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Framework for evaluation of RDT interventions: ACT consortium

Description

ACT Consortium experiences with public health evaluation and involvement in assessing the implementation of rapid diagnostic tests (RDTs).

Category: Useful Resources

Sub Category: Method Guidance

Author: Clare Chandler, Rachel Hall-Clifford, Shunmay Yeung

Published Date: 29 November 2009

Description

 [Français / Português]

This document is a work-in-progress that arose as a result of the recognition of the need for a comprehensive framework in which to frame activities planned within the ACT Consortium as well as in the greater global health community, particularly with regards to the implementation of RDTs. 

The development of this evaluation framework built on our own experiences with public health evaluation and involvement in assessing the implementation of RDTs as well as building upon established theory in intervention evaluation.  We began formation of the framework with the specific aim of designing robust evaluations for ACT Consortium projects.  Our goal was for the evaluations across these projects to both include the same key measurements while also recognizing the important impact that contextual and other project-specific factors have on intervention outcomes. 

Since we began developing the framework, it became clear that its use could be wider than the ACT Consortium, and our aim is to contribute to the design of operational research of RDT implementation and evaluation of national-level implementation of RDTs in public and/or private sectors.  Through its use, we hope the framework can be refined and built upon. We welcome ongoing feedback and revisions to this initial framework.

The theoretical basis of the framework builds on the strong existing literature on intervention evaluation.  We incorporate the widely used components of process, context and outcome evaluation, including proximal as well as more distal impacts on RDT and ACT use.  (Please see the reference list at the end of the document for a selection of free-access evaluation literature).

The framework consists of four evaluation components: process evaluation, proximal outcome evaluation, distal outcome evaluation and context evaluation. Through these four components, we attempt to capture factors feeding into and out of the implementation of RDTs in the public and/or private sectors.

We have tried to capture and categorise the processes leading to RDT implementation from the inception and funding to training and information, education and communication about RDTs.

We then break down the immediate, proximate, outcomes of RDT use by providers, including ACT use and perceptions of careseekers and providers around specific treatment seeking episodes.

Next, we move to broader, distal, outcomes of RDT use. Here, we include the impact on the individual illness episode and aggregate measures of mortality, morbidity and cost impacts as well as wider impacts on the behaviour of community members, providers, and on the private sector and public health system at large.

Finally, we include the analysis of the context of RDT implementation in a specific setting.

In order to gain a comprehensive insight into RDT implementation, we recommend all four components of the evaluation framework are conducted. Given resource constraints, we have attempted to identify where variables are already being measured in current or potential new routine data sources, such as registers feeding into health management information systems, supervisory checklists, provider surveys (such as ACT Watch’s outlet surveys and supply chain analyses), demographic and health surveillance surveys and malaria indicator surveys. We also identify methods for the assessment of domains not covered by existing data sources that could be undertaken as operational research activities.

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