Exploring Evaluation in Practice from the Perspective of Public Health and Health Professionals: a Qualitative Field Study

Background There were concerns that robust evaluation of national public health programmes delivered locally was not being done, resulting in a lack of evidence to demonstrate the impact of programmes. Methods A qualitative field study drawing on ethnographic approaches was carried out over 18 months in a Public Health department in a UK Primary Care Trust. Interview and observation data from 16 participants of varying roles and experience involved in implementing the NHS Health Check programme including programme documentary data was analysed using the constant comparative method to understand how evaluation was perceived and conducted in practice. Results Participants' informal evaluation definitions encompassed different activities that formed an integral part of assessing the progress of the programme’s delivery and implementation. Formal evaluation was defined as the processes required to produce reports for official scrutiny, demonstrate compliance with official targets, and provide evidence that programmes are delivered. Organisational structures, resources and expectations were instrumental in determining how evaluation was conducted. Evaluation in practice was observed to be predominantly retrospective, unstructured and focused on generating descriptive information about the programme's processes and progress. Participants devised their own multi-purpose and diverse evaluation procedures to meet personal, professional and organisational obligations to demonstrate success in some form. Conclusion Limited use of recognised public health evaluation methodologies at local level was due to a mixture of operational, political and personal factors, including the desire to show success. The purpose of evaluation was to provide information to justify policy and financial decisions and to preserve services and jobs. Therefore the political and organisational structures and arrangements need to be in place to enable public health professionals to conduct robust evidence to deliver critical findings

Exploring the influence of health management processes on health outcomes among internally displaced persons (IDPs)

Background: Despite global action and policy initiatives, internally displaced persons (IDPs) experience poor living conditions and lack healthcare access compared to refugees. This study sought to understand the relationship between health management processes and health outcomes among camp-dwelling IDPs in northern Nigeria. Method: 73 individuals participated in either a focus group (n = 49) or one-to-one interview (n = 24), comprising IDPs (n = 49), camp managers (n = 9), health workers (n = 7) and government administrative authorities (n = 8). Interviews explored IDP health management processes, partners and perceptions around camp management. Data were analysed using an inductive thematic approach. Results: Four main themes were identified: opinions about healthcare organisation and management, service availability, interventions and information management, and IDP health outcomes. Though many stakeholders, partnerships, and national and international government agencies were involved in the provision of healthcare services, respondents described efforts as disjointed. Reports suggested that the coordination and management of health services and resources were not tailored to the needs of those living in all camps. And because so many national and international agencies were involved, but under weak coordination, access to services was less than optimal and adequate management of critical public health interventions was lacking. Varied allocation of resources such as funding, medication and medically trained staff were viewed as key factors in the availability and the ability to access what was considered as essential healthcare services. Conclusion: The health of IDPs in camp-like settings was compromised by uncoordinated management, treatment, and control of communicable and non-communicable diseases. Government authorities need to be aware and consider the complexity of the multiagency involvement in the management and provision of IDP healthcare services. Introducing systems to streamline, monitor and support IDP healthcare management could be cost-effective strategies for achieving optimal health care

An audit of healthcare provision in internally displaced population camps in Nigeria

Background: Armed conflict in Nigeria resulted in more than 2 million internally displaced persons (IDPs). IDPs live in poor conditions lacking basic resources with variable provision across different locations. This audit aimed to determine the health-related resources available to IDPs in camp-like settings in Nigeria and whether these met international standards. Methods: Using a cross-sectional study approach, information was collected in 9 camps across 7 states from camp managers, and direct observation in September-October 2016. The Sphere minimum standards in humanitarian crises were used as the audit standards. Findings: Five of 15 assessed standards were met to some extent, including the availability of water and shelter. Sanitation and vaccination were unmet in 5 camps, with severe overcrowding in 5 camps, and inadequate waste disposal in all camps. Health programme implementation was uneven, and especially poor in self-settled and dispersed settlements. Conclusion: Inequality in distribution of humanitarian support was observed across different settings, which could lead to a higher likelihood of water, food and air related diseases and thereby, a poorer quality of life for IDPs. Ensuring standardised health assessments could promote a more even distribution of resources across IDP locations

Urinary soluble VCAM-1 is a useful biomarker of disease activity and treatment response in lupus nephritis

Introduction: Vascular cell adhesion molecule-1 (VCAM-1) is involved in the progression of glomerular and tubulointerstitial injury in lupus nephritis (LN) and can be easily assessed in urine. The aim of this study was to assess urinary soluble VCAM-1 (uVCAM-1) as a biomarker of disease activity and treatment response in LN. Methods: This prospective study enrolled 62 patients with class III, IV or V LN diagnosed within the last 3 years and divided them in two groups: with and without active nephritis at the inclusion, each group with 31 patients. At each visit, a urine sample was collected for uVCAM-1 evaluation and the nephritis status was assessed. Results: Median uVCAM-1 level was elevated in patients with active compared to inactive LN (P < 0.001). The ROC curve of uVCAM-1 demonstrated an AUC of 0.84 and a cutoff of 47.2 ng/mgCr yielded a good sensitivity (74.2%) and specificity (74.2%) for the diagnosis of active LN. A significant correlation was found between uVCAM-1 level and renal activity scores and traditional biomarkers of LN. The level of uVCAM-1 dropped in patients with active LN who went into remission (P < 0.001), increased in patients who went into activity (P = 0.002) and did not change in patients who remained inactive (P = 0.797). The level of uVCAM-1 peaked during the flare of LN (P < 0.05). Conclusion: The uVCAM-1 is a reliable biomarker that reflects renal disease activity and is useful for monitoring individual patients with lupus nephritis over time

Eliciting and reconstructing programme theory: an exercise in translating theory into practice

The importance of evaluation to demonstrate the effectiveness of policies, programmes and interventions is widely recognised. Evaluation in the context of public health and healthcare is viewed as a complicated exercise, particularly when dealing with complex interventions involving multiple partners, multiple components and multiple outcomes. Eliciting the programme theory is an important starting point of an evaluation process to enable the link between theory and action to be articulated. This article gives a pragmatic account of the practicalities of working with stakeholders as they embark on a formative evaluation of a complex public health initiative, using a using a theory-based approach. Drawing on the principles of Leeuw’s strategic assessment, we planned a workshop to reflect the four stages of this approach–group formation, assumption surfacing, dialectical debate and synthesis. Stakeholders took part in four activities–Free Listing, Sphere of Influence, Beattie’s Theoretical Framework and Programme Concept Mapping. We found that our elicitation approach was particularly suited to reconstructing the programme theory in a non-threatening and playful environment, bringing about an alignment of programme theories by consensus and reducing anxiety

Eradicating slave labour by 2030: the challenge of worker health surveillance

Eradicating modern slavery is a relevant scientific, social, and institutional challenge issue. Indeed, efforts are being made at a global scale to understand and eradicate contemporary slavery as a target of the United Nations Sustainable Development Goals by 2030. However, little attention has been given to the Worker Health Surveillance (WHS) in the struggle against contemporary forms of slavery. To fill this gap, the paper discuss contemporary slave labour (CSL)a workers health surveillance perspective, calling attention to challenges evident in the case of Brazil. Further, we explain the connection of CSL to workers health and to workers health surveillance (WHS). We then identify and discuss three challenges of CSL to WHS: 1. help to characterise and identify economic sectors and populations most affected by slave labour; 2. identify determinants, risks, and health effects related to CSL; and 3. strengthen workers health services to trigger specific actions in terms of formation, information, and intervention in regions of high CSL prevalence. We conclude that Workers Health Surveillance can play an important role towards workers emancipationslavery relations

An audit of healthcare provision in internally displaced population camps in Nigeria

Background: Armed conflict in Nigeria resulted in more than 2 million internally displaced persons (IDPs). IDPs live in poor conditions lacking basic resources with variable provision across different locations. This audit aimed to determine the health-related resources available to IDPs in camp-like settings in Nigeria and whether these met international standards. Methods: Using a cross-sectional study approach, information was collected in 9 camps across 7 states from camp managers, and direct observation in September-October 2016. The Sphere minimum standards in humanitarian crises were used as the audit standards. Findings: Five of 15 assessed standards were met to some extent, including the availability of water and shelter. Sanitation and vaccination were unmet in 5 camps, with severe overcrowding in 5 camps, and inadequate waste disposal in all camps. Health programme implementation was uneven, and especially poor in self-settled and dispersed settlements. Conclusion: Inequality in distribution of humanitarian support was observed across different settings, which could lead to a higher likelihood of water, food and air related diseases and thereby, a poorer quality of life for IDPs. Ensuring standardised health assessments could promote a more even distribution of resources across IDP locations