Estimating the impact of donor programs on child mortality in low- and middle-income countries: a synthetic control analysis of child health programs funded by the United States Agency for International Development

Background Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. Methods This study uses the synthetic control analysis method to estimate the impact of one donor’s funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. Results In the study period (2000–16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of − 2 to − 38). This finding was consistent with several sensitivity analyses. Conclusions The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.

Perspective: Opportunities and Scope for Expanded Deworming Programs for Soil-Transmitted Helminths in India

The current deworming strategy for soil-transmitted helminthiases (STH) focuses on pre-school and school-aged children and women in the reproductive age to eliminate morbidity. However, mathematical modeling and meta-analysis show that STH could be eliminated if the entire population, including adults, were treated. The Government of India (GOI) has been deworming children through various maternal and child health programs and school health programs. One of the largest initiatives is the school-based biannual deworming program for children aged 1-19 years in the ‘National Deworming Day’ since 2015. Women of the reproductive age have the opportunity to get dewormed under the Anemia Free India program. Adult men and women have the opportunity to receive Albendazole in the lymphatic filariasis (LF) endemic districts. The gaps in deworming are women above the age of 49 and adult men above 19 years, living in non-LF endemic areas. Understanding gaps in deworming will help plan policy changes and program strategies for STH elimination in India, which has 21% of the global STH burden, as well as in other STH endemic countries.

Landscape Analysis of Supportive Supervisory mechanisms in Maternal and Child Health Programs in India

Background: Supportive supervision has lately been gaining traction in various national health systems as an effective way of boosting the performance of community health workers in a constructive and sustainable way. However, not much is known about the basis/mandate of supportive supervision and its approach in maternal and child health programs in India. The current analysis contributes to a clearer understanding of the paradigms within which supportive supervision is envisioned to operate within India and identifies potential strengths and areas requiring attention. Method: Document analysis of implementation documents such as guidelines/ operational manuals/operationalization modules/ training modules of nationally implemented maternal and child health programs, with data extraction according to a pre-determined domain-based template. Results: Many of the documents reviewed do not mention supportive supervision at all. In the few documents where supportive supervision is mentioned, the paradigms within which it is supposed to operate (who will do it, when will it be done, how to do it, training and logistic support, reporting formats, etc.) have not been clearly identified in most programs. Conclusion: Even though supportive supervision is being increasingly identified as an effective way of performative improvement in national health programs in India, more effort needs to be put into identifying and enforcing the tenets of supportive supervision in practice, in order to bring about the desired change.

Faktor yang Berhubungan dengan Stimulasi Toilet Training pada Anak Usia Toddler (1-3 Tahun) di Wilayah Kerja Puskesmas Rasimah Ahmad Kota Bukittinggi

Toilet training trains children to control their bowel and bladder. However, many mothers do not carry out toilet training stimulation for toddlers because they do not know the benefits are very great in growing children's independence. Toilet training teaches children to clean their own feces and reuse their pants. The purpose of this study is to find out the factors associated with toilet training stimulation in toddler age children in the Rasimah Ahmad Community Health Center in Bukittinggi in 2019, the factors studied were mother's knowledge, education mother and family support with toilet training stimulation in toddler age children. The research design was descriptive analytic using a cross sectional approach with a sample of 139 mothers, data processing was performed using the Chi-Square test. This study proves that there is a significant relationship between knowledge, education and family support with toilet training stimulation in toddler age children with a PV of 0.001. It is expected that Pukesmas officers and holders of maternal and child health programs will incorporate toilet training into the health education program at the posyandu.

Utilizing Principles of Private Enterprise to Improve Maternal and Child Health Programs

High quality maternal and child health (MCH) programs are needed to meet the global Sustainable Development Goals 1, 2, 3, and 10. Yet, the vast majority of MCH programs are small, lack capacity and personnel, and are judged based on their relationships with funders, rather than their performance in the field. Adopting principles common among private enterprise could have a significant impact on shifting MCH to focus on implementing larger, higher quality programs and to routinely evaluate MCH as meeting/ not meeting their primary mission. For example, focusing on recruiting personnel who have excellent social skills and are pragmatic problem-solvers reflects a principle of Hire the Best Staff. Similar principles such as Leadership Matters and Create a Culture of Discipline are guideposts that can improve the quality of MCH programs over time. This commentary outlines criteria which could both guide MCH organizational development and funders’ evaluations of MCH. Key words: • Leadership • Private Sector • Maternal And Child Health Programs • Global Health • Developing Countries Copyright © 2020 Rotheram-Borus and Tomlinson. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Putting Rigorous Evidence Within Reach: Lessons Learned from the New Heights Evaluation

Purpose This article uses an evaluation of New Heights, a school-based program for pregnant and parenting teens in the District of Columbia Public Schools, to illustrate how maternal and child health programs can obtain rigorous evaluations at reasonable cost using extant administrative data. The key purpose of the article is to draw out lessons learned about planning and conducting this type of evaluation, including the important role of partnerships between program staff and evaluators. Description This article summarizes the evaluation’s research design, data sources, and lessons learned about ingredients contributing to the successful implementation of this study. The evaluation employed a difference-in-differences design to estimate program impacts using administrative data merged across agencies. Assessment Several features of New Heights and its context facilitated an evaluation. First, New Heights leaders could clearly describe program components and how the program was expected to improve specific student education outcomes. These outcomes were easy to measure for program and comparison groups using administrative data, which agencies were willing to provide. Second, buy-in from program staff facilitated study approval, data agreements, and unanticipated opportunities to learn about program implementation. Finally, time spent by evaluators and program staff in conversation about the program’s components, context, and data resulted in greater understanding and a more useful evaluation. Conclusion The New Heights evaluation is a concrete example of how a small program with a modest evaluation budget can obtain evidence of impact. Collaborative relationships between researchers and program staff can enable these informative studies to flourish.

Using Randomized Controlled Trials to Estimate Long-Run Impacts in Development Economics

We assess evidence from randomized controlled trials (RCTs) on long-run economic productivity and living standards in poor countries. We first document that several studies estimate large positive long-run impacts, but that relatively few existing RCTs have been evaluated over the long run. We next present evidence from a systematic survey of existing RCTs, with a focus on cash transfer and child health programs, and show that a meaningful subset can realistically be evaluated for long-run effects. We discuss ways to bridge the gap between the burgeoning number of development RCTs and the limited number that have been followed up to date, including through new panel (longitudinal) data; improved participant tracking methods; alternative research designs; and access to administrative, remote sensing, and cell phone data. We conclude that the rise of development economics RCTs since roughly 2000 provides a novel opportunity to generate high-quality evidence on the long-run drivers of living standards.