanent Methods of Contraception in Bangladesh: A Policy Brief2014English, , , This policy brief gives a systematic review of the trend of demand for and use of long-acting and permanentmethods (LAPM), such asIUDs, implants, and female or male sterilizations, and programmatic and socio-cultural factors associated with the low use of LAPM, and combines the findings from the evaluation of the Mayer Hashiproject that provided interventions to increase the use of LAPM in 21 districts of Bangladesh during 2010-2013. Recommendations that will helpfamily planning programs strategize and prioritize the future LAPM program actions in Bangladesh are provided.fs-14-131
Fact Sheet: MEASURE Evaluation in Bangladesh2011Englishfs-11-48
Bulletin 6: Evaluation of the Impact of Population and Health Programs2003English, , The sixth issue of the MEASURE Evaluation Bulletin contains the following stories: A comparative multi-level analysis of health program effects on individual use of reproductive sexual health services; changes in use of health services during Indonesia's economic crisis; health facility characteristics and the decision to seek care; determinants of fertility in rural Peru: program effects in the early years of the National Family Planning Program; determinants of contraceptive method choice in rural Tanzania between 1991 and 1999; the impact of reproductive health project interventions on contraceptive use in Uganda; and an evaluation of the rural service delivery partnership (RSDP) in Bangladesh.bu-03-06
Strengthening Routine Health Information Systems through Electronic Management Systems in BangladeshMEAUSURE Evaluation2018English, , , , The aims of the Electronic Management Information System(s) are large: nothing less than to change the way public sector community health workers (CHWs) do their jobs. CHWs provide outreach, information, and referral for health services in culturally and socially appropriate ways. They are a link between communities and health facilities and collect vital demographic and health service-related data on people living within their catchment areas. Prior to the initiative, these frontline healthworkers used paper-based forms and huge register books to gather data on health complaints of presenting clients, health services delivered, and medicines used. All those data were to inform policy making and resource allocations to improve health for the population. This technical document gives an overview of the tools developed under the eMIS initiative.tr-18-249
Bangladesh Maternal Mortality and Health Care Survey 2016: Preliminary ReportNational Institute of Population Research and Training; International Centre for Diarrhoeal Disease Research, Bangladesh; and MEASURE Evaluation2017English, , , The Government of Bangladesh is committed to reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015. The decline in MMR between 2001 and 2010 indicates remarkable progress. The 4th Health, Population and Nutrition Sector Program 20172022 has set the target of reaching an MMR of 105 per 100,000 live births in 2022. Within this context, the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS 2016) sought to assess how well the country is progressing toward these targets. The survey was funded by the Government of Peoples Republic of Bangladesh, the United States Agency for International Development, and the Department for International Development. The BMMS 2016 sample size was designed to estimate the MMR with a similar level of relative precision to the estimate obtained in the 2010 BMMS, assuming that the MDG target of 143 per 100,000 live births had been met. The BMMS 2016 used a multistage sampling procedure, using sampling frames derived from the 2011 census. This report, supported by the United States Agency for International Development-funded MEASURE Evaluation, covers a preliminary outline of the results of the BMMS 2016. Follow the links below for a brief summary of the preliminary report in English and Bengali: FS-17-245-en FS-17-245-batr-17-218
Bangladesh Mayer Hashi II 2015 Baseline Survey ReportMEASURE Evaluation2017English, , , An external impact evaluation of the Mayer Hashi Phase II (MH-II) project was requested by the U.S. Agency for International Development (USAID)/Bangladesh. MH-II, which is a follow-on project to the previous Mayer Hashi (MH-I) project, was awarded to EngenderHealth in September 2013. It will be conducted between October 2013 and September 2017. The 2015 Baseline Mayer Hashi Phase II Evaluation Survey is the first of two surveys to evaluate the impact of MH-II in increasing the use of effective family planning (FP) and reproductive health services among the population in Bangladesh. The baseline survey has three main objectives. First, it is designed to provide baseline estimates of the primary and secondary outcomes in areas where MH-II initiated its activities at different times. Second, it aims to assess baseline differences in the outcomes among areas with different lengths of exposure to the project. Third, with an end-line survey planned in early 2017, the baseline survey is designed to support evaluation of project impact through a difference-in-differences (DID) approach comparing pre-post differences in outcomes between areas with different lengths of exposure to the project.tr-17-183
Bangladesh Nongovernmental Organization Health Service Delivery Project 2014 Baseline Urban Survey ReportMEASURE Evaluation2016English, , , The United States Agency for International Development (USAID)/Bangladesh requires an external impact evaluation of the Nongovernmental (NGO) Health Service Delivery Project (NHSDP) program that was awarded to Pathfinder International in December 2012. The impact evaluation will use a difference-in-difference (DID) strategy to determine program impact. This design requires collecting baseline and endline data in program intervention areas and similar comparison areas, which serve as the counterfactual for the impact evaluation. The main objective of the 2014 NHSDP baseline survey was to measure USAID performance indicators related to health and family planning that the program seeks to improve in program intervention areas and in similar comparison areas (where NHSDP is not in operation). The survey provides baseline characteristics for assessing the programs performance at the population level. Additionally, the survey collected information on individual, household, and neighborhood-level characteristics associated with health outcomes and health behaviors.tr-16-125b
Findings from a Multi-Country Assessment of Integrated Health Programs2014English, , , , Integration of health interventions is promoted to make better use of resources, meet health needs, and achieve sustained improvements in health. Many definitions of integration exist, and some converge on a concept of integrated health services within the context of a supportive health system that provides clients with a continuum of services according to their needs over time (Waddington & Egger, 2008). Studies of integrated health services have shown integration to be feasible, and that it can improve quality of care, increase service uptake, and improve outcomes such as contraceptive use and HIV testing uptake (Spaulding et al., 2009; Lindegren et al., 2012; Wilcher et al., 2013). Evidence is more limited regarding effects on health impacts and costs. The United States government (USG) contributes to a worldwide effort to communicate, learn about, and promote integration by funding projects, issuing guidance, developing indicators, convening meetings and working groups, sponsoring literature reviews and publishing. Specifically, a USG inter-agency group on integration published the GHI Principle Paper on Integration in the Health Sector in May 2012, developed a related results framework for integration, defined a list of indicators to measure the outputs and outcomes of integration (document forthcoming), and articulated a learning agenda. This report presents the results of a multi-country assessment of integrated health programs in 10 countries conducted by MEASURE Evaluation to inform this broader learning agenda on integration of health services. This multi-country assessment was intended to be a first step in gathering information to understand the types of services that are being integrated; rationale for the choice of integration model and interventions; perceived strengths, weaknesses, and gaps of M&E systems; and environment, policies and systems that facilitate service integration.tr-14-115
Impact Evaluation of the Mayer Hashi Program of Long-Acting and Permanent Methods of Contraception in BangladeshRahman M, Curtis SL, Haider MM2014English, , , , The Mayer Hashi (MH) project covered 21 low-performing districts of Bangladesh to improve access, quality, and use of long-acting and permanent methods (LAPM) of contraception and selective maternal health services. This evaluation report focuses on the LAPM activities. Under a before-after and intervention-comparison evaluation framework, six districts from the MH program districts and three otherwise comparable districts from non-program districts were selected. The evaluation design permits a difference-in-difference (DID) analysis of the project impact. Endline surveys were conducted among 5,864 currently married women of reproductive ages (CMWRA) and 627 service providers during February-May 2013. Baseline data on 32,018 CMWRA were taken from the 2010 Bangladesh Maternal Mortality Survey (BMMS) (conducted during January-August 2010) for the nine selected districts: Barisal, Patuakhali, Coxs Bazar, Comilla, Moulovibazar, and Sunamganj are program districts; and Kishoreganj, Mymensingh, and Narsingdi are non-program districts.tr-14-102
Bangladesh Smiling Sun Franchise Program Endline Survey Report 2011Lance P, Angeles G, Kamal N2013English, , , The Bangladesh Smiling Sun Franchise Program (BSSFP), running from 2007 to 2012, was a USAID-funded health service delivery program that aimed to deliver family planning and a broad package of maternal and child health-focused essential services through a network of clinics administered by 23 local NGOs. It was the most recent phase of an evolving series of interventions that began with separate urban and rural components, called, respectively, the Urban Family Health Partnership (UFHP) and Rural Service Delivery Partnership (RSDP), before being consolidated into the successor NGO Service Delivery Program (NSDP).tr-13-91
Bangladesh Smiling Sun Franchise Program Impact Evaluation ReportLance P, Angeles G, Kamal N2012English, , , The Bangladesh Smiling Sun Franchise Program (BSSFP) is a United States Agency for International Development (USAID)/Bangladesh funded health care delivery program providing a package of essential health services through a network of local non-governmental organizations (NGOs). It is a continuation of the NGO Service Delivery Program (NSDP), which had been in place in various forms since the late 1990s. BSSFP operated in areas that had been identified by the Government of Bangladesh (GOB) to have inadequate public health service delivery systems where the government sought assistance from partners to fill the service gap (henceforth referred to as project areas). USAID committed US$46 million for BSSFP over a four-year period (2007-2011). The program was later extended for another year with additional funding of around US$11 million. The programs overall objectives were to increase the use of family planning, maternal, child, and other basic health services in areas served by BSSFP, with an emphasis on serving the poor and on improving the sustainability of local NGOs in continuing to provide these services. The program was developed at a time when funding for USAID/Bangladesh was expected to decline drastically. Thus, improving financial sustainability of local NGOs within a four-year period was a major emphasis of the program. To meet the desired outcomes, BSSFP had four objectives: (1) to develop a franchise model; (2) to recover 70 percent of operational costs by the end of the project; (3) to increase and expand quality service volume; and (4) to ensure that 30 percent of all health services provided are service contacts targeted towards the poor who are unable or only partially able to pay. In 2010, three changes were made to the BSSFP program based on a mid-term program assessment conducted in April 2010 and USAIDs periodic program reviews. First, the program was extended for an additional year beyond its fourth year. Second, the programs cost recovery target was revised downwards to 45 percent of its operational costs. The initial target of 70 percent cost recovery was abandoned since it would have involved further increases in user fees, in addition to the two price hikes introduced in the first three years of the project. Third, further efforts to establish a franchise were ceased. The BSSFP was implemented under a contract between USAID and Chemonics International through 26 local NGOs operating a network of 323 static clinics, around 8,800 satellite (outreach) clinics, and over 6,000 community volunteers known as Community Service Providers (CSPs)/depotholders. The BSSFP served a catchment population of roughly 20 million through 193 clinics in urban areas and 130 clinics in rural areas. The urban and rural components of the BSSFP program varied slightly in design and implementation owing to differences in urban and rural settings. The rural component of the BSSFP had a CSP/depotholder component for community mobilization but the urban one did not.tr-12-89
Bangladesh Maternal Mortality and Health Care Survey 20102012English, , , , The Government of Bangladesh has invested in a maternal health program with support from a number of development partners. Committed to achieving the Millennium Development Goal (MDG) 5, Bangladeshs targets are to reduce the maternal mortality ratio (MMR) to 143 per 100,000 live births by 2015, and to increase skilled attendance at birth to 50 percent by 2016. In the last decade, the health, nutrition, and population sector program of Bangladesh has adopted a national strategy for maternal health focusing on Emergency Obstetric Care (EmOC) for reducing maternal mortality, focusing especially on early detection and appropriate referral of complications, and improvement of quality of care. Since 2001, the government embarked on program to retrain existing government community health care workers as Community Skilled Birth Attendants (CSBA) as the primary operational strategy for achieving the 2015 target of 50 percent skilled attendance at birth. The second Bangladesh Maternal Mortality and Health Care Survey was conducted in 2010 (BMMS 2010) with the major objectives being to provide a maternal mortality estimate for the period 2008-2010, to determine whether MMR has significantly declined from 1998-2001, and to ascertain the causes of maternal death. The first such national level survey was conducted in 2001 (BMMS 2001). The survey was carried out in a national sample of 175,000 households, interviewing ever-married women 13 to 49, as well as investigating any deaths to women of reproductive ages, especially maternal and pregnancy-related deaths. Data collection for the survey was conducted from 18 January to 6 August, 2010.tr-12-87
Bangladesh District Level Socio-demographic and Health Care Utilization IndicatorsMEASURE Evaluation, ICDDR,B2011English, , tr-11-84
2008 Baseline Urban Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation SurveyLance P, Angeles G, Islam S2009English, , , , , , The 2008 Baseline Urban Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey is the first installment in a series of two surveys intended to assess the efficacy of the urban component of the BSSFP program in terms of its ability to deliver an essential services package (ESP) of family planning and maternal and child health services to under-served populations across Bangladesh. The baseline survey is designed to provide a picture of circumstances at the population level in BSSFP catchment areas and similar, nearby non-project areas where the BSSFP is not operating but the government is. Useful in its own right as a source of information as critical programmatic decisions are made in the early phase of the BSSFP project, the baseline survey also provides information regarding circumstances on the eve of conversion from the operational model of the National Service Delivery Program (NSDP, which the BSSFP succeeds) to that of the BSSFP. This is critical information which, when combined with that from a follow-up wave to be conducted three years hence, will allow for the tracking of the performance of the program over time.tr-09-73b
2008 Baseline Rural Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation SurveyLance P, Angeles G, Hayat Khan MS2009English, , , , , , The 2008 Baseline Rural Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey is the first installment in a series of two surveys intended to assess the efficacy of the rural component of the BSSFP program in terms of its ability to deliver an essential services package (ESP) of family planning and maternal and child health services to under-served populations across Bangladesh. The baseline survey is designed to provide a picture of circumstances at the population level in BSSFP catchment areas and similar, nearby non-project areas where the BSSFP is not operating but the government is. Useful in its own right as a source of information as critical programmatic decisions are made in the early phase of the BSSFP project, the baseline survey also provides information regarding circumstances on the eve of conversion from the operational model of the National Service Delivery Program (NSDP, which the BSSFP succeeds) to that of the BSSFP. This is critical information which, when combined with that from a follow-up wave to be conducted three years hence, will allow for tracking performance of the program over time.tr-09-73a
2006 Bangladesh Urban Health Survey (UHS)Angeles G, Al-Sabir A, Lance P, Buckner B, Streatfield PK, Karar ZA, et al2008English, , , Nearly all of the global population growth in the next three decades will occur in urban areas, primarily as a massive migration occurs from the rural areas of middle and lower-income societies to their cities. Many, if not most of these migrants, who are generally possessed of low human and financial capital on arrival in the city, will settle in slums, the areas of concentrated poverty and environmental vulnerability that are already a dominant feature of much of the urban landscape of the developing world. Bangladesh will be no exception to these trends. The growth in her urban population is set to outstrip by a wide margin that in rural areas. Moreover, the urban growth already experienced in recent decades demonstrates that slums will likely be an increasingly important feature of urban existence in Bangladesh. Anticipating these developments, USAID and the Government of Bangladesh tasked a research team based in Bangladesh and the United States (at the University of North Carolina at Chapel Hill) with conducting a survey designed to obtain a broad health profile of the urban population of Bangladesh. The ultimate fruit of this effort was the 2006 Urban Health Survey (2006 UHS), a rich, microlevel health-interview survey of communities, households, and individuals throughout the City Corporations and a sample of District Municipalities.tr-08-68
2005 Urban NGO Service Delivery Program (NSDP) Evaluation SurveyAngeles G, Lance P2006English, , , , , This survey addresses the urban portion of the 2005 NGO Service Delivery Program (NSDP), which delivers an Essential Service Package (ESP)of primary health care interventions to underserved urban populations of Bangladesh. The Survey's main objective was to collect information about knowledge, awareness and use of services related to family planning and maternal and child health provided through the NSDP project and its alternatives. This survey is part of a continuing evaluation conducted in 1998, 2001, and 2003, by Mitra and Associates with technical assistance from MEASURE Evaluation. It includes data from 5,923 women served by the NSDP and 4,343 women from non NSDP areas.tr-06-37b
2005 Rural NGO Service Delivery Program (NSDP) Evaluation SurveyAngeles G, Lance P2006English, , , , The 2005 Rural NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the rural component of the NGO Service Delivery Program (NSDP), a four-year, USAID-funded health and population project. It provides information on the use of Essential Service Package (ESP) components for a representative sample of 7,651 women in NSDP project areas and 4,418 women in non-NSDP areas, including utilization of services at the NSDP network of facilities (static and satellite clinics and depotholders) and alternative providers, knowledge of health promotion behaviors, awareness of NSDP services, and the quality of treatment at NSDP clinics. The survey, part of a continuing evaluation that began with a baseline survey in 1998 followed by mid-project evaluation surveys in 2001 and 2003, was conducted by Associates for Community and Population Research (ACPR), a Dhaka-based research firm, with technical assistance from the MEASURE Evaluation Project at the University of North Carolina at Chapel Hill.tr-06-37a
Slums of Urban Bangladesh: Mapping and Census, 2005Islam N, Mahbub A, Nazem NI, Angeles G, Lance P2006English, Slums of Urban Bangladesh, Mapping and Census, 2005 was carried out to physically identify the boundaries of slums and squatter settlements in the six City Corporations of Bangladesh to facilitate implementation of the urban health survey.tr-06-35
2003 Urban NGO Service Delivery Program (NSDP) Evaluation Survey2005English, , , , , The 2003 Urban NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the urban component of the NSDP in terms of delivering an Essential Service Package (ESP) of primary health care interventions to under-served urban populations of Bangladesh. The surveys main objective was to collect information about knowledge, awareness, and use of services related to family planning and maternal and child health provided through the NSDP project and its alternatives. Part of a continuing evaluation that began with a 1998 baseline survey and a 2001 mid-project impact evaluation, the 2003 survey was conducted by Mitra and Associates with technical assistance from the MEASURE Evaluation project at the University of North Carolina at Chapel Hill. Data were collected from 5,691 women in urban areas served by the NSDP and from 4,201 women in non-NSDP urban areas.tr-05-28c
2003 BPHC Evaluation Survey2005English, , , , , Since 1988, the principal objective of the BPHC project has been to deliver maternal and child health and family planning services to poor and underserved communities in Bangladesh. The 2003 BPHC evaluation survey was conducted in Bangladesh to assess the performance of BPHC nongovernmental organizations (NGOs) in terms of this objective. The survey was designed to assess performance as measured by U.S. Agency for International Development (USAID) performance indicators relative to the rural component of the NGO Service Delivery Partnership (NSDP) and comparable NSDP project areas adjacent to BPHC project areas.tr-05-28b
2003 Rural NGO Service Delivery Program (NSDP) Evaluation Survey2005English, , , , , , The 2003 Rural NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the rural component of the NSDP, a four-year health and population project funded by the U.S. Agency for International Development (USAID). It provides information on the use of Essential Service Package (ESP) components for 7,507 women in NSDP project areas and 4,372 women in non-NSDP areas, including utilization of services at the NSDP network of facilities (static and satellite clinics, and depot holders) and alternative providers, knowledge of health promotion behaviors, awareness of NSDP services, and the quality of treatment at NSDP clinics. The survey, part of a continuing evaluation that began with a baseline survey in 1998 followed by a mid-project evaluation survey in 2001, was conducted by Associates for Community and Population Research (ACPR), a Dhaka-based research firm, with technical assistance from the MEASURE Evaluation project at the University of North Carolina at Chapel Hill.tr-05-28a
Bangladesh: Evaluation of Impacts of the Urban Family Health Partnership (UFHP)2003English, , Data from the 2001 Urban Family Health Partnership (UFHP) Evaluation Survey are used to determine the impact of the project in improving populations' health and health care seeking behaviors. The results here have two main components: 1) a discussion of trends in the use of UFHP services, and 2) multilevel analyses of determinants of health outcomes and health-care seeking behaviors. The evaluation survey presents the following key findings: 1) Since 1998, there have been notable increases in the share of UFHP providers in the supply of antenatal care, contraceptive methods, and childhood immunizations. The project seems to have little impact on children's curative care. 2) Except for antenatal care and modern contraception, there is little statistical difference between the poor and non-poor in many health outcomes and the use of UFHP health providers. 3) Proximity to UHFP providers significantly increases the likelihood that women will use essential UFHP services. The quality of UFHP satellite clinics has a significant impact upon their use. 4) Price has a small effect on use of services. 5) Considerable overlap exists between UFHP and non-UFHP catchment areas.tr-03-15f
Bangladesh: Evaluation of Impacts of the Rural Service Delivery Partnership (RSDP)2003English, , , Data from the 2001 Rural Service Delivery Partnership (RSDP) Evaluation Survey indicate that the project has had positive effects on the health and health-care seeking behaviors of the targeted populations. Much of this impact analysis focuses on qualifying key changes in the use of essential services since the 1998 Baseline Survey and identifying the pathways through which those changes have occurred. The following key findings were found: The RSDP program is responsible for substantial increases in antenatal care use. Simulations indicate that the project is responsible for an 8.6 percentage point increase in antenatal care, an 8.6 percentage point increase in the number of pregnant women with two or more tetanus toxoid injections, and a 3.3 percentage point increase in the use of modern contraception from 1998 to 2001. For child health outcomes, the impact of the project was smaller. Price generally had a small effect on the use of services at RSDP clinics and depot holders; distance, however, appears to have a larger effect and is likely a significant determinant of overall use of antenatal care and of RSDP providers for antenatal care and modern contraception. Multilevel analyses indicate that RSDP provider characteristics generally do not have significant impacts on the likelihood of their use, with the exceptions of distance, satellite clinic worker experience, and service availability.tr-03-15e
Bangladesh: 2001 Urban Family Health partnership Evaluation Survey – Facility Survey Report2003English, , , , , The 2001 Urban Family Health Partnership (UFHP) Evaluation Survey was designed to evaluate the performance of the UFHP program in delivering an Essential Service Package of primary health care interventions through a network of static clinics and satellite clinics to underserved urban populations of Bangladesh. The facility survey had two main goals: 1) to define the service supply environment for populations in the 2001 UFHP Evaluation Survey in order to examine the choices that women make in deciding whether or not to use health services, and 2) to permit comparisons in quality, size, and efficiency among different types of health facilities that are available to the study population.tr-03-15d
Bangladesh: 2001 Rural Service Delivery Partnership Evaluation Survey – Facility Survey Report2003English, , , , , The 2001 Rural Service Delivery Partnership (RSDP) Evaluation Survey was designed to evaluate the performance of the RSDP program in delivering an Essential Service Package of primary health care interventions. These interventions were provided through a network of static clinics and satellite clinics and depot holders aimed at serving underserved rural populations of Bangladesh. The facility survey had two main goals: 1) to define the service supply environment for populations in the 2001 RSDP Evaluation Survey in order to examine the choices that women make in deciding whether or not to use health services; and 2) to permit comparisons in quality, size, and efficiency among the different types of health facilities that are available to the study population.tr-03-15c
Bangladesh: 2001 Urban Family Health Partnership Evaluation Survey – Household Survey Report2003English, , , , , , The 2001 Urban Family Health Partnership (UFHP) Evaluation Survey was designed to evaluate the progress of the UFHP program in delivering an essential service package of primary health care interventions in underserved urban populations of Bangladesh. Data focus primarily on knowledge and use of services related to family planning, maternal and child health, and awareness and use of UFHP facilities. The survey itself has two main purposes: 1) to collect information relevant to monitoring the progress of the project as specified in USAID's NIPHP Results Framework and 2) to provide data for evaluating the impact of the UFHP program on improving the health status of the population in UFHP areas and in expanding access to ESP services. This report presents findings from the following topics: contraceptive use, antenatal care, childhood vaccinations, child health, knowledge of health promotion behaviors, fertility, and early childhood mortality.tr-03-15b
Bangladesh: 2001 Rural Service Delivery Partnership Evaluation Survey – Household Survey Report2003English, , , , , , The 2001 Rural Service Delivery Partnership (RSDP) Evaluation Survey was designed to evaluate the rural component of the National Integrated Population and Health Program, a seven-year USAID health and population project. The survey had two main objectives: 1) to collect information on and monitor changes in the USAID performance indicators since the RSDP Baseline Survey in 1992, and 2) to evaluate the RSDP program's impact on the health of the project's catchment area population by linking data on individual behaviors and health outcomes with data on the health service supply environment. This report presents findings in the following areas, contraceptive use, antenatal care, childhood vaccinations, child health, awareness of RSDP services, knowledge of health promotion behaviors, early childhood mortality, and fertility.tr-03-15a
Quick Poverty Score Toolkit: User’s Guide and Spreadsheet2009EnglishThe Quick Poverty Score (QPS) is a simple, easy-to-use tool that health service programs can use to assess the prevalence of poverty among their clients. Using three components, QPS provides a snapshot of uptake of program services by those living below the national poverty line, below U.S. $2 per day, and below U.S. $1 per day. Country-specific user's guides explain how to apply QPS and interpret outputs in 10 countries, with Microsoft Excel spreadsheets for each country (Spanish translations are available for Honduras and Guatemala).ms-09-35
An assessment of the Advancing Adolescent Health (A2H) Program in Rangpur: Implications for future interventionsQuamrun Nahar, Anadil Alam, Sadia Afrin, Shusmita Khan, Sharad Barkataki, Mizanur Rahman2021English, , , , , The USAID-supported Advancing Adolescent Health (A2H) program implemented by Plan International during 2016-2019 in Rangpur established a foundation for social change to reduce the incidence of early marriage. The program organized foundational life skills training sessions for adolescents that provided information on sexual and reproductive health matters and negotiation skills to address issues such as age at marriage, delaying births, and other behaviors that affect sexual and reproductive health. The program engaged parents, guardians, and community-influential persons through orientation sessions to create an enabling environment for adolescents and improve their negotiations skills on postponement of early marriage. Findings from a quantitative survey, complemented by a qualitative study, conducted in 2018 show that 38% of unmarried 15-19 year-old girls attended at least one of the eight A2H training sessions, while 13% of married adolescent girls of the same age participated in any training sessions. Both the quantitative and qualitative information indicate that the program may have influenced adolescents to undertake activities to postpone early marriage with support from parents and guardians. About 56% of 15-19 year-old girls remained never-married in A2H areas compared to 47% in the comparison areas. Programs like A2H, with some modifications, have the potential for reducing the incidence of teenage marriage in Bangladesh.wp-20-245-d4i
Needs Assessment on Resources for Use of Routine and Other Secondary Data for Health Evaluation and ResearchFehringer, J., Millar, E., Wilkes, B. (Data for Impact)2020English, , , , , , There is increasing recognition of opportunities to use routinely collected or other secondary health data to answer global health evaluation and research questions. Using such data is a cost-effective way to gain insight into health areas and health system functions. However, many factors affect whether and how these data are used. These include data quality and accessibility, the existing capacity to conduct statistical analysis and interpret findings, and the available resources to guide and support this work. The needs of the United States Agency for International Development (USAID) missions and local partners around these topics, and the resources available to aid analysis, use, and visualization of these data, are unclear. To fill this knowledge gap, Data for Impact (D4I) conducted a survey with USAID missions and implementing partners (IPs) to better understand the perceived capabilities, needs, and available resources related to use of routine and other existing data sources to conduct evaluation or other research. We also conducted a review of available online resources to support such data use. This report shares our findings and makes recommendations for how to better support field needs related to the use of routine and other existing data for evaluation and research.tr-20-431-d4i
Datos para generar impacto en Colombia: mejora en la toma de decisiones basada en datos para la protección infantilData for Impact2020Spanish, , , , , USAID aportó a los datos de Colombia a través del apoyo a la Encuesta sobre violencia contra niños y jóvenes, y continúa respaldando la coordinación para dar una respuesta nacional a los resultados de esta encuesta. USAID también tiene como objetivo fortalecer la capacidad de los trabajadores de servicios sociales y potenciar al gobierno de Colombia, especialmente la función del Instituto Colombiano de Bienestar Familiar (ICBF), para garantizar el bienesta de los niños. Esto incluye impulsar el fortalecimiento de la capacidad en la práctica para aumentar la eficiencia y eficacia en la gestión de los casos. Para complementar las actividades en curso en esta área, el proyecto Data for Impact (D4I), financiado por USAID, está disponible para mejorar la capacidad del ICBF de gestionar casos de protección infantil mediante una mejor utilización de los datos y sistemas de información.fs-20-511-es-d4i
Monitoring the Integration of Family Planning and HIV Services: A Manual to Support the Use of Indicators to Measure Progress toward PEPFAR’s 90-90-90 Targets and Protect Women’s Reproductive RightsFreyder M, Craig L, Kaji A (MEASURE Evaluation)2016English, , , , , , tr-16-138
The status of postpartum family planning in Bangladesh: A situation analysis and way forwardData for Impact2020English, , , , , , The postpartum family planning (PPFP) program in Bangladesh began in 2002. Initially it was focused on providing postpartum tubectomy but had little success in increasing the use of this method. More recently, provision of IUDs (since 2008) and implants (since 2016) at delivery have been included in the PPFP program. Although various pilot trainings and other intervention projects have been implemented in the public, nongovernmental organization (NGO), and private sectors since 2008, implementation of the PPFP program has generally been weak and spread thinly. This policy brief provides an overview of the status of PPFP in Bangladesh and provides recommendations for improving the effectiveness of the PPFP program.wp-20-244-d4i
Potential interventions to improve the use of long-acting reversible contraceptives and permanent methods in BangladeshMizanur Rahman, M. Moinuddin Haider, Sian Curtis2020English, , , , Bangladesh has done exceedingly well in family planning (FP) and achieved a total fertility rate (TFR) of 2.3 births per woman, nearly a replacement-level fertility, with a contraceptive prevalence rate (CPR) among married women of reproductive age of around 62 percent in 2017 (NIPORT, et al., 2019). One central programmatic concern is the consistently low use (9%) of long-acting reversible contraceptives (LARC), which are IUDs and implants, and permanent methods (PM), which are tubal ligation and no-scalpel vasectomy (NSV). Most couples—those who want to space births and those who want to limit pregnancies—rely on short-term methods, namely pills (28% in 2014 and 25% in 2017-2018), injectables (12% in 2014 and 11% in 2017-2018), condoms (6% in 2014 and 7% in 2017-2018), and traditional methods (8% in 2014 and 10% in 2017-2018) (NIPORT, et al., 2016; NIPORT, et al., 2019). In this policy brief we argue that shifting the method mix towards LARC and PM, even without increasing CPR, would lead to a total fertility rate (TFR) of 2.0 or below per woman and would reduce the incidence of abortion that can result in reduced maternal morbidities and mortality. The recent remarkable increase in facility delivery (currently at 50%; NIPORT, et al., 2019) offers an opportunity for providing postpartum IUDs, implants, and tubal ligation (PPIITL) at the delivery table. To increase the uptake of LARC and PM, we suggest that several potential interventions are indicated—the realization of which would require meaningful engagement from both public and private health sectors.wp-20-243-d4i
The Impact of USAID’s Integrated Health Program in the Democratic Republic of the Congo: Baseline ReportDavid Hotchkiss, Janna Wisniewski, Paul-Samson Lusamba-Dikassa, Lauren Blum, Matt Worges, Charles Stoecker, Eva Silvestre2020English, , , , , , , , , , Data for Impact (D4I), which is funded by the United States Agency for International Development (USAID), is conducting a performance and impact evaluation of the Programme de Santé Intégré de l'USAID en République Démocratique du Congo (PROSANI USAID), known in English as USAID’s Integrated Health Program (IHP) in the Democratic Republic of the Congo (DRC). The evaluation investigates the following issues: 1. Did the expected changes in outcomes and impacts occur? 2. If there were changes in healthy behaviors during the study period, to what extent were these attributable to USAID IHP? 3. Did the project contribute to gender equity in health services and in the health system? 4. What factors enabled or limited the success of USAID IHP? We report baseline data from three sources: (1) surveys of health facilities and households in USAID IHP-supported areas; (2) routine data from the DRC’s routine health information system (RHIS) for USAID IHP-supported areas and a matched control group; and (3) qualitative data collected from representatives of the government health system, implementing staff, and beneficiaries. To assess baseline health behaviors, we analyzed data from the DRC’s health information system (which is built on the District Health Information Software, version 2 [DHIS2]) for both USAID IHP provinces and provinces not receiving USAID support. Results suggest that the government health system faces multiple challenges to effectively plan, implement, and monitor services, including: lack of electricity, cellular communication, and Internet; wide variations by province in the availability of medicines and equipment; limited managerial autonomy; variations in the levels of external supervision; insufficient number of staff; and low levels of health worker satisfaction. Although many of the health system challenges identified through the study are outside the control of the project (and are the purview of the government), they are nonetheless critical constraints. Other challenges can be partially addressed through project-supported interventions. See a report on the midline evaluation.tre-20-28-d4i
Segmented-Client Communication Intervention for Improving the Use of Long-Acting Reversible Contraceptives and Permanent Methods in Rural BangladeshMd. Jasim Uddin, HSPSD, icddr,b; Md. Wazed Ali, HSPSD, icddr,b; Hemel Das, HSPSD, icddr,b; Quamrun Nahar, MCHD, icddr,b; Mizanur Rahman, D4I, UNC Chapel Hill2020English, , , , The Research for Decision Makers (RDM) project supported by the United States Agency for International Development (USAID), in collaboration with the Data for Impact (D4I) project, conducted the intervention “Segmented-Client Communication Intervention to Increase LARC and PM Use” in Gurudaspur, a subdistrict of Natore district where contraceptive prevalence is high at just below 70 percent. This report shares findings and recommendations.tr-20-429-d4i
Data for Impact in Colombia – Enhancing Data-Informed Decision Making for Child ProtectionData for Impact2020English, , , , , Data for Impact in Colombia will support the Instituto Colombiano de Bienestar Familiar to strengthen their collection, management, and use of quality routine data for the provision of child protection and care. This brief shares more.fs-20-511-d4i
Routine Family Planning Data in the Low- and Middle-Income Country Context: A Synthesis of Findings From 17 Small Research GrantsBridgit Adamou, Janine Barden-O’Fallon, Katie Williams and Amani Selim2020English, , , , , Health information systems rely on high-quality data to measure, track, and inform decision making. Currently, the quality, uptake, and use of family planning data in routine health information systems is limited, presenting an opportunity for improvement on many levels. The current synthesis assessed findings from 17 small grants that MEASURE Evaluation issued to low- and middle-income country research teams between 2015 and 2019. Main findings from that research were collaboratively categorized in 4 major themes: (1) the enabling environment for managing and using family planning information; (2) barriers to integration of family planning in routine health information systems; (3) gaps in the analysis, interpretation, and use of routine family planning data; and (4) family planning data use in management, programmatic, and budgetary decisions. Data quality at the systemic, organizational, technical, and output levels was a crosscutting theme. Collectively, the findings outline barriers to and opportunities for improved integration of family planning data and subsequent strengthening of routine health information systems.
Evaluation of the Improving Nutrition through Community Approaches (INCA) Project in Bangladesh: Outcome and Impact EvaluationKhan, S., Angeles, G., Rahman, M., Chakraborty, N., Moinuddin Haider, M., Escudero, G., Ahsan, K.Z., Ijdi, R.E. (Data for Impact)2020English, , , , This document is an endline report resulting from the evaluation of USAID/Bangladesh’s Improving Nutrition through Community-Based Approaches (INCA) project, which was designed to provide a comprehensive set of community and service strengthening activities with the objective of strengthening nutrition knowledge, practices, and use of services to improve the nutritional status of pregnant women and children under age two (0–23 months) living in selected areas in southern Bangladesh. Findings from this evaluation will serve three purposes: 1) to establish the impact of INCA interventions on a rural and undernourished area of the country; 2) to help USAID/Bangladesh design future nutrition interventions; and 3) to promote learning for other government or donor-funded projects that work in the field of nutrition. This evaluation also adds to the common evidence base of community-based interventions in low- and middle-income countries.tre-20-30-d4i
Family Planning 2020 Process Learning Activity: Process, Transitions, and New HorizonsData for Impact2020English, , In May 2020, USAID commissioned a Process Learning Activity (PLA) under the Data for Impact (D4I) project of the University of North Carolina at Chapel Hill. The PLA set out to assess how FP2020’s—and especially the Secretariat’s—most valued and effective functions and implementation approaches of the past eight years could be embedded in the proposed future decentralized structure, including identifying the risks and benefits. To this end, the aims of the PLA were to assess and document how the functions and implementation approaches of FP2020 have contributed to: (1) the 2012 London Summit goal of “120 by 20”; and (2) a more supportive environment for FP (funding, voluntary FP, youth engagement, donor coordination, data availability and use, etc.). This report shares details on the results of the PLA.tr-20-427-d4i
The availability of and readiness for providing long-acting contraceptives and permanent methods in BangladeshMizanur Rahman, Moinuddin Haider, Ali Ahmed, Sharad Barkataki2020English, , , , Data for Impact (D4I), an associate award of MEASURE Evaluation Phase IV, and Research for Decision Makers at icddr,b—both of which are programs funded by the United States Agency for International Development ((USAID)—conducted an analysis of data from the 2014 Bangladesh Health Facility Survey (BHFS) to explore supply-side constraints that have likely affected access and use of long-acting reversible contraceptives (LARC) and permanent methods (PM) in Bangladesh (Haider et al. 2019). The analysis of these constraints was done before the 2017 BHFS (NIPORT et al. 2019a) and therefore does not reflect information from that report that shows some increase in the availability of intrauterine devices in facilities compared to the 2014 findings (NIPORT et al 2016). Between the two reports, however, there are no notable changes in the availability at facilities of implants, tubectomy, and vasectomy and only minimal change was observed in the availability of trained staff for family planning during this time. Thus, the 2014 key findings and recommendations presented here can be taken as representative of the current scenario for LARC and PM uptake.wp-20-242-d4i
Strengthening Collection, Management, and Use of Quality Routine Data for Alternative Care in UgandaData for Impact2020English, , , , , , In Uganda, Data for Impact will build on the accomplishments of the MEASURE Evaluation project—funded by USAID—in which the team worked closely with the Ministry of Gender Labour and Social Development (MGLSD) in Uganda to support the government in assessing, addressing, and monitoring care reform. The overall goal of this activity is to strengthen the capacity of the MGLSD and its partners at national and subnational levels to collect, analyze, and use data to improve the provision of alternative care services in Uganda. This brief shares more.fs-20-509-d4i
Spatial Data Fundamentals Training MaterialsMEASURE Evaluation2010English, cl-20-044
Data Demand and Use Concepts and Tools: A Training Tool KitMEASURE Evaluation2018English, , This course aims to provide the conceptual basis for data use within an organization or program, or at the national, state, or district levels of government. Included in the course are several tools created by MEASURE Evaluation to facilitate the use of data in decision making. Specific learning objectives include: - Improving the understanding of the role of data in decision making, the context of decision making, the determinants of data use, and the importance of data sharing and feedback - Building skills for applying data demand and using tools The course is intended to be delivered to teams of individuals from the same organization or government level. Each team should include both data users and data producers.Datausersare health professionals, policymakers, and other key health decision makers who use data to inform the design, implementation, monitoring, and improvement of health programs.Data producersare professionals who acquire and analyze health data and prepare them for distribution to audiences of users. These include monitoring and evaluation (M&E) specialists, data clerks, or researchers. The team approach has proven effective because it ensures that all of those involved understand their respective roles in data demand and use, and how the roles interact with each other.cl-19-017
How Do We Know if a Program Made a Difference? A Guide to Statistical Methods for Program Impact EvaluationLance P, Guilkey D, Hattori A, Angeles G2014EnglishThis manual provides an overview of core statistical and econometric methods for program impact evaluation (and, more generally, causal modelling). More detailed and advanced than typical brief reviews of the subject, it also strives to be more approachable to a wider range of readers than the advanced theoretical literature on program impact evaluation estimators. It thus forms a bridge between more basic treatments of the essentials of impact evaluation methods and the more advanced discussions. It seeks to discuss impact evaluation estimators in a thorough manner that does justice to their complexity, but in a fashion that is approachable. The manual is targeted to: public health professionals at programs, government agencies, and NGOs who are the consumers of the information generated by program impact evaluations; professionals serving the aforementioned role in any area of programming that influences human welfare; graduate students in public health, public policy and the social sciences; technical staff at evaluation projects; journalists looking for a more nuanced understanding of the steady stream of impact (and, more broadly, causal) studies on which they are asked to report; analysts at health analytics organizations; and so on. Download STATA do files for the programs behind the numerical examples in the manual. The first number of each do file indicates its associated chapter, and the second number indicates order within the chapter. The current version of this manual is a revision posted on September 22, 2014. This manual was heavily edited before initial release, but inevitably for such a detailed, equation-intense piece, some typographical errors have been found since that time. We expect that some errors remain, and therefore anticipate periodic future revisions. We apologize for any inconvenience this causes.ms-14-87-en
Data Demand and Use: An Introduction to Concepts and ToolsNutley T, Snyder E, Judice N2012 (rev. 2015)English, , Significant human and financial resources have been invested worldwide in the collection of population, facility, and community-based data. However, this information often is not used by key stakeholders to effectively inform policy and programmatic decision making. As a result, many health programs fail to fully link evidence to decisions and suffer from a decreased ability to respond to the priority needs of the populations they serve. Many possible factors undermine evidence-based decision making. Some relate to how information flows to decision makers, and how they make their decisions; others to the context in which information is collected and decisions are made; and yet others to the organizational infrastructure and technical capacity of those that generate and use data.This course aims to provide the conceptual basis for data-informed decision making within an organization or program, or at the national, state, or district levels of government. Also included in the course are introductions to several tools created by MEASURE Evaluation to facilitate the use of data in decision making. The specific learning objective of the course is to improve the understanding of: - the role of data in decision making - the context of decision making the determinants of data use - the importance of data sharing and feedbackms-12-54
Learner’s Guide to Monitoring and Evaluation of Care Reform in ArmeniaCharyeva, Z., Ghukasyan, H., & Gheorghe, C. (MEASURE Evaluation)2020English, , , , , , , The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF) works in countries around the world to improve the safety, well-being, and development of vulnerable children, with particular attention to preserving and facilitating their access to appropriate, protective, and permanent family care. The overall goal of the USAID/DCOF-funded activity in Armenia is to strengthen the countrys leadership to advance the reform of national policies and systems for the care of children who lack adequate family care. Enhanced government capacity to assess, address, and monitor care reform is the long-term vision of USAID/DCOF, the USAID-funded MEASURE Evaluation project, and government partners in the country. To support this agenda, MEASURE Evaluation conducted a series of training sessions in monitoring and evaluation (M&E) during 2018 to 2019 for stakeholders in Armenia. The training included basic training in M&E, training on data use and demand, data quality, and data analysis. This guide serves as a reference document for participants who attended the MEASURE Evaluation training sessions. It also serves as a self-learning guide for people who do M&E work but who were unable to attend the training. It is expected that the guides users will apply key M&E concepts in their daily work. Because this is a self-learning material, there is no opportunity to discuss new concepts in a group setting or to ask questions. It is therefore suggested that users visit the MEASURE Evaluation website (https://www.measureevaluation.org/resources) for additional M&E materials.ms-20-185
Երեխաների այլընտրանքային խնամքի համակարգի հզորացում Բացահայտումներ Հայաստանից, Գանային, Ուգանդային և ՄոլդովայիցMEASURE Evaluation2018Armenian, , , , , Միացյալ Նահանգների միջազգային զարգացման գործակալության (ԱՄՆՄԶԳ) Տեղահանված և ծնողազուրկ երեխաների հիմնադրամը (DCOF) աջակցում է MEASURE Evaluation ծրագրին հզորացնելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումները մշտադիտարկելու, գնահատելու և վերհանված խնդիրներին արձագանքելու կառավարությունների կարողությունները Հայաստանում, Գանայում, Մոլդովայում և Ուգանդայում՝: 2017 թվականի վերջում և 2018 թվականի սկզբին MEASURE Evaluation ծրագիրն աջակցեցերկրն երիի հիմնական թիմերին (ԵՀԹ)` յուրաքանչյուր երկրում իրականացնելու այլընտրանքային խնամքի համակարգի բարեփոխումների մասնակցային ինքնագնահատում: Կիրառված նահատման գործիքն ի սկզբանե մշակվել էր ԱՄՆ ՄԶԳ / DCOF-ի և MEASURE Evaluation ծրագրի կողմից՝ հիմնվելով ՄԱԿ-ի երեխաների այլընտրանքային խնամքի ուղեցույցի վրա և նպատակ ուներ գնահատելու երեխաների այլընտրանքային խնամքի համակարգերը: Յուրաքանչյուր երկիր տեղայնացրել է այս գործիքը՝ հիմնվելով Լոնդոնում կայացած աշխատաժողովի ընթացքում գործիքի վերանայման քննարկումների վրա (մանրամասների համար, այցելեք՝ https://www.measureevaluation.org/resources/publications/wp-17-39): Հարյուր վաթսուն հինգ մարդ է մասնակցել չորս երկրներում կազմակերպված գնահատման աշխատաժաղովներին (Հայաստանում` 66 մասնակից, Գանայում՝ 28, Մոլդովայում` 26, Ուգանդայում `45), պետական և ոչ պետական կառույցները, հասարակական կազմակերպությունները (ՀԿ) և միջազգային և դոնոր կազմակերպությունները լայնորեն ներկայացված էին: Բոլոր երկրներում ԵՀԹ-ի անդամները աջակցում կամ վարում էին գնահատման աշխատաժողովները։ Իրականացված գնահատումների հիման վրա, MEASURE Evaluation ծրագիրը մշակել է մանրամասն զեկույցներ՝ յուրաքանչյուր երկրում երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների վերաբերյալ: Յուրաքանչյուր երկրի հետ գնահատելով երեխաների խնամքի և պաշտպանության իր համակարգը, MEASURE Evaluation ծրագիրն աջակցել է նաև տվյալ երկրում այլընտրանքային խնամքի համակարգի բարեփոխումների համար պատասխանատու նախարարությանը կազմակերպելու աշխատաժողով՝ գնահատման արդյունքների հիման վրա առաջնահերթություններ սահմանելու և գործողությունների ծրագրեր մշակելու համար: Այս զեկույցում ներկայացված են բոլոր չորս երկրների բացահայտումներն, ըստ համակարգի բաղադրիչների և խնամքի ոլորտների և ամփոփված են այլընտրանքային խնամքի համակարգերի զարգացման համար կատարված առաջարկությունները։tr-18-282-ar
ՀԱՅԱՍՏԱՆՈՒՄ ԵՐԵԽԱՆԵՐԻ ԽՆԱՄՔԻ ԵՎ ՊԱՇՏՊԱՆՈՒԹՅԱՆ ՀԱՄԱԿԱՐԳԻ ԲԱՐԵՓՈԽՈՒՄՆԵՐԻ ՄՇՏԱԴԻՏԱՐԿՈՒՄ, ԳՆԱՀԱՏՈՒՄ ԵՎ ՎԵՐՀԱՆՎԱԾ ԽՆԴԻՐՆԵՐԻՆ ԱՐՁԱԳԱՆՔՈՒՄ․ ՄԱՍՆԱԿՑԱՅԻՆ ԳՆԱՀԱՏՄԱՆ ՀԱՇՎԵՏՎՈՒԹՅՈՒՆԶուլֆիյա Չարիևա, Տեխնիկական խորհրդատու, MEASURE Evaluation/Պալադիում, Հասմիկ Ղուկասյան, ՄԳ հարցերով խորհրդատու, MEASURE Evaluation/Պալադիում Երկրի հիմնական թիմի անդամներ (MEASURE Evaluation)2018Armenian, , , , , Հայաստանում երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների գնահատման նախաձեռնությունը հիմնված է Միավորված ազգերի կազմակերպության «Երեխայի այլընտրանքային խնամքի մասին ուղեցույցի» վրա, որը նկարագրում է երեխաների պատշաճ խնամքին վերաբերող հիմնական սկզբունքներն ու ստանդարտները, որոնք ուղղված են ապահովելու, որ երեխաները մեծանան պաշտպանված միջավայրում՝ զերծ զրկանքներից, շահագործումից, վտանգներից և անապահովությունից։ Այս նպատակներին աջակցելու համար ՀՀ աշխատանքի և սոցիալական հարցերի նախարարությունը (ԱՍՀՆ) Ամերիկայի Միացյալ Նահանգների Միջազգային զարգացման գործակալության (ԱՄՆ ՄԶԳ) «Տեղահանված և ծնողազուրկ երեխաների հիմնադրամի» (DCOF) և “MEASURE Evaluation» ծրագրի ֆինանսավորմամբ և մասնագիտական աջակցությամբ իրականացրեց երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների մասնակցային ինքնագնահատում՝ հիմնական շահագրգիռ կողմերի հետ աշխատաժողովի միջոցով, որը տեղի ունեցավ Հայաստանում 2018 թվականի հունվարի 17-ից-19-ը, Ծաղկաձորի «Ռոսիա» հյուրանոցում։ Գնահատման աշխատաժողովի նպատակն էր մեկտեղել երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումներում ներգրավված հիմնական դերակատարներին, այդ թվում՝ որոշում կայացնողներին, քաղաքականություն մշակողներին, ծառայություն մատուցողներին, քաղաքացիական հասարակության ներկայացուցիչներին և դոնորներին՝ գնահատելու և հայտնաբերելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների այն ուղղությունները, որոնք պահանջում են հրատապ միջամտություն և գործողություններ։ Գնահատման արդյունքները կնպաստեն բարելավելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների իրականացումը՝ կառավարության ստանձնած միջազգային պարտավորություններին և ՀՀ երեխայի իրավունքների պաշտպանության 2017-2021թթ․ ազգային ռազմավարության ու միջոցառումների ծրագրին համահունչ։ Գնահատման աշխատաժողովի հիմնական արդյունքներն ամփոփվել են ըստ խնամքի ոլորտների, հետևելով քննարկումների տրամաբանությանը, իսկ առաջարկությունների ցանկը տրամադրվել է ըստ համակարգի բաղադրիչների, ինչը թույլ կտա արագ հայտնաբերել խնամքի բոլոր ոլորտների համար անհապաղ ուշադրություն պահանջող ընդհանուր հարցերը։tr-18-268-ar
Assessing Alternative Care for Children in ArmeniaZulfiya Charyeva, Hasmik Ghukasyan, Armenia country core team (MEASURE Evaluation)2018English, , , , , Armenias care reform initiative is based on the United Nations Guidelines for Alternative Care of Children (hereinafter referred to as the UN Guidelines), which outlines specific principles and standards for the appropriate care of children to ensure that they grow up in a protective environment, free from deprivation, exploitation, danger, and insecurity. To support this agenda, the Ministry of Labor and Social Affairs (MOLSA), with funding and technical assistance from the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) and MEASURE Evaluation, conducted a self-assessment of the care reform system at a participatory stakeholder workshop held January 1719, 2018, at the Tsakhkadzor Hotel Russia, in Armenia. The purpose of the assessment workshop was to bring together key stakeholdersdecision makers, policy developers, service providers, civil society representatives, and donorsto assess and identify the main care reform areas in which action is needed. The assessment results aim to provide information to improve the implementation of care reform in line with the governments international commitments and the National Strategy and Action Plan on Child Rights Protection in the Republic of Armenia for 20172021. The main findings of the assessment workshop are summarized by area of care, following the logic of the discussions. We also summarize findings by system components, followed by a summary of recommendations organized in the same way, to allow for the rapid identification of common issues for all areas of care that require immediate attention.tr-18-268
Evaluarea ngrijirii Alternative a Copilului n Moldova: Raport de Evaluare (Volumul 2)Molly Cannon, Camelia Gheorghe, Echipa-Nucleu de ar Moldova (MEASURE Evaluation)2018Romanian, , , , , ,

n anul 2017, Fondul pentru Copii Separai de Familie i Copii Orfani (DCOF) al Ageniei Statelor Unite pentru Dezvoltare Internaional (USAID) a angajat echipa proiectului MEASURE Evaluation, finanat de USAID, pentru a sprijini eforturile naionale de abordare a problematicii copiilor lipsii de ngrijire printeasc n Moldova. Cu sprijinul MEASURE Evaluation, Ministerul Sntii, Muncii i Proteciei Sociale (MSMPSP) a desfurat o auto-evaluare participativ a sistemului naional de ngrijire alternativ a copilului. Mai exact, evaluarea a examinat stadiul n care se afl Moldova n ce privete implementarea Liniilor Directoare ONU pentru ngrijirea Alternativ a Copiilor. Scopul atelierului de evaluare a fost s informeze procesul de planificare a aciunilor necesare pentru abordarea nevoilor din domeniul ngrijirii alternative a copiilor.

Acest raport de evaluare conine dou volume. Volumul 1 prezint o vedere de ansamblu asupra instrumentului de evaluare i metodelor utilizate, precum i constatrile principale ale evalurii pe domenii de ngrijire i componente de sistem. De asemenea, acest volum include i un rezumat al recomandrilor rezultate din evaluare. Volumul 2 prezint instrumentul de evaluare, glosarul termenilor utilizai, recomandri detaliate i referine bibliografice. n plus, volumul include o prezentare a componenei Echipei-Nucleu de ar (EN) i lista participanilor la atelierul de evaluare.

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Assessing Alternative Care for Children in Moldova: Appendixes (Volume 2)Molly Cannon, Camelia Gheorghe, Moldova country core team (MEASURE Evaluation)2018English, , , , , In 2017, the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) engaged the USAID-funded MEASURE Evaluation to build on and reinforce progress in advancing national efforts on behalf of children who lack adequate family-based care in Moldova. With the support of MEASURE Evaluation, the Ministry of Health, Labour and Social Protection (MOHLSP) conducted a participatory self-assessment of the national alternative care system. Specifically, the assessment measured Moldovas status on implementation of the United Nations Guidelines for Alternative Care of Children. The purpose of the assessment workshop was to inform action planning to address priority needs identified in alternative care for children. This Volume 2 of the report presents the assessment tool and responses, a glossary of key terms, detailed recommendations, and a list of references. It also presents the country core team (CCT) membership and the assessment workshop participants.Volume 1, available here, provides an overview of the assessment tool and methods used for conducting the assessment and presents the key findings of the assessment, by alternative care areas and system components. It also includes a summary of recommendations.tr-18-262b
Evaluarea ngrijirii Alternative a Copilului n Moldova: Raport de Evaluare (Volumul 1)Molly Cannon, Camelia Gheorghe, Echipa Nucleu de ar Moldova (MEASURE Evaluation)2018Romanian, , , , , ,

n anul 2017, Fondul pentru Copii Separai de Familie i Copii Orfani (DCOF) al Ageniei Statelor Unite pentru Dezvoltare Internaional (USAID) a angajat echipa proiectului MEASURE Evaluation, finanat de USAID, pentru a sprijini eforturile naionale de abordare a problematicii copiilor lipsii de ngrijire printeasc n Moldova. Cu sprijinul MEASURE Evaluation, Ministerul Sntii, Muncii i Proteciei Sociale (MSMPSP) a desfurat o auto-evaluare participativ a sistemului naional de ngrijire alternativ a copilului. Mai exact, evaluarea a examinat stadiul n care se afl Moldova n ce privete implementarea Liniilor Directoare ONU pentru ngrijirea Alternativ a Copiilor. Scopul atelierului de evaluare a fost s informeze procesul de planificare a aciunilor necesare pentru abordarea nevoilor din domeniul ngrijirii alternative a copiilor.

Acest raport de evaluare conine dou volume. Volumul 1 prezint o vedere de ansamblu asupra instrumentului de evaluare i metodelor utilizate, precum i constatrile principale ale evalurii pe domenii de ngrijire i componente de sistem. De asemenea, acest volum include i un rezumat al recomandrilor rezultate din evaluare. Volumul 2 prezint instrumentul de evaluare, glosarul termenilor utilizai, recomandri detaliate i referine bibliografice. n plus, volumul include o prezentare a componenei Echipei-Nucleu de ar (EN) i lista participanilor la atelierul de evaluare.

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Assessing Alternative Care for Children in Moldova: Assessment Report (Volume 1)Molly Cannon, Camelia Gheorghe, Moldova country core team (MEASURE Evaluation)2018English, , , , , In 2017, the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) engaged the USAID-funded MEASURE Evaluation to build on and reinforce progress in advancing national efforts on behalf of children who lack adequate family-based care in Moldova. With the support of MEASURE Evaluation, the Ministry of Health, Labour and Social Protection (MOHLSP) conducted a participatory self-assessment of the national alternative care system. Specifically, the assessment measured Moldovas status on implementation of the United Nations Guidelines for Alternative Care of Children. The purpose of the assessment workshop was to inform action planning to address priority needs identified in alternative care for children. This Volume 1 of the report provides an overview of the assessment tool and methods used for conducting the assessment and presents the key findings of the assessment, by alternative care areas and system components. It also includes a summary of recommendations. Volume 2, available here, presents the assessment tool and responses, a glossary of key terms, detailed recommendations, and a list of references. It also presents the country core team (CCT) membership and the assessment workshop participants.tr-18-262a
Assessing Alternative Care for Children in GhanaMari Hickman, Bashiru Adams, Ghana country core team (MEASURE Evaluation)2018English, , , , , Ghanas care reform initiative is based on the United Nations Guidelines for the Alternative Care of Children (hereinafter called UN guidelines; United Nations, 2012), which outlines specific principles and standards for the appropriate care of children, to ensure that they grow in a protective environment, free from deprivation, exploitation, danger, and insecurity. In November 2017, the DSW, under the MOGCSP, with funding and technical assistance from USAIDs DCOF and MEASURE Evaluation, conducted a self-assessment of the care reform system through a participatory stakeholders workshop that took place from November 1417, 2017, at the Sunset Hotel in Kumasi, Ghana. The assessment workshop aimed to strengthen the capacity of government partners to accomplish the following specific objectives:
  • Provide leadership in implementing a structured assessment of national care reform systems and strategies using a standardized framework/tool.
  • Identify gaps and continuing needs in care reform.
  • Develop plans to address priority needs in care reform.
The report presented here provides detailed findings from the assessment, based on analysis, and specific recommendations and actions to be taken by the government and partners based on the findings.		tr-18-251
Assessing Alternative Care for Children in UgandaIsmael Ddumba-Nyanzi, Michelle Li, Uganda country core team (MEASURE Evaluation)2018English, , , , , , Ugandas alternative care system for children is based on the United Nations Guidelines for Alternative Care of Children, which outline principles and standards for appropriate care of children, to ensure that they grow in a protective environment, free from deprivation, exploitation, danger, and insecurity. To support this agenda, Uganda's Ministry of Gender, Labor and Social Development, with funding and technical assistance from USAIDsDisplaced Children and Orphans Fund and MEASURE Evaluation, conducted a self-assessment of the alternative care system for children through a participatory stakeholder workshop, held November 2730, 2017, at the Imperial Royale Hotel in Kampala, Uganda. The assessment workshop aimed to strengthen the capacities of government partners to accomplish the following objectives:
  • Provide leadership in implementing a structured assessment of the national alternative care system for children and strategies using a standardized framework and tool
  • Identify gaps and continuing needs in alternative care for children
  • Develop plans to address high-priority needs in alternative care for children
This report provides detailed findings from the assessment, based on analysis, as well as specific recommendations and actions taken by government and partners based on the findings.		tr-18-250
Երեխաների այլընտրանքային խնամք Ամսագիր Նոյեմբեր, 2018թMEASURE Evaluation2018Armenian, , , , , Ձեր ուշադրությանն ենք ներկայացնում «Երեխաների այլընտրանքային խնամք» ամսագրի 2-րդ համարը։ Այնտեղ կգտնեք թարմ տեղեկություններ այլընտրանքային խնամքի համակարգի բարեփոխումների վերաբերյալ Հայաստանում, Գանայում, Մոլդովայում և Ուգանդայում անցկացված գնահատման աշխատաժողովներին հաջորդած վեցամսյա ժամանակահատվածի մասին։ «Երեխաների այլընտրանքային խնամք» ամսագիրը ծառայում է որպես երկրների միջև շփումն ու գիտելիքի փոխանակումը խթանող օգտակար գործիք։ Այդ աշխատանքները լուսաբանող վեբ հարթակում կան ձեր երկիրը երկայացնող էջեր։ Այցելելու համար օգտվե՛ք՝ www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care.fs-18-316-ar
An Assessment of the Prerequisites for a Social Welfare Information Management System in GhanaOtieno, P., Mutwiri, J., & Antwi-Boasiako, E. W. (MEASURE Evaluation)2020English, , , , , , Since 2017, through financial support from the USAID Displaced Children and Orphans Fund, the MEASURE Evaluation project has collaborated with the Republic of Ghanas Department of Social Welfare (DSW), USAID/Ghana, and UNICEF to assess, address, and monitor alternative care of children in Ghana in line with the United Nations Guidelines for the Alternative Care of Children, which serves to enhance the implementation of the United Nations Convention on the Rights of the Child. In 2018, Ghanas MOGCSP, with support from UNICEF, developed a concept note for an information system that would capture data for child protection and social welfare services. This system aims to strengthen the coordinated delivery of social services across the areas of social protection, community development, gender-based violence, justice for children, child protection, education, and health. Alternative care will be included in the system, with the plan to eventually provide access to RHCs. The SWIMS will adopt an open-source case management software, developed by UNICEF headquarters, called Protection Related Information Management System, or Primero. This online platform is designed to be adapted to the country-specific context and can be configured to the specific system of child welfare services in Ghana. To support preparations for the SWIMS deployment, MEASURE Evaluation gathered information for some of the requirements for the rollout of a national Ghana SWIMS. This report presents our findings.tr-20-396
Tool for Assessing and Monitoring National Alternative Care SystemsMEASURE Evaluation2019English, , , , Ensuring children grow up in protective family care, free from deprivation, exploitation, and danger is a priority for many countries. Significant improvements have been made in government systems and policies related to the well-being and development of vulnerable children, with particular attention to preserving and facilitating children's access to appropriate, protective, and permanent family care. The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF), along with several other stakeholders, invest in strengthening government systems to ensure family-based care for children around the world. MEASURE Evaluation, with support from USAID/DCOF, developed this tool to support countries as they assess, address, and monitor national care system reform. This tool applies the United Nations (UN) Guidelines for the Alternative Care of Children. The structure of the tool follows a framework that covers key areas of caring for children outside of family care: foster care, residential care, supervised independent living, kinship care, other forms of informal care, adoption, and family reunification and system deinstitutionalization. This tool also has questions related to preventing unnecessary child-family separation, which is a critical component of keeping children in family-based care. The tool applies a system strengthening framework. We present system components that are commonly agreed upon to be critical to sustainably and effectively strengthening national systems.tl-19-25
Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services – An Examination of 13 Projects in PEPFAR-Supported CountriesGage A, Do M, and Grant D (MEASURE Evaluation)2017English, , , , , Adolescents (ages 10–19) and youth (ages 15–24) bear a disproportionate share of the HIV burden, especially in sub-Saharan Africa. However, little is known about what projects are doing to make their interventions adolescent- and youth-friendly and what interventions are effective for changing HIV-related outcomes for these age groups. Program managers and policymakers have little rigorous evidence on how best to invest resources to achieve 90-90-90 targets among adolescents and young people. Recognizing this evidence gap, MEASURE Evaluation—funded by the U.S. Agency for International Development (USAID)—reviewed the evidence on adolescent- and youth-friendly HIV services as a contribution to the goal of an AIDS-free generation that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is pursuing. This review had three objectives: (1) document knowledge of what is working and what is not working in terms of delivering adolescent- and youth-friendly HIV services, and why strategies and program activities work or do not work; (2) identify useful lessons learned about key elements of successful adolescent- and youth-friendly HIV services; and (3) promote the use and adaptation of best practices for adolescent- and youth-friendly HIV services in order to improve the quality of HIV services delivered to young people and to attract adolescents and youth to retain them in those services. The 13 projects covered in the compendium are those we received permission to summarize. A review group graded the projects using well-established criteria. These criteria were adolescent and youth involvement, relevance, effectiveness/impact, reach, feasibility, sustainability, replicability or transferability, ethical soundness, and efficiency. Seven best practices, four promising practices, and two emerging practices were identified, of which five provided strong evidence needed to recommend priorities for action. “Best Practices for Adolescent- and Youth-Friendly HIV Services: A Compendium of Selected Projects in PEPFAR-Supported Countries” reflects the results from a call for best-practices proposals and an examination of peer-reviewed and gray literature in 22 PEPFAR-supported countries. These guidelines are a companion to that document.sr-16-134
Evaluation of a School-Based Sexuality and HIV-Prevention Activity in South Africa: Midline Qualitative ReportMkhwanazi, N., Mandal, M., Biehl, H., & Durno, D. (MEASURE Evaluation)2019English, , , , , , With support from the United States Agency for International Development (USAID) and in partnership with the South African National Department of Basic Education (DBE), the MEASURE Evaluation project is conducting an impact evaluation of the implementation of scripted lesson plans (SLPs) and supporting activities that were developed to increase the rigor and uniformity of a life skills program for in-school youth. The evaluation’s nested qualitative study explores the perceptions and acceptance of, and the comfort with the sexuality and HIV prevention education activity; and identifies the structural facilitators and barriers that affect the implementation of the activity at multiple levels. The evaluation’s qualitative component was implemented in six schools across three districts. Qualitative data were collected from male and female learners in Grade 10 and from the parents/guardians of learners, Life Orientation (LO) educators, members of school governing bodies, and members of school management teams. More learners in intervention schools than in control schools showed high interest in sexuality education. Learners in intervention schools could recall specific lessons compared with those in control schools, although respondents had limited ability to specify how they applied the knowledge gained to their own lives. Parents were generally comfortable knowing that their children were learning about sexuality and about HIV and pregnancy prevention in schools, but were not familiar with the content. LO educators in control schools said that they were not comfortable teaching the sexuality education part of the LO curriculum, but also reported that they found the LO guide useful. By contrast, LO educators in intervention schools reported that they did not find the LO guide helpful.tre-19-017
A Practical Guide to Using Routine Data in EvaluationEva Silvestre (MEASURE Evaluation)2020English, , , , , , , , This guidance document presents a summary of 13 related technical briefs, including topics such as why routine data was used, what worked well, the main challenges, and guidance based on what was learned. The resource was prepared to provide guidance to future evaluators and researchers who are considering using routine data in their projects.tr-20-242-d4i
Child Protection Case Management Information Systems: Promoting Appropriate Care for Children: A Framework for EngagementMolly Cannon, Stuardo Herrera, Patricia Mechael (MEASURE Evaluation)2020English, , , , , , , , , , , , , Data for Impact revised this document in October 2022. In March 2017 USAID, through its Displaced Children and Orphans Fund (DCOF), engaged the USAID-funded MEASURE Evaluation (MEval) project to reinforce and build on U.S. government programming on childcare and protection in Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes. Successful implementation of child protection and social welfare services depends on the availability and effective use of relevant child protection and social welfare data. With countries’ and programs’ increased interest in advancing digital solutions for case management of children at risk, USAID DCOF asked MEval to convene experts from December 4–6, 2019, at Palladium’s office in Washington, D.C. to inform the development of a framework for case management information systems (CMIS) centered on child protection and care. The main purpose of the Information Systems Framework for the Case Management of Child Protection and Care (hereafter, the framework) is to consolidate lessons learned from those who have developed, implemented, and used such systems and agree upon best practices when approaching the design and strengthening of such systems. This document is written from the perspective of supporting government-led and owned systems, but it recognizes that nongovernmental organizations (NGOs) may have other systems that feed into those government systems or operate independently for their programming purposes. S recommendations so ply to The framework is a product of a participatory design workshop involving 25 women and 17 men from USAID DCOF and the Office of HIV/AIDS, UNICEF headquarters and field offices, case management experts, monitoring and evaluation (M&E) experts, and digital solution experts. Armenia, Cambodia, Ghana, Guatemala, Kenya, Moldova, Romania, Uganda, and the United States were represented.ms-20-186
Strengthening Collection, Management and Use of Quality Routine Data for the Provision of Child Protection and Care in ArmeniaData for Impact2020English, , , , , , , , , , , The overall goal of the Data for Impact project in Armenia is to support the Government of Armenia. Agencies involved are the Ministry of Labour and Social Affairs (MOLSA), the Ministry of Education, Science, Culture and Sports (MOESCS), and the Ministry of Territorial Administration and Infrastructure (MOTAI). The goal is to strengthen collection, management, and use of quality routine data to support effective case management, thus improving the provision of child protection and care. This brief shares more.fs-20-507-d4i
Advances in Solutions for Data QualityJim Thomas, David Boone2018English, For data to be useful to improve health outcomes, they must be trusted by data users and program planners. The first page of this brief presents a picture of the global context of data quality—past, present, and future. The second page offers links to data quality resources. The infographic begins with the global goal for data quality. It then outlines the data quality situation in 2013; moves into the next five years, with a list of strategic approaches and progress made (“2014–2018 Advances”); and ends with recommendations of areas on which global players should focus to improve data quality (“Next”). The resources on the second page are categorized by human resources, data use, gender, geospatial data, data quality assessment, digital data, and scale.gr-18-52
Support Clubs for Children and Youth in Haiti Living with HIV: Technical Brief on a Case StudyData for Impact2020English, , , , , , , , This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects. Data for Impact (D4I) has compiled these examples from its own work and the work of others found through a literature review—and consultation with the original authors—to compare ways routine data can be appropriate for evaluations and to shed light on its benefits and shortcomings for evaluation. This report details how routine data were used to evaluate a program to retain children and youth in HIV treatment and care in Haiti.fs-20-506-d4i
Assessing Healthcare Quality Using Routine Data: Evaluating the Performance of the National Tuberculosis Program in South AfricaData for Impact2020English, , , , , , , , This brief discusses the value of routine facility data on treatment for tuberculosis in assessing quality of care in South Africa and for informing policy considerations. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-503-d4i
Impact of a District-Wide Health Center Strengthening Intervention on Healthcare Utilization in Rural Rwanda: Use of Interrupted Time Series AnalysisData for Impact2020English, , , , , , , , This brief describes an evaluation of an intervention to assess the effectiveness of a health system strengthening initiative that sought to increase utilization of healthcare services in Rwanda. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-504-d4i
Evaluating the Impact of Malaria Interventions in Zanzibar, 2000–2015: Report Prepared for the U.S. President’s Malaria InitiativeData for Impact2020English, , , , , , , , This brief outlines an approach used to evaluate malaria programs to transition from malaria control to malaria intervention in Zanzibar. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-500-d4i
Brief on Strengthening Tuberculosis Control in Ukraine: Evaluation of the Impact of the TB-HIV Integration Strategy on Treatment OutcomesData for Impact2020English, , , , , , , , The brief describes the effects of a program to integrate HIV care with care for patients co-infected with tuberculosis (TB) in Ukraine. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-494-d4i
Quality of Care, Risk Management, and Technology in Obstetrics to Reduce Hospital-based Maternal Mortality in Senegal and Mali (QUARITE): A Cluster Randomized TrialData for Impact2020English, , , , , , , , This brief describes an evaluation of a trial program to train providers in emergency obstetrics and perinatal care as part of an effort to reduce maternal mortality in Mali. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-495-d4i
Assessment of the 2017 National Campaign for the Promotion of Family Planning in MaliData for Impact2020English, , , , , , , , MEASURE Evaluation was contracted by USAID/Mali to conduct an evaluation of the 2016 national campaign and, a year later, to evaluate if the 2017 campaign had applied the recommendations of the earlier study. This brief shares more. This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects.fs-20-491-d4i
Improving Maternal and Child Health Outcomes in Kenya: Impact of the Free Maternity Service Policy on Healthcare Use and Lives SavedData for Impact2020English, , , , , , , , This document is part of a series that describes how routine data were used in research and evaluations of health programs and projects. Data for Impact (D4I) has compiled these examples from its own work and the work of others found through a literature review—and consultation with the original authors—to compare ways routine data can be appropriate for evaluations and to shed light on its benefits and shortcomings for evaluation. This brief focuses on a study that aimed to assess the effect of Kenya’s Free Maternity Service Policy on maternal healthcare use and maternal and newborn health outcomes.