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Maria Carolina Alban Conto, Spogmai Akseer, Thomas Dreesen, Akito Kamei, Suguru Mizunoya, Annika Rigole
Jennifer Waidler, Franziska Gassmann, Bruno Martorano
Amber Peterman, Amiya Bhatia, Alessandra Guedes, Camilla Fabbri, Ilan Cerna-Turoff, Ellen Turner, Michelle Lokot, Ajwang Warria, Sumnima Tuladhar, Clare Tanton, Louise Knight, Shelley Lees, Beniamino Cislaghi, Jaqueline Bhabha, Karen Devries
UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition.
This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work.
From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods.
UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.
Essa Chanie Mussa, Frank Otchere, Vincenzo Vinci, Abduljelil Reshad, Tia Palermo
Community-Based Health Insurance (CBHI) has received increasing attention in low and middle-income countries as a pathway toward universal health coverage. In 2011, the government of Ethiopia piloted CBHI and subsequently integrated CBHI with its flagship social protection programme, the Productive Safety Net Program (PSNP). We examined enrolment decisions by PSNP households, including, understanding of the programme, reasons for non-coverage, and factors associated with enrolment.
Current CBHI enrolment is higher among public works (PW) households (70.1 %) than Permanent Direct Support (PDS) clients (50.3 %). The most common reason for not enrolling in both PW and PDS households is cost. Results further show that the following characteristics are positively associated with CBHI enrolment: the number of children and working-age adults in the household, older household head, female household head, married household head, having been food insecure in the previous 12 months, heads having experienced illness in the past month, and increasing household wealth status.
While demographic factors are important in households’ decisions to enrol in CBHI, various mechanisms could be used to increase enrolment among vulnerable households such as PDS clients. In this regard, while better communication about CBHI could increase enrolment for some households, other poor and vulnerable households will need fee waivers to induce enrolment.
Sudhanshu Handa, Frank Otchere, Paul Sirma
We present evidence on the overall impacts of state-sponsored cash transfer programmes in sub-Saharan Africa, using data from three impact evaluations of government programmes. All three programmes were a key component of the poverty reduction strategy of the respective governments at the time of the evaluations. We show effects across nine broad domains including both protection, production and human development, using baseline and follow-up household surveys on treatment and control groups. We relate the pattern of impacts to programme design parameters to further understand the constraints faced by ultra-poor rural households.
All three programmes have strong effects on their primary objective—food security or food consumption, as well as on secondary objectives that include livelihood strengthening and children’s well-being. The largest and most consistent impacts occur in Malawi, where transfer values are in line with international best practice and payments were made regularly during the study period. All programmes show a positive income multiplier, with the multiplier largest in Malawi at 2.94.
The overall results across three national programmes add to the growing evidence from Africa that government unconditional cash transfers have important positive effects on households, that these effects are not limited to just food security, and that programme design features influence the pattern and size of impacts.
Camila Perera Aladro, Shivit Bakrania, Alessandra Ipince, Zahrah Nesbitt-Ahmed, Oluwaseun Obasola, Dominic Richardson
Amber Peterman, Elsa Valli, Tia Palermo
We examine whether a government cash transfer program, paired with a health insurance premium waiver and targeted to pregnant women and mothers of young children in Ghana, reduced intimate partner violence (IPV). The evaluation took place in two northern regions and followed a 24-month longitudinal quasi-experimental design. Findings show significant decreases in the 12-month frequency of emotional, physical and combined IPV (0.09 – 0.12 standard deviations). Analysis of pathways indicate improvements in economic security and women’s empowerment may account for reductions in IPV. Results indicate a promising role for social protection in improving the lives of pregnant women and new mothers.
Jose Cuesta, Anna Maria Milazzo