title: Measuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations.
abstract: Evaluation of large-scale programmes and initiatives aimed at improvement of health in countries of low and middle income needs a new approach. Traditional designs, which compare areas with and without a given programme, are no longer relevant at a time when many programmes are being scaled up in virtually every district in the world. We propose an evolution in evaluation design, a national platform approach that: uses the district as the unit of design and analysis; is based on continuous monitoring of different levels of indicators; gathers additional data before, during, and after the period to be assessed by multiple methods; uses several analytical techniques to deal with various data gaps and biases; and includes interim and summative evaluation analyses. This new approach will promote country ownership, transparency, and donor coordination while providing a rigorous comparison of the cost-effectiveness of different scale-up approaches.
authors.affiliation: Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. cvictora@terra.com.br
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: J Ties
authors.initials: JT
authors.lastname: Boerma
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D003906:Developing Countries; D006801:Humans; D009313:National Health Programs / Q000191:economics*