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1 HEARD Project Semiannual Technical Report FY2018, Quarters 3-4 (April 1, 2018 – September 30, 2018)

HEALTH EVALUATION AND APPLIED RESEARCH

DEVELOPMENT (HEARD) PROJECT

SEMIANNUAL TECHNICAL REPORT

APRIL 1, 2018 – SEPTEMBER 30, 2018

COOPERATIVE AGREEMENT NO. AID-OAA-A-17-00002

Distributed to: Neal Brandes, AOR, USAID

Washington, DC

This report was produced for review by the United States Agency for International Development. It was prepared by University Research Co., LLC. This report is made possible by the support of the American People through the Unites States Agency for International Development (USAID). The contents of this report are the sole responsibility of University Research Co., LLC and do not necessarily reflect the views of USAID or the United States Government.

Health, Evaluation and Applied Research Development, HEARD, is funded by United States Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-17-00002.


TABLE OF CONTENTS

Executive Summary ....................................................................................................................................... 5

Introduction: HEARD Project Overview ........................................................................................................ 6

Partnership and Agenda Development ......................................................................................................... 7

Evidence Strengthening and Data Liberation ............................................................................................. 13

Program Communications .......................................................................................................................... 15

Implementation of Specific Studies and Sponsored Activities ................................................................... 16

Monitoring of Project Progress ................................................................................................................... 23

Gender ........................................................................................................................................................ 24

Human Subjects Protection ........................................................................................................................ 24

Environmental Compliance ......................................................................................................................... 24

Planned Activities for Next Reporting Period ............................................................................................. 25

Annexes ....................................................................................................................................................... 27

A. Thematic Area Descriptions ................................................................................................................ 27

B. Manuscripts, Abstracts, Presentations ............................................................................................... 28


List of Acronyms

AAPH Africa Academy for Public Health

ART Antiretroviral therapy

AT Assistive Technologies

BPF Best Practices Forum

CEO Chief Executive Officer

CECA Center on Children in Adversity

CGHDD Center for Global Health Delivery and Diplomacy

CH Community Health

CIRCLE Coordinating Implementation Research to Communicate Learning and Evidence

CUGH Consortium of Universities for Global Health

CUNY City University of New York

CWG Communications Working Group

DCOF Displaced Children and Orphans Fund

DJCC Directors Joint Consultative Committee

DRG Democracy, Rights, and Governance

ECOWAS Economic Community of West African States

ECSA-HC ECSA-Health Community

EI Empowerment and Inclusion

FPH Faculty of Public Health

FY Fiscal year

GEIS Global Evidence and Implementation Summit

GH Global Health

GHIS Global Health Innovations and Security

GH Pro Global Health Program Cycle Improvement Project

HEARD Health Evaluation and Applied Research Development

HIV/AIDS Human immunodeficiency virus / Acquired immunodeficiency syndrome

HMC Health Ministers' Conference

HRH Human Resources for Health

HRP Health Research Program

HSR Global Symposium on Health Systems Research

IAP Implementation Assistance Provider

IDI Infectious Disease Institute

IHI Ifakara Health Institute

IMC Improving Malaria Care (Project)

IQD Incentivizing Quality of Delivery

IR Intermediate Result

IS Implementation Science

ISC Implementation Science Collaborative

ISforGH Implementation Science for Global Health

LMIC Low and middle-income country

LMS Learning Management System

M&E Monitoring and Evaluation


MHTF Maternal Health Task Force

NMCP National Malaria Strategic Plan

PAHO Pan American Health Organization

PMI President’s Malaria Initiative

PPD Partners in Population and Development

PSS Psychosocial Support

QED Quality, Equity and Dignity

QRG Quality Reference Group

RCT Randomized Controlled Trial

RHITES EC Regional Health Integration to Enhance Services in East Central Uganda Project

RFA Request for Application

RFI Request for Information

RMC Respectful Maternity Care

SIR Sub-intermediate result

SA South Africa

SOP Standard Operating Procedures

SOW Scope of Work

SRG Strategy Reference Group

SRG Study Review Group

SSA Sub Saharan Africa

TA Technical assistance

TB Tuberculosis

TBD To be determined

TDG Technical Development Group

TOR Terms of Reference

TRAction Translating Research into Action Project

TRP Technical Review Panel

TyG Triglyceride-glucose

TZ Tanzania

UCB University of California, Berkeley

UCSF University of California, San Francisco

UI University of Indonesia

UNAIDS The Joint United Nations Programme on HIV/AIDS

UNICEF United Nations Children's Fund

UNFPA United Nations Population Fund

URC University Research Co., LLC

USAID Unites States Agency for International Development

VACS Violence Against Children Survey

VOT Victims of Torture

WAHO West African Health Organization

WCC Woman-Centered Care

WHO World Health Organization


EXECUTIVE SUMMARY

The purpose of the United States Agency for International Development’s (USAID) Health Evaluation and Applied Research Development (HEARD) Project is to undertake research efforts to accelerate progress towards achieving USAID’s global health and development goals. The HEARD Project focuses on implementation science and evaluative research that accelerates research-to-use processes including:

Multidisciplinary applied and implementation research and related activities that accelerate the research-to-use process focusing on targeted questions, barriers, and bottlenecks related to high priority interventions, technologies, policies and products that show promise or are ready for scale-up.

Evaluative research and post-marketing surveillance of pilot programs and at-scale tools, technologies, interventions and policies around the main causes of maternal, child and neonatal deaths and morbidity.

This report covers the latter two quarters of FY2018, April 1 – September 30, 2018, and it provides updates on activities described in the FY2018 Implementation Plan. During this reporting period, the HEARD Core team made significant progress within its various operational activities: Partnership and Agenda Development, Evidence Strengthening and Data Liberation, Program Communications, Implementation of Specific Studies and Sponsored Activities, and Products and Knowledge Management.

The primary aim of Partnership and Agenda Development is to establish an effective, sustainable, and responsive partnership for fostering collaboration in global health implementation science. This reporting period, the HEARD Project made progress in the following relevant areas: Implementation Science Collaborative (ISC) Ad Hoc HEARD Partners’ Committee; engaging various stakeholders in discussions about the principles of stakeholder engagement in global health implementation science; building a directory of technical resources; and establishing a platform for developing and sharing case studies (CaseMaker). Additionally, the Core Team contributed to the following relevant meetings: The Maternal Health Task Force’s Global Maternal Health Symposium, and the 11th ECSA-HC Best Practices Forum and 27th Directors Joint Consultative Committee Meeting.

Evidence Strengthening and Data Liberation activities primarily leverage existing data and strengthen evidence to answer priority implementation science questions identified through the implementation science priority consultative process and to accelerate evidence use. During this reporting period, progress was made on a rapid response systematic review learning module, and the Lancet Commission on Tuberculosis.

HEARD’s Program Communications activities focus on ensuring efficient operation of the HEARD Project as well as effective and strategic communication of HEARD activities within the HEARD Partnership. In this reporting period, the Project worked on its operational partnership with Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE), the HEARD Project Website, and the ISforGH Newsletters.

Implementation of Specific Studies and Sponsored Activities, which respond to USAID priorities for implementation science or evaluations, was also advanced during this reporting period. Significant progress was made on the Improving Malaria Care (IMC) Project Evaluation, the Global Health Program Cycle Improvement Project (GH Pro) Performance Evaluation, the Urban Health East Africa Three-country Nutrition Assessment, and Respectful Maternity Care in Tanzania. Development of new activities sponsored by USAID’s Democracy, Rights, and Governance Program and by USAID/Nigeria were initiated.


INTRODUCTION: HEARD PROJECT OVERVIEW

The purpose of USAID’s HEARD Project, managed by University Research Co., LLC (URC), is to undertake research and evaluation efforts to accelerate progress towards achieving USAID’s global health and development goals, including Ending Preventable Child and Maternal Death, achieving an AIDS Free Generation, and Protecting Communities from Infectious Diseases Initiatives, including the Global Health Security Agenda. The HEARD Project focuses on implementation science and accelerating evidence-to-use processes.

The HEARD Project is engaged with building a partnership around implementation science (IS), which is comprised of organizations that work to advance global health goals as implementation assistance providers, regional health bodies, policy advocacy groups, civil society-based evidence advocates, research organizations, and academic institutions. This strategic mix of partners helps inform which research questions are prioritized in different contexts, to generate and analyze evidence, and to better package and move evidence through channels which render it more accessible to inform policy and practice.

Applying this partnership approach, the HEARD Project seeks to: 1. Effectively respond to evaluation and research-to-use global health priorities: developing the

study designs and issue-specific partnerships required to navigate a complex effort along a strategic research-to-use pathway;

2. Actively engage national, regional, and global-level stakeholders for the development of those priorities: engaging and supporting a growing community of interested implementers, policy makers, and investigators in shaping and promoting a more relevant research-to-use agenda and capacity; and

3. Strengthen and connect the institutional applied research capacities required to sustain a vigorous implementation science agenda in support of global health goals, emerging threats, and new opportunities.

Emphasizing effective stakeholder engagement and knowledge management throughout, the main strategies of the HEARD Project are: (1) partnership and agenda development; (2) data liberation and evidence strengthening; and (3) research and evaluation study design and implementation; all of which contribute to the acceleration of evidence-to-use processes.

The HEARD Project uses thematic areas to focus its activities. These thematic areas continue to evolve and change over the life of the project in response to stakeholders’ identified needs and interests. The thematic areas during this reporting period are described in Annex A. Within each thematic area, the HEARD Project engages in a range of operational activities, including partnership and agenda development, evidence strengthening and data liberation, program communications, resource mobilization and accountability, research and evaluation study development and support capacity, and implementation of specific studies and sponsored activities.


PARTNERSHIP AND AGENDA DEVELOPMENT

PARTNERSHIP GOVERNANCE MECHANISMS

IMPLEMENTATION SCIENCE COLLABORATIVE AD HOC HEARD PARTNERS’ COMMITTEE

The Implementation Science Collaborative (ISC) will schedule its final Ad Hoc HEARD Partners’ Committee (“Ad Hoc Committee”) to be held at the Health Systems Research Symposium in Liverpool England in October 2018. During the meeting members of the Committee will agree to the draft governance documents (Workplan, Bylaws, Governance Manual, Framework). In preparation for the final meeting, ad hoc participants have consulted on the make-up of the Interim Steering Committing, agreeing to a six-category framing of the stakeholder groups which would serve on the steering committee.

The expectation is for the Interim Steering Committee to be launched following the final meeting of the ad hoc governance committee.

ESTABLISHING PRINCIPLES FOR STAKEHOLDER ENGAGEMENT

As the HEARD Project has engaged a wide range of stakeholders in the conceptualization of the ISC, a reoccurring question has emerged: how will the ISC manage asymmetric power relationships that can potentially undermine collaboration? Understanding that the ISC would need to be committed to ensuring comprehensive stakeholder engagement at each level, the Ad Hoc Partners’ Committee wanted to adopt principles of engagement. However, first, as there are no principles or metrics for measurement, these would need to be created.

In June 2018, HEARD together with the Georgetown University Law Center hosted an event featuring two high-level panels at the Law Center to discuss the need to create a more inclusive process for establishing implementation science research agendas for the improvement of health in low and middle-income countries. The convening of the distinguished group of panelists and audience members represented one step in a longer process that has taken place over the last year to create agreed-upon principles for stakeholder engagement in the priority-setting process for implementation science and research.

The high-level panels both moderated by Dr. Stefano Bertozzi, former Dean of UC Berkeley School of Public Health and Professor of Health Policy and Management, focused on two key topics. First, what is the current understanding of the best practices for engaging all relevant stakeholders in priority-setting for implementation science and research? Second, building off the initial conversation, what is needed to make research more relevant and accessible so that it is can be used to address local, national, and global health challenges? Participants in the discussion are listed below:

Contribution Name Title and InstitutionOpening Remarks

John Monahan Senior Fellow and Senior Advisor to the President of Georgetown University for Global Initiatives

Moderator Stefano Bertozzi Professor of Health Policy and Management, School of Public Health

University of California, Berkeley

Panel 1 Matt Barnhart Senior Medical and Scientific Officer, USAID


Deus Bazira Founding Director, Center of International Health, Education and Biosecurity, University of Maryland School of Medicine

Lisa Carty Director, U.S. Liaison Office - The Joint United Nations Program on HIV/AIDS, UNAIDS

Charles Holmes Co-Director, Center for Global Health and Quality, Georgetown University Medical Center

Anne Peterson Senior Vice President, Global Programs, Americares

Panel 2

Luis Gabriel Cuervo Amore

Senior Advisor, Research Promotion and Development, Health Systems and Services Department, PAHO

Agnes Binagwaho Vice Chancellor, University of Global Health Equity

Matthew Kavanagh

Director, Global Health Policy and Governance Initiative, Georgetown University Law Center, O'Neil Institute

Rachel Sturke Deputy Director, Division of International Science Policy, Planning and Evaluation (DISPPE), NIH-Fogarty

Closing Remarks

Maeve McKean Senior Policy Advisor, Center for Immigrant, Refugee and Global Health at City University of New York (CUNY), USAID’s Health Evaluation and Applied Research Development (HEARD) Project

A meeting readout was drafted, and a commentary paper on the need for principles is currently underway. The paper is being co-written by panelist participants, and a first draft was completed in this reporting period. Next steps include moving towards publication and using lessons learned to develop the shared principles.

Consultation process and Surveys

Recognizing that understanding and overcoming the challenge of engaging stakeholders in the agenda setting process requires engagement with stakeholders in articulating what is needed, the HEARD Project has undertaken a process to gather the opinions of stakeholder on this issue. Collecting over 100 opinion surveys at multiple conferences, the HEARD Project continues to collect robust data which both confirms the hypothesis of the agreed upon importance of stakeholder engagement, while seeing that there is a feeling that it is not well done. This survey has been conducted at:

CUGH, New York, March 2018

ECSA- HC, Tanzania April 2018

WAHO BPF, Ghana, 2018 (anticipated)

ORGANIZING UPDATE ON THE DEVELOPMENT OF THE ISC AT HSR2018

As part of HEARD’s preparations for participation at HSR2018, a meeting will be convened to update interested stakeholders on the Partnership’s achievements and progress since HSR2016 (Vancouver) in efforts to stand up and develop the ISC. The meeting will offer an overview of the theory behind the ISC, including laying out a two-year vision. It will also feature a discussion of the value of a formal partnership that includes diverse stakeholders spanning implementers, advocates, policy-makers, researchers, and donors.


TECHNICAL RESOURCE DEVELOPMENT

DIRECTORY OF TECHNICAL RESOURCES

The Implementation Science Technical Resource Directory is aimed helping implementation science partners and experts connect and collaborate. With information organized in an interactive and easy-to-find format, the directory will include participating researchers, implementers, policymakers, advocates, funders, and other implementation science community members.

Based on results from the survey that was conducted in the last reporting period, UCSF explored and tested several potential platforms including Salesforce, eXo Platform, and eDirectory

Based on testing (features/functionality), speaking with various representatives, and cost, neither Salesforce and eXo Platform are viable options

o Note: depending on how the TRD grows, Salesforce may be an option in the future

eDirectory is currently being tested and seems to be the most promising; UCSF will mock-up a sample directory to share with the team for feedback

DEVELOPING AN EFFECTIVE CASE STUDY PLATFORM

HEARD is working to develop CaseMaker, a web-based platform that addresses a need for more innovative, open-source mechanisms that facilitate evidence sharing and use. It uses a human-centered design approach that (1) walks case study developers (e.g. implementers, researchers, advocates) through the process of developing a case study and (2) acts as a library of IS case studies that can be accessed by evidence users. From the case study developer perspective, the platform prompts and guides research teams to input key findings and experiences into a template. From the end user perspective, CaseMaker houses open-source case studies in a searchable web-based library. In FY18 a HEARD-contracted developer completed a demo of both the developer and library portions of the platform with two initial case study template options. In FY19, HEARD will work to populate the case study library with existing and new case studies, gathering feedback on user experiences with both platform components as we go.

In support of this platform development and in coordination with the UCSF and UCB Center for Global Health Delivery and Diplomacy (CGHDD), HEARD Global Technical Anchor, a landscape analysis of existing case study libraries was completed, and a survey was implemented among those who consume and share evidence and lessons learned relevant to Global Health Implementation Science.

The landscape analysis identified several sources for case studies online, but the organizations listed below had the largest and most relevant collection of global health case studies relevant to implementation science in low- and middle-income countries (n>15). Among these organizations, 283 case studies were reviewed. Cornell University (Division of Nutrition) had the largest collection of case studies (n=88) identified, followed by the Global Delivery Initiative (n=64) which is a World Bank initiative.

Center for Global Development (# case studies=22)Cornell University (88) Global Delivery Initiative (64) Harvard University (20)

Pathfinder International (24)UNICEF (27) UNFPA (24) WHO (19)


Based on this landscaping, key elements for a ‘good’ implementation science case study included:

● Studies must clearly describe the desired health impact of the intervention of the target population, providing evidence (i.e., in the form of evaluation results) to support their intervention. Results should focus on health metrics which may include resource use, costs, economic outcomes, as well as analysis for the implementation and intervention strategy.

● Implementation science case studies should clearly demarcate where in the implementation pathway they are. A good case study clearly identifies if they are focusing on an implementation development/strategy versus the delivery/intervention. For example, the implementation strategy might include staff training, development of protocols and the creation of monitoring tools while the intervention might include peer education sessions and counseling. This is of utmost importance for users who would like to adapt different strategies throughout different phases of their research/interventions.

● Reports must detail the background/context in which the intervention was implemented (i.e. social, economic, policy, health systems and organizational barriers and facilitators that might influence implementation, as well as unintended consequences and contextual changes that may have affected outcomes).

● Additional in-depth discussion of policies, practices and research implications should be included, specifically in regards to scalability of the implementation strategy and sustainability of interventions.

● Attention must be paid to fidelity, or the degree of adherence to the implementation strategy and intervention, as well as adaptation, the degree to which the intervention is modified based on the local context. It is also essential to document the decision-making process regarding programmatic adaptations. A lack of fidelity of an intervention may reduce the level of effectiveness, while a lack of adaptation to the local context can inhibit effective implementation. These concepts can be highlighted when describing the implementation pathway, by highlighting the components to which fidelity is expected, and those that may be adapted.

● A challenge remains in providing sufficient information in an easy to read, condensed format. As such, it is highly recommended to provide an “abstract”. For example, the Global Delivery Initiative provides a “Quick Case Study” in addition to the full-length version.

The survey aimed to capture opinions related to the components that make a great implementation science case study, the information is most valuable to different types of users, and how to present information to ensure that it is useable by different stakeholders. The survey was released online (via QuestionPro) for three weeks in FY19 Q4 and obtained 216 responses. In-depth interviews with up to ten survey respondents will be completed in early FY19 to gather more in-depth information on user experiences with various case study platforms, including CaseMaker. Key survey findings include:

• Stakeholders are eager to share their work through case studies, but require support

• Common barriers include a lack of time, uncertainty about how to present work and confidentiality concerns

• Stakeholders would like templates, guidelines and instructions

• An easy-to-use, professional interface is important; peer review is less important


• 23% (n= 50) of our respondents were found to be working locally in a low or middle-income country (LMIC)

• Respondents seek evidence and best practices for the purposes of research (75%), continuing education (71%), program management (61%), advocacy (57%), policy (47%), and teaching (39%)

• Stakeholders prefer information resources with case studies and infographics/data visualization over other features

GLOBAL CONSULTATIVE MECHANISMS

GLOBAL MATERNAL HEALTH SYMPOSIUM

On 17 September 2018, the Gates-funded Maternal Health Task Force, part of the Women and Health Initiative at the Harvard T Chan School of Public Health, celebrated ten years and the end of the MHTF with a Symposium (the full event video can be found on Vimeo here). The Symposium was an opportunity to support and reconnect with the MHTF colleagues, as they were a former TRAction/HEARD partner. It also afforded the chance to meet with Mary Mwanyika-Sando from AAPH to plan for the RMC Tanzania work and planning visit to Dar es Salaam in October.

The event included keynote speeches by Joyce Banda, President of the Republic of Malawi (2012-2014) and Dr. Mary-Ann Etiebet, Lead and Executive Director, Merck for Mothers. The keynotes were followed by two moderated panels which included the following participants:

Aparajita Gogoi, National Coordinator, White Ribbon Alliance India

Christy Turlington-Burns, Founder and CEO, Every Mother Counts

Jigyasa Sharma, Doctor of Science Candidate, Harvard Chan School of Public Health

Margaret Kruk, Associate Professor of Global Health, Harvard Chan School of Public Health

Mary Mwanyika-Sando, CEO, Africa Academy of Public Health

Neel Shah, Director of the Delivery Decisions Initiative, Ariadne Labs

Nina Martin, Reporter, ProPublica

Richard Adanu, Dean of the School of Public Health, University of Ghana

Additionally, Global Health Visionary awards were given to 10 individuals from across the globe including Theresa Shaver (founder of the White Ribbon Alliance for Safe Motherhood) and Ozge Tuncalp of WHO. The full list can be found here: https://www.mhtf.org/2018/09/18/globalmhvisionaries/

There is no follow-on to the MHTF. The regular email, ‘Maternal Health Buzz’ with the 5 articles to readwill continue within the Maternal and Newborn Center of Excellence with the support of students under the leadership of Henning Tiemeier. It is unclear if there is a “way forward” or who will occupy this space or serve as this platform in the future.


SUB-REGIONAL CONSULTATIVE MECHANISMS

11TH ECSA-HC BEST PRACTICES FORUM AND 27TH DIRECTORS JOINT CONSULTATIVE

COMMITTEE MEETING

The 11th ECSA Best Practices Forum (BPF) and 27th Directors Joint Consultative Committee (DJCC) were hosted by the East, Central and Southern Africa Health Community (ECSA-HC) and held in Arusha, Tanzania on June 26-28, 2018 under the theme, “Universal Health Coverage: Addressing the needs of the underserved.” The meetings brought together a diverse range of stakeholders from ECSA-HC Member States and beyond, including senior Ministry of Health officials, health experts, health researchers, and heads of health training institutions from Member States, along with representatives from UN agencies and other multi-lateral organizations, and diverse collaborating partners in the region and beyond. The conference aimed to identify policy priorities and evidence to inform accelerated scale up of best practices in the ECSA region. HEARD partners from the ECSA region, including – Ifakara Health Institute (IHI), Infectious Diseases Institute (ID), TAMASHA and a local URC technical consultant—presented at the Forum

Following a thematic keynote address on urban health in East Africa by Churchill Shakim of TAMAHSA, Dr. Ester Elisaria from IHI and Dr. Jane Wanyama from IDI presented on a panel that highlighted the need for partnership and evidence to inform action around addressing the needs of the urban poor. Their presentation on the HEARD Project’s Three Country Urban Health Assessment and Implementation Science Collaboration Urban Health in East Africa, formally launched the Assessment. ECSA-HC, which is part of the Collaboration, will host a workshop to introduce and validate the Assessment findings on the fringes of the 2019 Best Practices Forum. In addition to the urban health contributions, URC consultant, Ms. Dorothy Temu-Usiri gave a presentation on Generating Evidence through Implementation Science to Institutionalize Respectful Maternity Care. This presentation built upon a recommendation from a previous Best Practices Forum regarding the need for implementation science to advance respectful care in Member States. Further, Dr. Fatuma Manzi presented on IHI’s use of quality improvement approaches to improve maternal health in Tanzania and achieve universal health coverage.

Among the HEARD Project’s major contributions to the event was the roll-out of the survey to assess the need and utility for some agreed-upon principles for stakeholder engagement in the priority-setting process for implementation science and research (described above). The survey of ECSA-HC BPF and DJCC participants represented an important step in the ISC consultative process. The survey was completed by 41 of 86 conference participants (48% response rate).

Overall, findings documented among respondents the perceived need for and importance of principles for stakeholder engagement. Findings point to near-unanimous consensus on the need to involve the following stakeholders in determining research priorities and questions: national policy makers, program implementers, academic researchers, advocacy groups/community-based organizations, donors and beneficiaries. They also highlight the perception among LMIC stakeholders that a) they do not have an equal voice in determining the focus of research and b) those who will use research findings often are not engaged until the end of research-to-use process.


EVIDENCE STRENGTHENING AND DATA LIBERATION

EVIDENCE REVIEWS

RAPID RESPONSE SYSTEMATIC REVIEW LEARNING MODULE

As a part of the efforts to improve the capacity of policy makers and researchers in producing credible evidence in a timely manner, Universitas Indonesia (FPH UI) conducted a 1-week course on Rapid Review. The course was held in 2-6 April 2018 at FPH UI campus. The purpose of the course was to introduce the concept of Rapid Review, how it differs from the regular systematic review, and to go through its step-by-step. By the end of the course, participants produced a rapid review protocol and should be able to implement rapid review steps. The course targeted graduate students of FPH UI of whom many are researchers or policymakers from various government institutions. The involvement of policymakers in rapid reviews not only will ensure that the review addresses the questions most relevant for improving public health policy but also to accelerate the translation of evidence into policy, which falls within the focus of the HEARD Project.

Twenty participants attended the course. They were graduate students, policy makers from the Research and Development Agency of the Ministry of Health, lecturers from other universities, and public health researchers and practitioners. The course was facilitated by members of UI-HEARD team, resource persons from the Department of Epidemiology FPH UI, and librarians from UI. The course sessions and modules were designed to allow hands-on experience through multiple practice sessions especially for literature search and using analytical software.

The 20 participants were divided into groups and each group was assigned to produce one rapid review protocol. Participants expressed interest in working on the reviews as per their protocol under the mentoring of FPH UI team. Participants provided positive feedback after the course. They perceived the hands-on experience and discussions to be very helpful. In fact, FPH UI received a request from 25 doctorate students to organize a systematic review and rapid review course. This Rapid Review Course was the first in FPH UI, but we expect that in the future, FPH UI will continue to conduct the systematic review and rapid review courses, contributing to the global efforts for improving the capacity of policy-makers and researchers in evidence synthesis.

Following the course, FPH UI consulted with the HEARD team on the protocols proposed by participants. Three of the protocols were considered to fit in HEARD's focus of interest and were reviewed further for the potential of being supported by HEARD. The three protocols focus on:

1. The use of TyG (Triglyceride-glucose) index to predict diabetes among pre-diabetic women of reproductive age

2. Association between antiretroviral therapy (ART) and adverse pregnancy outcomes in HIV-infected pregnant women

3. Comparison between magnesium sulfate (MgSO4) and other anticonvulsant therapies for the management of hypertensive disorder in pregnancy

The HEARD team provided feedback suggesting that the research questions be refined to focus on implementation research rather than clinical research. FPH UI worked with participants to refine the research questions; however, only the last two protocols above (which are on the use of ART and


MgSO4 treatment) could accommodate this. The research question on the use of TyG index for diabetes screening could not be reformulated into an implementation research question since the current research on this area are still generating evidence for the predictability of the TyG test rather than an implementation of the test. The refined protocols with implementation research questions are:

1. A Rapid Systematic Review on Barriers and Facilitators of ART provision among HIV-infected pregnant women

2. A Rapid Systematic Review on Barriers and Facilitators on the Use of Magnesium Sulfate (MgSO4) Treatment for Management of Hypertensive Disorder in Pregnancy

FPH UI will host a 1-day workshop to work with participants to refine the protocols, refresh their understanding of rapid review, and start implementing the initial steps of the review process. In addition, as a way to link with global discussions, UI FPH submitted an abstract to the Global Evidence and Implementation Summit 2018 (GEIS) that will take place in Melbourne on 22—24 October 2018. The abstract proposed a panel to share experience in conducting the Rapid Review course and actual implementation of rapid review involving policymakers from public institutions. The panel aims to facilitate dialogue on views and recommendations on how to increase the use of rapid review to improve health policy and program, its challenges and potential solutions, and how to strengthen the engagement of policymakers to accelerate the translation of evidence into policy.

LANCET COMMISSION ON TUBERCULOSIS

This commission will provide in-depth analyses of tuberculosis (TB) services and outcomes in several high burden countries. In each of these countries, the commission is using the framework of the ‘care continuum’ to characterize gaps in service and funding, as well as to model the impact of priority interventions. Furthermore, the Commission will attempt to provide the concomitant investment case for implementing these interventions. This Lancet Commission will reaffirm the WHO’s End TB strategy, while proposing both global and country-specific actions necessary to catalyze current efforts. In this reporting period, the Commission report was submitted to the Lancet for peer review (May 12, 2018) and is still under review. In the interim, the first High Level Meeting on Tuberculosis was held at the Union Nations in New York (September 26, 2018). The outcome of this meeting, in terms of the key declarations and statements, will inevitably change the message and emphases of the report. Once comments are received back from the reviewers, the Commission report will be updated to reflect the changes resulting from the High-Level Meeting on Tuberculosis.

Key outputs from the Commission since the last progress report include:

Website: The website http://buildatbfreeworld.org was launched on September 26th. It highlights key messages from the Commission report as well as specific activities related to the Commission. It includes infographics developed specifically from the report.

Publications: A number of supplementary publications and commentaries have been produced by Commissions related to the Commission and the topics therein. These include:

Reid MJA, Goosby E. Eradicating TB. BMJ. 2018 Sep 25; 362:k3918. PMID: 30254022.

Gottesfeld P, Reid M, Goosby E. Preventing tuberculosis among high-risk workers. Lancet Glob Health. 2018 Sep 24. PMID: 30262448


Daftary A, Mitchell EMH, Reid MJA, Fekadu E, Goosby E. To End TB, First-Ever High-Level Meeting on TB Must Address Stigma. Am J Trop Med Hyg. 2018 Sep 17. PMID: 30226149.

Shete PB, Reid M, Goosby E. Message to world leaders: we cannot end tuberculosis without addressing the social and economic burden of the disease. Lancet Glob Health. 2018 Sep 14. PMID: 30224288.

Pai M. Time for high-burden countries to lead the tuberculosis research agenda. PLoS Med. 2018. PMID: 29570726

Commissioners’ meeting: Commissioners will meet one remaining time in The Hague at the Union TB meeting in October 2018. This will be a brief and informal meeting to discuss the report and hopefully provide an opportunity for Commissioners to react to peer reviewers’ comments (if released by the Lancet by then). This meeting will also provide an opportunity to discuss the launch of the report, now tabled for the first quarter of 2019. Commissioners will pay for their own transport and accommodation expenses related to this meeting.

Symposium: The Commission will host a symposium at the CUGH conference in Chicago, in March 2019. This event will highlight key elements of the report as well as provide a context for discussing the pathway to ending global TB.

PROGRAM COMMUNICATIONS

GLOBAL AND SUB-REGIONAL COMMUNICATIONS STRATEGY

The HEARD Project and Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) Project are collaborating on a variety of areas with the goal of having one unified communication strategy across all HRP Programs. This includes continued collaboration on the Health Research Program (HRP) website, as well as a commitment to seeking out other opportunities for collaborative work.

Collaboration on social media activities has been identified as an area for improvement in our operational partnership. HEARD will share with CIRCLE all social media toolkit for feedback and support for dissemination. As part of this HEARD will coordinate with CIRCLE to identify a comprehensive social media process for the Fifth Global Symposium on Health Systems Research (Liverpool, October 2018). USAID’s Communication’s team will also be part of this work.

HEARD PROJECT WEBSITE

In looking at Google Analytics for the HEARD Project website for the time period of April 1, 2018-September 30, 2018, there were 620 visitors to the website, of which 126 are returning visitors. Standard metrics (such as users, return users, page views, unique views, etc.) will be established and reviewed regularly.

ISFORGH NEWSLETTERS

The Implementation Science for Global Health (ISforGH) monthly e-newsletter was created to provide updates on the HEARD Project as well as the ISC, one of the key outputs of HEARD. The purpose of the newsletter is to:


Increase awareness of implementation science and developments in the field

Advance awareness of the HEARD Project and of the ISC among partners and beyond

Share key HEARD activities with partners and beyond

Provide a forum for HEARD/ISC Partners to highlight their work

The newsletter is intended for a wide array of public health stakeholders including policymakers, implementers, researchers, and funders/donors. Each issue is focused on different key implementation science events or areas of interest:

April 2018: Multilateral Health Bodies Outside of the World Health Organization

May 2018: Creating an Implementation Science Collaboration on Urban Health in East Africa

June 2018: Rapid Reviews: Generating Relevant and Timely Evidence for Decision Makers to Improve Health Policy and Systems

July/August 2018: The 11th ECSA Best Practices Forum and 27th Directors Joint Consultative Committee

The monthly e-newsletter is sent out via Mailchimp to a listserv of over 2,000 people.

In April, we began A/B testing the subject line of each newsletter to see if certain subjects would garner more opens and clicks. Each month, a general subject line (Implementation Science for Global Health updates are here!) is tested with a more event or theme-specific subject (Regional bodies advance evidence-to-use). Results are compiled each month in a digital media update, but to date, nothing has been decisive. In the future, A/B testing subject lines and potentially content will continue to be tested. Testing day of week and time of day will also be conducted (keeping in mind that subscribers are all around the world—one person’s bedtime is the start to another person’s work day).

IMPLEMENTATION OF SPECIFIC STUDIES AND SPONSORED

ACTIVITIES

EXISTING HEARD ACTIVITIES

GHIS: BURKINA FASO: IMPROVING MALARIA CARE PROJECT EVALUATION

The IMC Project’s goal by the end of 2018 was to contribute to the reduction of malaria morbidity and mortality in Burkina Faso by improving the quality of prevention, diagnosis and treatment of malaria in 100% of the country’s public health facilities. The project aimed to contribute to a 50% reduction in malaria morbidity and mortality, relative to 2011 health management information system (HMIS) data. With the project originally due to end in September 2018, USAID/Burkina Faso requested an external evaluation to assess project progress and challenges related to malaria prevention and treatment efforts and to aid in the development of plans for future USAID-funded support to the national malaria control effort.

The evaluation has three aims: 1. To identify lessons learned and propose recommendations to guide the development of new

USAID-funded malaria assistance programs in Burkina Faso;


2. To assess the effectiveness of IMC Project design, implementation, and sustainability mechanisms; and

3. To assess progress towards achieving the expected results of the IMC Project (October 2013-October 2018);

a. Improve malaria prevention in support of the National Malaria Strategic Plan (NMCP) b. Improve malaria diagnosis and treatment interventions in support of the National

Malaria Strategic Plan c. Strengthen the NMCP’s capacity to plan, design, manage and coordinate a

comprehensive malaria control program.

The evaluation activities were completed in the previous reporting period, as well as the submission of the report on preliminary findings.

During this reporting period the evaluation team completed and submitted the final evaluation report to USAID. The HEARD project received USAID comments on the preliminary findings report on April 27. The final evaluation report addressing USAID comments on preliminary findings report was submitted to USAID on June 29, 2018. The executive summary of the report was developed as a more detailed stand-alone document and translated in French to share with the IMC project stakeholders at USAID’s discretion. On July 25, HEARD team received comments from USAID/President’s Malaria Initiative (PMI) and USAID Mission in Burkina Faso. The final evaluation report addressing all the comments and questions from USAID was submitted on August 14, 2018. USAID approval of the final evaluation report is pending.

Additionally, the HEARD project requested to present the evaluation findings to USAID AOR team and USAID PMI team in DC. The Mission has given a tentative concurrence for the presentation due to potentially procurement sensitive information in the report and possibly the presentation expressing the request that they would like to be involved in the review of both the report and presentation before they provide a final determination. On July 12, HEARD project sent the draft power point presentation for an internal debrief for the Mission’s review and approval.

GH PRO PROGRAM PERFORMANCE EVALUATION

The HEARD Project is conducting a performance evaluation of the Global Health Program Cycle Improvement Project (GH Pro). The purpose of this midterm evaluation is to review the project’s performance to date in the context of the landscape of various Global Health Bureau support mechanisms with the goal of identifying opportunities to add value, improving program quality and efficiency, and reducing costs.

During this period, the Evaluation Team reviewed and analyzed GH Pro documentation around operations and assignment output, performance, and client satisfaction, self-assessment sampling strategy, and available self-assessment data, all which had helped guide the development of sampling and data collection strategies. A three-component evaluation design was implemented to address the following three evaluation questions:

Q1. To what extent was the GH Pro Project effective and efficient in meeting stakeholder needs in three key project areas? (Program and Project Evaluation, Mission Support and Technical Assistance)

Q2. To what extent are USAID and PEPFAR evaluation quality standards employed and achieved by the GH Pro Project?


Q3. What is the comparative value of GH Pro to the USAID Global Health Bureau and Missions for the three key project areas considering other, existing mechanisms?

To address the first component: an evaluator-facilitated document review was conducted on a sampled selection of assignments; surveys were conducted with GH Pro clients, consultants, staff, and non-clients; and in-depth key informant interviews took place with a total of 25 GH Pro staff, 5 USAID GH Pro management team members, and a subsample of 4 Client Survey respondents who provided their emails for potential follow-up and either reported very positive or very negative experiences with the mechanism. Quantitative and qualitative results were analyzed to produce findings and conclusions. To address the second component, the Evaluation Team convened a Quality Reference Group (QRG) of eight evaluation experts who independently reviewed and consolidated views on the extent to which evaluations met quality standards based on USAID, PEPFAR, and existing literature standards. A two-step review process was implemented that included sampling, review and scoring, and data analysis.

To address the third component, additional key informant interviews with a subset of CORs/AORs from reviewed projects, a COR/AOR survey, and a Strategy Reference Group of six experienced, former USAID senior program managers informed an analysis that produced a Support Mechanism Matrix and a Map of Evaluation Products. These all determined findings and conclusions.

The Evaluation Team submitted drafts as well as a final version of the midterm performance evaluation report during this reporting period and provided in-person debriefs on evaluation results with GH Pro staff and USAID’s Bureau for Global Health.

URBAN HEALTH: EAST AFRICA THREE-COUNTRY NUTRITION ASSESSMENT

Partner Workshop

A two-day workshop was hosted by HEARD and held in Nairobi, Kenya at the UNICEF offices on May 3-4, 2018 and was attended by the co-directors, country teams, and UNICEF ESARO and country office delegates. The workshop allowed participants to deliberate upon the three-country assessment design, share country perspectives to date, and consider country team feedback to inform the assessment. The objectives of the workshop were to review the opportunity, provide inputs to the research plan, clarify roles and responsibilities, review timeline and consider opportunities for cross learning. The workshop allowed for buy-in by UNICEF and a deeper understanding of the assessment focus by all implementation teams. The workshop inputs were incorporated by the study co-directors into the “master assessment plan” for review by the urban assessment study review group.

Study Review Group

The study review group (SRG) terms of reference and assessment review forms were created and distributed to the standing and ad-hoc members of the SRG prior to convening (virtually) on August 15, 2018. The meeting was co-chaired by Dr. Danielle Charlet (HEARD/URC) and Dr. Sabina Rashid (JPG) and included participation of the SRG members from Save the Children, Muhimbili University of Health and Allied Services, Harvard University, and Project Concern International along with the assessment co-directors and USAID. The objectives were to provide technical review of the assessment approach and products, review and discuss the process to develop the study to date and provide further suggestions on additional strategic engagement of partners. The meeting resulted in inputs that were incorporated into the final version of the “master assessment plan” to be adapted by the country implementation teams.


Country Team Preparations

During this period, it was decided that Population Council and Africa Population and Research Centre (APHRC) would not both be able to lead the effort in Kenya due to limited funds. Upon discussion with Population Council, it was agreed to proceed with APHRC as the sole implementing partner in Kenya. The end of this period of performance included APHRC preparing their budget and work plan for approval toward the issuance of an agreement and IDI and IHI working on budgets and work plans for approval by URC. The budgeting and adaptation of the master plan process took longer than expected given the breadth of the assessment (multiple work packages) and limited funding.

RESPECTFUL MATERNITY CARE IN TANZANIA (IN DEVELOPMENT)

During the previous period of performance, USAID Tanzania formally bought into the HEARD project, allowing for more and better partner engagement around the advancement of RMC. Upon receipt of the funds, HEARD released a request for information to undertake RMC activities in Tanzania. Three applications were received and reviewed/scored by a technical review panel. The decision was to award AAPH funding to spearhead activities in collaboration with sub-regional anchor IHI. The agreement with AAPH was executed during this period. In addition, IHI worked on finalizing their work plan and budget for the RMC activities.

NEW ACTIVITY DEVELOPMENT

EVALUATION OF TWO MODELS OF SERVICE DELIVERY IN NIGERIA

USAID/Nigeria is investing in two new major health projects—Integrated Health Project and PMI for States—anticipated to start in late 2018. A comparative impact evaluation of the two projects was initially conceptualized by USAID/Nigeria and described in a scope of work (SOW) that was shared with the HEARD Project. The HEARD team provided written feedback on the SOW to USAID/Nigeria and this was followed by a series of discussions to plan a working visit to refine the SOW, including clarifying the objectives of the evaluation and the key evaluation questions.

In September, the HEARD team provided a concept note describing design considerations for consideration by USAID/Nigeria and future discussion, including the planning of the working visit.

SUPPORT TO DEMOCRACY, HUMAN RIGHTS, AND GOVERNANCE (DRG) PROGRAM EFFORTS

The envisioned support from the HEARD Project to the USAID/DRG efforts are in three major areas, namely: Assistive Technologies, Victims of Torture and Children in adversity. In this reporting period, the HEARD Project has held several meetings with DRG office representatives, individual and with the AOR team. Working overviews that include Theory of Change and results framework presentations have been developed through conversations between USAID/DRG staff and HEARD Project staff.

DRG: ASSISTIVE TECHNOLOGIES

The main thrust of the envisioned support from the HEARD Project to the DRG efforts addressing Assistive Technologies is the identification of and support of an independent institutional entity focused on advancing wheelchair technology and training related standards. Major anticipated efforts, to be further refined through the FY19 Implementation Plan process include:


1. Identification of Sub-Awards to Technical Partners

a. Establishment of Wheelchair Service Standards including potential accreditation or credentialing

b. Develop wheelchair product standards for adverse conditions c. Promote the adoption, utilization and contextualization of product standards, service

standards and related policies d. Maintain coordination among the wheelchair sector

2. Research/Implementation Science Activities: The components of activities that will be further elaborated will include efforts to:

a. develop and maintain a minimum data set; b. collect and house global data on wheelchair provision and outcomes; and c. develop investment case for wheelchair policies.

In this reporting period an RFI to identify technical partners was issued, a technical review panel was convened to review the submissions, and a recommendation to proceed with two applicants was submitted to USAID.

SIR1Evidence-based

product and professional

standards

SIR2↑ IS capacities in

LMIC research institutions

SIR3↑ IS capacities of

implementers

SIR4↑Demand for evidence from country-level

decision-makers

SIR5↑ Collaborative

learning networks among wheelchair-related profession associations and

advocates

SIR6Observatories established for

access to relevant implementation

evidence

Improved availability and accessibility of appropriate wheelchair products and services in LMICs

IR2Process and impact evaluations

enhance assessment and refinement of priority health programs

IR1Strengthen the evidence-base for wheelchair products and service

standards

Four Collaborative StrategiesPartnership and Agenda Development

Data Liberation and Evidence StrengtheningResearch Studies and Evaluation

Capacity Strengthening for Evidence-to-Use Acceleration

IR2+Sustainable Technical Standards Partnerships and

Collaboration

IR1+Better evidence use in advancing wheelchair standards

IR3IS strategies and efforts strengthen

international collaboration in wheelchair sector

Inputs/Activities

O1: Review of existing

evidence and identification of evidence

gaps

O3: Generation

of necessary evidence

O2: Ongoing synthesis

of evidence

O8: IS collaborations developed

O7:Working groups

established

O4: Country needs

assessed

O5: Investment

cases created

O6: Champions Identified

O9: Analysis of

procurement pathways for appropriate

products

O10: Establishing

credentialing/

accreditation pathway

O11: Contextua-lization of evidence/standards

DRG Assistive Technologies EffortsPresented in HEARD Project Results Framework

Proximal Outcomes

Indicative Outputs

Intermediate Outcomes

Distal Outcomes

Impact


DRG: VICTIMS OF TORTURE FUND

One of the biggest challenges facing victims of torture and those affected by torture is the lack of mental health systems of care in the areas that they live. While there are many interventions that have been demonstrated to be effective in clinical or limited settings, taking them to scale has been a challenge. The main thrust of the envisioned support from the HEARD Project to the DRG efforts addressing Victims of Torture will focus on advancing the evidence base for systems strengthening and effective intervention development and demonstration. Major anticipated efforts, to be further refined through the FY19 Implementation Plan process include:

1. System strengthening 2. Building evidence for psychosocial support interventions 3. Evaluation of existing efforts 4. Support secretariat functions of a USAID internal mental health services assessment,

development, and expert steering committee

SIR1↑ Use and

relevance of studies

SIR2↑ IS capacities in

LMIC research institutions

SIR3↑ IS capacities of

implementers

SIR4↑Demand for evidence from country-level

decision-makers

SIR5↑ Collaborative

learning networks

SIR6↑ Narratives on

successful IS approaches

Improved access to and integration of evidence-based mental health and psycho-social support (MH/PSS) interventions within the health system for victims of torture

IR2Improved process for use of evidence

base

IR1Strengthened evidence base for MH/

PSS interventions for VoT

Four Collaborative StrategiesPartnership and Agenda Development

Data Liberation and Evidence StrengtheningResearch Studies and Evaluation

Capacity Strengthening for Evidence-to-Use Acceleration

IR2+Sustainable IS Partnerships and Collaboration on

implementation and integration of MH/PSS approaches/interventions

IR1+Better evidence use for MH/PSS programming

IR3Strengthened IS strategies and efforts for international collaboration on MH/

PSS programming

Inputs/Activities

O1: Systematic review on systems’

approaches to MH/PSS

O3: Implementation study on scaling

up intervention/

systems approach

O2: MoH-engaged

proposals (responding to RFA) for testing

scaling-up interventions

O8: Internal MH Services Expert

Steering Committee launched

O7: Internal MH Services

Assessment conducted

O4: PSS approaches

tested

O5: Project evaluation completed

O6: Internal MH Services Expert

Steering Committee

process elaborated

O9: Community of Practice engaged to share new evidence

Victims of Torture Fund EffortsPresented in HEARD Project Results Framework

Proximal Outcomes

Indicative Outputs

Intermediate Outcomes

Distal Outcomes

Impact

health evaluation and applied research … semiannual report...health evaluation and applied...

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