PMID- 28981663
OWN - NLM
STAT- MEDLINE
DCOM- 20180522
LR  - 20181202
IS  - 1460-2237 (Electronic)
IS  - 0268-1080 (Print)
IS  - 0268-1080 (Linking)
VI  - 32
IP  - 9
DP  - 2017 Nov 1
TI  - Institutionalizing and sustaining social change in health systems: the case of 
      Uganda.
PG  - 1248-1255
LID - 10.1093/heapol/czx066 [doi]
AB  - The key to high impact health services is institutionalizing and sustaining 
      programme evaluation. Uganda represents a success story in the use of a specific 
      programme evaluation method: Lot Quality Assurance Sampling (LQAS). 
      Institutionalization is defined by two C's: competent programme evaluators and 
      control mechanisms that effectively use evaluation data to improve health 
      services. Sustainability means continued training and funding for the evaluation 
      approach. Social science literature that researches institutionalization has 
      emphasized 'stability', whereas in global health, the issue is determining how to 
      improve the impact of services by 'changing' programmes. In Uganda, we measured 
      the extent of the institutionalization and sustainability of evaluating 
      programmes that produce change in nine districts sampled to represent three 
      largely rural regions and varying levels of effective health programmes. We used 
      the proportion of mothers with children aged 0-11 months who delivered in a 
      health facility as the principal indicator to measure programme effectiveness. 
      Interviews and focus groups were conducted among directors, evaluation 
      supervisors, data collectors in the district health offices, and informant 
      interviews conducted individually at the central government level. Seven of the 
      nine districts demonstrated a high level of institutionalization of evaluation. 
      The two others had only conducted one round of programme evaluation. When we 
      control for the availability of health facilities, we find that the degree of 
      institutionalization is moderately related to the prevalence of the delivery of a 
      baby in a health facility. Evaluation was institutionalized at the central 
      government level. Sustainability existed at both levels. Several measures 
      indicate that lessons from the nine district case studies may be relevant to the 
      74 districts that had at least two rounds of programme evaluation. We note that 
      there is an association between the evaluation data being used to change health 
      services, and the four separate indicators being used to measure women's health 
      and child survival services. We conclude that the two C's (competent evaluators 
      and control mechanisms) have been critical for sustaining programme evaluation in 
      Uganda.
CI  - (c) The Author 2017. Published by Oxford University Press in association with The 
      London School of Hygiene and Tropical Medicine.
FAU - Hage, Jerald
AU  - Hage J
AD  - Center for Innovation, University of Maryland, College Park, MD 20742, USA.
FAU - Valadez, Joseph J
AU  - Valadez JJ
AD  - Department of International Health, Liverpool School of Tropical Medicine, 
      Pembroke Place, Liverpool, L3 5QA, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Health Policy Plan
JT  - Health policy and planning
JID - 8610614
MH  - Adult
MH  - Delivery, Obstetric/statistics & numerical data
MH  - Federal Government
MH  - Female
MH  - Health Facilities/statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Local Government
MH  - Lot Quality Assurance Sampling/*statistics & numerical data
MH  - Program Evaluation/methods/*statistics & numerical data
MH  - Rural Health
MH  - *Social Change
MH  - Surveys and Questionnaires
MH  - Uganda
PMC - PMC5886222
OTO - NOTNLM
OT  - Community health
OT  - Uganda
OT  - health systems
OT  - institutionalization
OT  - learning
OT  - lot quality assurance sampling
OT  - maternal and child health sustainability
OT  - programme evaluation
OT  - sub-Saharan Africa
EDAT- 2017/10/06 06:00
MHDA- 2018/05/23 06:00
PMCR- 2017/07/19
CRDT- 2017/10/06 06:00
PHST- 2017/05/11 00:00 [accepted]
PHST- 2017/10/06 06:00 [entrez]
PHST- 2017/10/06 06:00 [pubmed]
PHST- 2018/05/23 06:00 [medline]
PHST- 2017/07/19 00:00 [pmc-release]
AID - 3979571 [pii]
AID - czx066 [pii]
AID - 10.1093/heapol/czx066 [doi]
PST - ppublish
SO  - Health Policy Plan. 2017 Nov 1;32(9):1248-1255. doi: 10.1093/heapol/czx066.