The last frontier in Global Health Partnerships: still to be conquered.

The last frontier in Global
Health Partnerships: still
to be conquered.
Rachel Thibeault
Occupational Therapy Program
Faculty of Health Sciences
University of Ottawa
Before naming the frontier, a brief
history of Global Health.
In the 60s, 70s, and 80s, Global Health
partnerships were nearly non-existent.
We responded to trade imperatives.
Massey-Ferguson tractors in the Sahara
Soviet snowplows in Bamako.
We lost face, so we moved on.
In the late 80s, still no true partnership: top
down approaches dictated to the Global
South by the North.
We often targeted the wrong populations.
And tackled the wrong issues.
Cerebral palsy as a CIDA priority in Burkina
Faso.
We moved along.
In the 90s, we got some of the right
populations.
But still went at it the wrong way.
AIDS and the World Bank and IMF.
We got to a critical junction.
In the 2000s, we started asking radical
questions:
Should we consult the target populations as to
their needs and wants?
They are in no way experts, but could they
have something to bring to the table?
The timid rise of Participatory Action Research
(PAR) in Global Health.
Participatory Action Research
PAR practitioners make a concerted effort to
integrate three basic aspects of their work:
participation (life in society and democracy),
action (engagement with experience and
history), and research (soundness in thought
and the growth of knowledge) (Chevalier
and Buckles, 2013).
SAS2 (Social Analysis Systems-2)
Tools for community
consultation,
mobilization, program
planning and monitoring
that allow the handling of
complex situations,
promote social change,
empowerment and
sustainability.
Gradually, often reluctantly, target
populations are given a voice in
the needs assessment.
Why is it important?
So the interventions fit and stick.
We have made significant gains
that must be celebrated.
But we also need to go further.
He who controls the data collection
controls the community’s future.
The last frontier in a true Global Health
partnership is the sharing of power in the
Monitoring, Evaluation and Learning (MEL)
process, currently the exclusive domain of
the funder or researcher.
What would a true partnership look
like?
Empowering ( Empowerment Evaluation by
Fetterman & Wandersman, 2005)
 Capacity building & organizational learning
 Community ownership & democratic participation
 Community knowledge & locally designed
evidence-based strategies
What would a true partnership look
like?
Transformative - transformative evaluation
(Mertens, 2009)
 Inclusion and diversity
 Mixed methods
What would a true partnership look
like?
Utilization-focused evaluation (Patton, 2012)
 Involving primary intended users – the community
monitors its own progress.
 Fostering use of evaluation process and findings.
Theory-driven evaluations (Chen, 2005)
 Making the implicit explicit
 Situating the evaluation within a comprehensive logic
model.
Looks complicated?
Not rocket science.
Annex 2 – Gradual Growth Evaluation Matrix - Example drawn from the Pre-School pilot study
Gradual Growth Evaluation Matrix
(Thibeault & MacDonald, 2012)
Engagement
Indicators
Process
Indicators
Outcome
Indicators
Result
Indicators
Children
rush to the bus in the
morning - qualitative
know sufficiently well what
homework they have to do
- level of comfort - scale
have fun, engage more
(attention span - duration)
encourage other
children to join
(number)
Parents
spend time with homework
respectful p-t.
communicationperception
observable new learning
e.g. counting
children teach
siblings/parents
(number)
Educators
come to work earlier
exact knowledge of
expectations – level of
comfort - scale
children get better marks
in their class
better morale for
educators (scale)
Managers
provide more staff support
timely, accurate reports
from staff
children make Grade R
(number)
more parents wanting
POP for their children
(number)
Funders
X-year commitment
regular progress reports
from agency highlighting
rates of children’s progress
- outcome indicators
number of children who
complete primary
education
number of children
taking part in
provincial/national
events (sports
competitions…)
Who’s resisting the trend?
WHO
Governments
Academic researchers
narrow interpretation by Ethics Review
Boards of the Tri-Council Policy Statement
on Ethical Conduct for Research Involving
Humans
In the end, using these tools or
others is not what matters.
‘Nothing about us without us.’
References
CDC. (1999). Framework for program evaluation in public health.
MMWR, 48(11), 1-35.
Chen, H.T. (2005). Practical program evaluation: Assessing and
improving planning, implementation, and effectiveness.
Thousand Oaks: SAGE Publications.
Fetterman, D.M., & Wandersman, A. (2005). Empowerment
evaluation principles in practice. Eds. New York: Guilford Press.
Grandisson, M., Hébert, M., Thibeault, R. (2012, Submitted). A
systematic review on how to conduct evaluations in communitybased rehabilitation.
Green, L.W. & Kreuter, M.W. (2005). Health Program Planning: An
Educational and Ecological Approach. 4th edition. NY: McGrawHill Higher Education.
ILO, UNESCO, & WHO. (2004). CBR Matrix. Retrieved 2011/02/11
from: http://www.who.int/disabilities/cbr/cbr_matrix_11.10.pdf
Mertens, D.M. (2009).Transformative research and evaluation (1st
ed.). New York: Guilford Press.
Patton, M.Q. (2012) Essentials of utilization-focused evaluation.
Thousand Oaks: SAGE Publications.
Rossi, P.H., Lipsey, M.W., & Freeman, H.E. (2004). Evaluation: A
systematic approach (7th ed.). Thousand Oaks: SAGE
Publications.
WHO, ILO, UNESCO, IDDC (2010). Community-based
rehabilitation (CBR) Guidelines. WHO Press, Geneva. Retrieved
September 25th, 2012 from URL:
http://www.who.int/disabilities/cbr/guidelines/en/index.html