Jennifer Bryce et al in International Health 3 (2011) 139– 146

Reviewed by David Hercot

Bryce et al are sharing with the scientific community the progress of their efforts to improve the way scaling up of MNCH interventions and programmes are evaluated. Their aim is to broaden the scope of evaluation to include aspects of the process, the inputs, the context, the policy environment and the equity of the programmes beyond more classical outputs and outcomes usually accounted for in impact evaluation like immunization coverage. This reflection is already accounted for in the 2010 report of the initiative (Bhutta et al. 2010). It is a welcome move in global health evaluation to pay more attention to what makes a programme work or not beyond the mere estimation of (epidemiological) impact. They propose an interesting development of the Tanahashi model by including policy and planning on one end and cost effectiveness to the other end of the determinants initially proposed by Tanahashi ( 1978).

The other framework they propose does not add much to the model van Olmen et al. Have developed ( 2010). We look forward to more discussion on this and to research using these frameworks. As Peters ad colleagues mention in another recent papers, the number of frameworks proposed by scientist facing shortages of methods used up to now to assess what we could call the processes of the health system at large is flourishing (Paina and Peters 2011;Svoronos and Mate 2011). What we need is now to apply them or a mix of them in our research and evaluation practice to test their validity. We already have made some steps forward using other methods (Boussery et al. 2011;Hercot et al. 2011).

In our view, the financial protection of the users as a final outcome of the health system is a missing element of the proposed framework (see eg Roberts et al. 2008;Van Olmen et al. 2010). We understand that in programme evaluation of services that are supposedly free of charge like Mother and Child health Programmes in West Africa (Bryce et al. 2010) this is not of a major but when studying larger programmes or looking more at the private sector like they rightly suggest, the excessive reliance on out of pocket payment is a burden on households that will hinder their health seeking behavior and their development at large(Meessen et al. 2003).


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