title: Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh.
abstract: Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming.
authors.affiliation: Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, aadams@icddrb.com.
authors.forename: Alayne
authors.initials: A
authors.lastname: Adams
authors.affiliation: The Averting Maternal Death and Disability Program (AMDD), Mailman School of Public Health, Columbia University, New York, NY, USA and.
authors.forename: Saroj
authors.initials: S
authors.lastname: Sedalia
authors.affiliation: The Averting Maternal Death and Disability Program (AMDD), Mailman School of Public Health, Columbia University, New York, NY, USA and.
authors.forename: Shanon
authors.initials: S
authors.lastname: McNab
authors.affiliation: James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Malabika
authors.initials: M
authors.lastname: Sarker
mesh_terms: D001459:Bangladesh; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D000068104:Infant Health / Q000592:standards*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods*; D011634:Public Health; D012017:Referral and Consultation; D012424:Rural Population
keywords: Bangladesh; implementation research; maternal and newborn health; realist evaluation