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    This repository includes summaries of systematic reviews drawn from a range of sources and sectors. The summaries include findings, methodologies and quality appraisal of existing reviews and protocols of ongoing studies.

    These provide a visual display of completed and ongoing systematic reviews and impact evaluations in a sector or sub-sector, structured around a framework of interventions and outcomes.

    We provide funding for replications, conduct in-house replication research and publish guidance on replication methodology. We also provide funding to original authors of 3ie-funded for preparing their raw datasets.

    As part of our mandate as a knowledge producer and translator for our main audiences, we publish a range of knowledge products. These include briefs, impact evaluation reports, systematic review reports and summaries, replication papers, evidence gap map reports, scoping reports and working papers.

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    3ie’s has two major evidence programmes that support the generation and use of high-quality evidence for informing decision-making in the water, sanitation and hygiene sector

    .

    We work with various departments in the Philippines government to develop and fund rigorous evidence useful for policymakers. We also support capacity-building activities for Philippine researchers and support the impact evaluation management framework of the National Economic and Development Authority.

    Working in collaboration with the Office of the Prime Minister, the primary aim is to improve developmental outcomes through evidence-informed decision making in Uganda. 3ie is currently supporting evaluation of government programmes around youth livelihood, family planning, public service delivery and local governance, and universal primary education.

    3ie and the government of Benin are working on a a multi-year regional initiative that aims to promote the institutionalization of evaluation in government systems across eight countries in West Africa, including: Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, Niger, Senegal and Togo.
     

    .

    3ie funds internal replications of influential or innovative impact evaluations of financial interventions on mobile money, cash transfers, bank deposits, and other financial service interventions targeted towards underserved and unbanked populations in developing countries.

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  • Our expertise
    • Evidence mapping
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    3ie invented evidence gap maps to improve decision-making around where to make investments in producing more evidence or synthesising existing evidence. Since then, we have pioneered further advancements, including developing our interactive online map platform and innovating evidence mapping to broaden its use in development decision-making.

    3ie funds and quality assures formative and impact evaluations of development programmes in low- and middle-income countries. These evaluations provide crucial evidence on what works, for whom, why and at what cost. On our website, we host the largest-of-its-kind impact evaluation repository that includes summaries of both 3ie-funded and other studies.

    We are global leaders in producing and assuring the quality of theory-based systematic reviews of the effectiveness of development interventions. 3ie continues to innovate and improve synthesis and systematic review methodologies and the uptake and use of synthesised evidence.

    3ie specialises in increasing access to, demand for and use of evidence by governments, parliaments, programme managers, civil society, programme participants and the media. We do this by emphasising the value of planning and engaging with stakeholders to ensure that evaluations and reviews are relevant and useful. We use robust and effective monitoring to measure evidence use so that we can convey evidence impact on programmes and policies with greater confidence.

    We set up our replication programme to address the need for a freely available global public good that helps improve the quality and reliability of impact evaluation evidence used for development decision-making. Replication is the most established method of research validation in science, yet it has not been fully embraced by the research community or development donors, leading to this gap.

    3ie’s evidence programmes and services help build technical capacity to commission and conduct rigorous evaluations, produce evidence gap maps, conduct evidence synthesis and use evidence. We also work with L&MIC governments to build effective monitoring and evaluation systems. 3ie’s bursary programme supports L&MIC policymakers, programme managers and researchers to participate in specialised training and international events.

    3ie has always been strongly committed to research transparency and open access to data. We are proud to be a leader in the growing movement to improve global standards for research transparency.

    On request, 3ie provides services to partners for supporting the generation and use of evidence to inform their development policies and programmes. We commission and quality assure evidence gap maps, evaluations and syntheses as well as provide training.

    3ie plays a unique role in promoting collaboration among researchers, policymakers and development programme managers at country, regional and global levels. Our global advocacy for evidence-informed action helps ensure decision makers have quality evidence about what works when they need it.

  • Evidence hub
    • Impact evaluation repository
    • Systematic review repository
    • Evidence gap maps
    • Replication studies
    • Publications
    • RIDIE

    Searching this database will bring up published impact evaluations from our Impact Evaluation Repository as well as completed 3ie-funded impact evaluations.

    This repository includes summaries of systematic reviews drawn from a range of sources and sectors. The summaries include findings, methodologies and quality appraisal of existing reviews and protocols of ongoing studies.

    These provide a visual display of completed and ongoing systematic reviews and impact evaluations in a sector or sub-sector, structured around a framework of interventions and outcomes.

    We provide funding for replications, conduct in-house replication research and publish guidance on replication methodology. We also provide funding to original authors of 3ie-funded for preparing their raw datasets.

    As part of our mandate as a knowledge producer and translator for our main audiences, we publish a range of knowledge products. These include briefs, impact evaluation reports, systematic review reports and summaries, replication papers, evidence gap map reports, scoping reports and working papers.

    3ie’s Registry for International Development Impact Evaluations (RIDIE) aims to enhance the transparency and quality of impact evaluation research before it begins.

  • Our work
      • Agriculture
      • Education
      • Environment
      • Governance
      • Health
      • Humanitarian
      • Infrastructure
      • Livelihoods
      • Public finance
      • Social protection
      • Water, sanitation and hygiene
    • Working with governments
      • Philippines
      • Uganda
      • West Africa Capacity Buidling and Impact Evaluation initiative
    • Replication
      • Replication Programme on Financial Services for the Poor
      • Replication programme on HIV prevention

    3ie’s evidence programmes support studies to fill critical knowledge gaps in a sector, sub-sector or in an area with limited rigorous evidence. We fund studies under a specific theme or which address a particular question or set of questions in programme areas where our donors want to expand global public knowledge of what works and what does not.

    To help address gaps in the understanding of what works and what does not, we fund a variety of studies across this programme area, including interventions focused on insurance, extension, land-use and forestry, and innovation and technology.

    3ie supports impact evaluations, systematic reviews and evidence gap maps on education effectiveness that help answer the questions of what works, for whom, why and at what cost.

    We fund the production of rigorous evidence on biodiversity and forest conservation programmes, environmental regulations, impact of sustainable fuels, climate change mitigation and adaptation.

    3ie is supporting the generation of evidence in areas such as transparency and accountability in natural resource governance. We also fund the production of rigorous evidence on interventions to curb corruption, judicial and civil service reforms, land reforms, public financial management, conflict prevention and peacebuilding, decentralised governance and public service delivery.

    We fund the production of rigorous evidence on interventions on HIV and AIDS immunisation maternal and child health nutrition and sexual and reproductive health Evidence products from this programme include replication studies, evidence gap maps, systematic reviews and impact evaluations.

    We are supporting the generation of rigorous evidence in humanitarian contexts on interventions related to water, sanitation and hygiene, food security, multi-sectoral humanitarian programming and interventions targeting malnutrition.

    We fund the production of rigorous evidence on the socio-economic and environmental impacts of public transportation by rail, bus and rapid transit systems, and essential services such as electricity and gas to expand access, foster inclusive growth, and combat climate change through sustainable systems.

    3ie, in collaboration with India’s rural development ministry is working to generate rigorous evidence on the impact of the National Rural Livelihoods Mission.

    We support policy-relevant studies that contribute to improving our understanding of public expenditure trends and improving the delivery of public goods.

    We support impact evaluations to build the evidence base on the effectiveness of interventions that reduce the risks faced by the poor through participation in public works and employment programmes.

    3ie’s has two major evidence programmes that support the generation and use of high-quality evidence for informing decision-making in the water, sanitation and hygiene sector

    .

    We work with various departments in the Philippines government to develop and fund rigorous evidence useful for policymakers. We also support capacity-building activities for Philippine researchers and support the impact evaluation management framework of the National Economic and Development Authority.

    Working in collaboration with the Office of the Prime Minister, the primary aim is to improve developmental outcomes through evidence-informed decision making in Uganda. 3ie is currently supporting evaluation of government programmes around youth livelihood, family planning, public service delivery and local governance, and universal primary education.

    3ie and the government of Benin are working on a a multi-year regional initiative that aims to promote the institutionalization of evaluation in government systems across eight countries in West Africa, including: Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, Niger, Senegal and Togo.
     

    .

    3ie funds internal replications of influential or innovative impact evaluations of financial interventions on mobile money, cash transfers, bank deposits, and other financial service interventions targeted towards underserved and unbanked populations in developing countries.

    3ie funds internal replications of influential or innovative impact evaluations of biomedical, behavioural, social, and structural HIV prevention and treatment interventions to improve the evidence base in low- and middle-income countries.

  • Funding
    • Open opportunities
    • Bursary programme

    View our current funding opportunities for evaluations, systematic reviews and internal replication studies.

    3ie’s bursary programme offers funding for individuals to attend workshops and conferences related to impact evaluations and systematic reviews.

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  4. Impacts of IRC’s Fifth Child community engagement strategy to increase immunisation in northern Uganda

Impacts of IRC’s Fifth Child community engagement strategy to increase immunisation in northern Uganda

Impact evaluation
Publication Type: 3ie final grantee report
Author: Jayne Webster, Justine Landegger, Jane Bruce, Dickson Malunda, Tracey Chantler, Edward Kumakech, Laura Schmucker, Lilian Kiapi, Naoko Kozuki, Comfort Olorunsaiye, Erin Byrne
Country: Uganda
Region: Sub-Saharan Africa (includes East and West Africa)
Sector: Health Nutrition and Population, Health Services
Institutional affiliations: London School of Hygiene and Tropical Medicine, International Rescue Committee, Innovations for Poverty Action
Grant-holding institution: International Rescue Committee, United Kingdom
Evaluation design: Randomised Controlled Trial (RCT)
Status: Completed
3ie Funding Window: Innovations in Increasing Immunisation Thematic Window

Publication details

Webster, J, Landegger, J, Bruce, J, Malunda, D, Chantler, T, Kumakech, E, Schmucker, L, Kiapi, L, Kozuki, N, Olorunsaiye, C and Byrne, E, 2019. Impacts of IRC’s Fifth Child community engagement strategy to increase immunisation in northern Uganda, 3ie Grantee Final Report. New Delhi: International Initiative for Impact Evaluation (3ie).

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Policy influence

IRC, in coordination with the Uganda Ministry of Health, is scaling up the mReach application and the Fifth Child community engagement strategy in Kitgum and Lamwo districts. A family planning module will be added to the existing mobile application, to promote integrated immunisation and postpartum family planning services.

Synopsis

This study evaluated the International Rescue Committee’s (IRC’s) Fifth Child integrated community engagement strategy to improve immunisation coverage in Northern Uganda.

Context

Northern Uganda faces several challenges in meeting the health needs of its population. Maternal and child health services, including immunisation, remain weak and have stagnated, with only 73 per cent of children receiving the third and final dose of the diphtheria-pertussis-tetanus vaccination (DPT3) (Uganda Demographic Health Survey, 2011). This rate has a range of causes, including limited community involvement and poor quality data to support decision-making. In early 2015, IRC established Fifth Child: a data-informed community engagement strategy to improve the stagnating immunisation coverage in northern Uganda.

Research questions

This study addresses the following questions:

  1. Does the intervention lead to an increase in DPT3 and Measles containing vaccine (MCV) combined immunisation coverage in 12 to 23-month-old children;
  2. Is there a reduction in vaccination drop-out rates for DPT 1, 2, 3 and oral polio vaccine 1, 2, 3;
  3. Will the intervention lead to improvements in the timely uptake of immunisations; and
  4. Has the intervention increased integrated community case management of children aged 6 – 59 months?

Methodology

Intervention design

The intervention aimed to enhance community engagement through the use of better quality data for target defaulter-tracing using a mobile-health data collection platform called mReach. The mReach application aggregated and presented data on the immunisation status of children, which was used for tracking those who were due for (or had defaulted from) their scheduled immunisations. Using the application, the facility-based health workers downloaded lists of children due for immunisations as well as defaulters. These lists were shared with community health volunteers known as Village Health Teams for follow-ups during home visits. These data were also shared with community leaders, who were actively co-managing immunisation outreaches with health workers. A second component of the intervention provided logistical support and supervision to health staff in both treatment and control areas for effective delivery of immunisation services.

Theory of change

The theory of change for this intervention hypothesised that data-driven, targeted community engagement will facilitate more effective defaulter-tracing, contributing to increased immunisation coverage in underserved, vulnerable and hard-to-reach communities. The theory of change rested on the following assumptions: (1) the intervention would facilitate community co-management of following up with immunisation defaulters and planning outreaches; (2) the mReach platform would improve data quality and provide health workers and community leaders with accurate and up-to-date data on immunisation defaulters; and (3) health workers and the Village Health Teams would be adequately trained to use the mReach data to conduct effective home visits that would prompt defaulting caregivers that are due for immunisation to complete the immunisation schedule of their children on time.  

Evaluation design

A cluster randomised controlled trial was conducted to evaluate whether the intervention increased coverage of DPT3 and MCV in children 12 to 23 months old. A cluster was defined as a health facility catchment area. Thirty-two of these were included; sixteen in the control arm and the remaining sixteen were intervention clusters. The sample comprised 55 children in the age group of 9-23 months per cluster, which brought the total number of children included in this study to 1,760. Cross-sectional household surveys were used at baseline and endline to measure the impact of the intervention.  

Findings

Please read these findings in light of the limitations detailed below.

  1. The study found significant increases in DPT3 and MCV coverage rates in both intervention and control (from 68% to 77%) groups. In the intervention group, coverage increased from 65% to 76%, while in the control group coverage increased from 68% to 77%. However, the difference between intervention and control at endline was not significant.
  2. The mReach platform was designed to allow Village Health Teams to easily identify defaulters and perform targeted outreach. However, the results showed no difference between intervention and control groups in exposure to household visits or the actions taken by caregivers after such visits.
  3. The intervention appeared to have no effect on the timeliness of vaccinations, as there was no significant difference between treatment and control groups at endline for timely receipt of DPT3 and MCV.
  4. Use of the platform proved challenging for some healthcare workers, who did not initially find the application straightforward. Additional training and supervision from IRC staff and an mHealth specialist were required to ensure proper use of the application.
  5. Caregivers had positive views towards the involvement of community leaders in supporting immunisation, particularly the community leaders’ ability to disseminate information to community members and to influence behaviour.
  6. All health workers in both treatment and control sites received immunisation update training from IRC and district leaders, which may have increased attention to immunisation services and improved coverage at study sites. Vaccine stock-outs were found to be common across all study sites.

Limitations of the study

The study has several major limitations, largely stemming from contamination between intervention and control groups. Some control sites implemented defaulter tracing systems that were similar to that provided by the mReach platform in intervention sites (albeit paper-based). In addition, some health workers were transferred from intervention to control sites during the course of the intervention. Thus, there is limited basis for drawing inferences about the causal impact of the intervention. Also, different measures of immunisation coverage showed different results: reported coverage based on administrative records (i.e., immunisation cards) showed marked improvement while coverage based on caregiver self-report showed no increase. Thus, it is possible that the overall increase in recorded coverage resulted only from improvements in administrative tracking.  

Blogs

  • ‘Last-Mile’ vaccine initiative increases immunization coverage in Uganda March 31, 2016, IRC blog

Thank you for your interest in this publication

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