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Lessons learned and recommendations

Operational research in health programmes supported by German Development Cooperation

GIZ Competence Center HealthProgramme to Support Innovation, Learning and Evidence in  HIV and Health Programmes of German Development Cooperation

on behalf of BMZ

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Content

1. Summary 5

2. Setting the scene 6

2.1 Why is health research for development re-emerging on the global agenda? 6

2.2 Which are factors that enable better research knowledge-to-practice translation? 8

2.3 What is the role of health research within German Development Cooperation? 10

3. Selection and appraisal of research projects funded through the sector project PROFILE 13

3.1 Process of project selection 13

3.2 Which kind of support was offered? 16

3.3 Supported research projects: which evidence gaps were addressed? 16

4. Evaluation of research projects and lessons learned 21

4.1 Quality of research cooperation between national and international researcher 21

4.2 Capacity building for research partner institutions 22

4.3 Benefits for the country health system / other sectors 22

4.4 Value added for implementation of German development cooperation programmes? 24

5. Recommendations and conclusions 25

5.1 Recommendations 25

5.2 Conclusions 28

6. References 30

Annex I: Definitions of widely used terms 32

Annex II: Factsheets of funded projects 33

Annex III: Questionnaire for assessment of research projects 49

Annex IV: Proposed criteria for the selection of research projects 51

Annex V: Proposed criteria for the selection of research partners 52

Annex VI: Short proposal format 53

Annex VII: Long proposal format 55

Annex VIII: Assessment long proposal 62

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Table of Boxes Box 1: Knowledge sharing 6Box 2: Health research capacity 7Box 3: Selected initiatives in German Development Cooperation at the interface between research and practice 11Box 4: Survey of selected sex workers in Zimbabwe 12

Table of Figures Figure 1: Factors influencing research knowledge-to-practice translation 8Figure 2: Different Notions of Evidence 9Figure 3: Procedure and corresponding responsibilities in the application and execution process as well as the services provided by PROFILE 15Figure 4: Map of PROFILE-supported research projects 17

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Acronyms and abbreviations

BMBF Bundesministerium für Bildung und ForschungBMZ Bundesministerium für wirtschaftliche Zusammenarbeit und EntwicklungCHF Community Health FundCIM Centrum für Internationale Migration und EntwicklungCOHRED Council on Health Research for DevelopmentDFID Department for International DevelopmentEDCTP European Developing Countries Clinical Trials PartnershipESTHER Ensemble pour une Solidarité Thérapeutique Hospitalière En RéseauESSENCE Enhancing Support for Strengthening the Effectiveness of National Capacity EffortsEVIPNet Evidence Informed Policy Network of the WHOGDC German Development CooperationHRP HRP is the main instrument within the United Nations system for research in human reproductionHPSR Health policy and systems research ILSSA Vietnamese Institute for Labour Science and Social AffairsKfW Kreditanstalt für WiederaufbauLMIC Low and Middle Income CountriesNHIF National Health Insurance Funds OECD Organisation for Economic Development and Co-operationPROFILE Programme to Foster Innovation, Learning and Evidence in HIV and Health ProgrammesTDR UNICEF/UNDP/WHO/World Bank Special Programme for Research and Training in Tropical DiseasesTGPSH Tanzanian-German Programme to Support HealthTOR Terms of ReferenceUNDP United Nations Development ProgrammeUNICEF United Nations Children’s FundWBI World Bank InstituteWHO World Health Organisation

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1. Summary

Since 2010, the sector project PROFILE commissioned by the Federal Ministry for Economic Coopera-tion and Development (BMZ) supported joint health research projects in partner countries. All projects aimed at contributing to results measurement as well as to research capacity strengthening. Being aware of the importance of health research and research capacity strengthening for partner countries as well as for development cooperation this paper reports on the grant implementation and research management processes and shows the results of a formal assessment of nine research projects supported by PROFILE through its component ´Results Measurement and Operational Health Research`. In general, the quality of the research cooperation between German Development Cooperation and research institutions in the partner countries was rated as good, however varied during the different phases of the single projects mainly due to budgetary limitations and varying degrees of engagement and time spent on the research. Joint research projects were seen by most respondents as a good instrument and opportunity for capa-city building in health research, but also in project management in general. All joint research projects reported at least moderate, but some reported also very good benefits with respect to capacity building for research partners. Most respondents indicated that the results of the research projects had some benefit for the whole partner country. It was, however, difficult to quantify the effects. The benefits for German Development Cooperation programmes were seen as manifold, ranging from a strengthened collaboration within the programme and an enhanced basis for the political dialogue with the partners to the concrete generation of baseline data for results measurement. Measuring the impact and other results of the health or social protection programmes was not a direct focus in many research projects. This would have required more time and involvement in the planning processes of the programmes. However, in many cases it contributed to generating data for baseline indi-cators and created the basis for future results measurement. In some cases data on specific target groups were made available which informed the programme about future design of interventions and support. A further benefit was the experience gathered with contracting and cooperating with national research partners in a structured way, and to learn about the selection of research partners and about assessing their research skills. This report concludes that establishing, commissioning and implementing a joint research project is a true alternative to contracting a consultancy from the North. With one budget, capacity building can be addressed in addition to generating data and evidence. Research results achieved and published by national research partners have a higher probability to be taken up by policymakers in the partner coun-try. There may be some uncertainty with regard to the research skills of national research organizations as compared to a well-known consultancy. Successful capacity building has a lot to do with less tangible elements such as ownership (research organizations, country), identity, legitimacy, values and motivation. Joint research always means capacity building for research on-the-job. These capacity building initiatives must be planned and implemented by both partners. If on-the-job training and regular communication and exchange between both partners cannot be guaranteed and no quality assurance is possible, a joint research project runs the risk of not being successful. It is recommended to create an internal support structure within German Development Cooperation to improve the quality of studies and research within its programmes. German Development Cooperation should engage more in health research capacity strengthening as this will also contribute to health systems strengthening. These efforts may be focused on health priority countries. Furthermore, an exchange with other donors and international initiatives to strengthen research capacities would be helpful.

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2. Setting the scene  

2.1 Why is health research for development re-emerging    on the global agenda?  The landscape of international development cooperation has changed dramatically over the past years. The Organisation for Economic Cooperation and Development (OECD) has coined the notion of ´shifting geography of growth and poverty` to describe the shifts in global growth and global power. With more countries transforming from poor to (lower) middle income economies the line between our traditional understanding of ´developing` and ´developed`, ´North` and ´South` and ´donor` and ´recipient` in-creasingly becomes blurred (Zoellick, 2011). Whilst the Millennium Development Goals (MDG) agenda has represented a ´welfare-oriented` era, debates on a post 2015 agenda put a stronger emphasis on South-South learning, knowledge sharing and the crucial role of science and innovation for development (Conway et al., 2010).

In order to adapt to the rapidly changing landscape and to provide support to its operational units and clients in the areas of collaborative governance, innovative solutions and open knowledge, the World Bank has recently launched the World Bank Institute (WBI). An Open Access Policy that took effect in July 2012 formalizes the Bank´s practice of global knowledge sharing and making research outputs freely accessible online. Free access to the vast storehouse of data (World Development Indicators) has already been provided since April 2010.1

Box 1: Knowledge sharing 

 “Knowledge sharing is defined as a process in which people, organisations and societies learn from one another with a view to strengthening their capacity to create sustainable development processes. [….] Knowledge sharing represents a new dynamic in the international cooperation debate and includes the dimensions of peer learning in transformation processes and innovative co-creation. This revolves around the need to forge development partnerships that go beyond the unilateral transfer of knowledge and finance, which are adapted to current global power shifts and so build a bridge between development cooperation and international cooperation. […] Knowledge sharing approaches already adopted by GIZ include: (i) Networks and personal/virtual dialogue platforms (e.g. Alliance for Financial Inclusion and alumni networks); (ii) Expert dialogues and negotiation of joint standards and regulations (e.g. Common Code for the Coffee Community); (iii) Support for top-level policy dialogues and for the preparation of specific themes (e.g. China and dialogue on the rule of law); (iv) drafting of joint studies; (v) physical and web-based databases; (vi) Mainstreaming of topics in the development cooperation community and (Ger-man) specialist communities […].” Source: GIZ Fact Sheet Methods and instruments – Knowledge Sharing https://intranet.giz.de/cps/rde/xchg/giz_intranet/XSL/hs.xsl/-/HTML/36071.htm (accessed 19.03.2013)

The British Department for International Development (DFID) has put into place an open and enhanced research policy where research is understood as “[…] a wide range of activities broadly designed to generate primary and secondary empirical data both to inform our own work and as global public good […].” The definition as a global public good implies that research outputs

1 http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23164771~pagePK:64257043~piPK:437376~theSitePK:4607,00.html (accessed 19.03.2013)

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(i.e. study findings and full text versions) which result from grants or contracts awarded after November 2012 are accessible for free and without restrictions to any user worldwide via an online searchable user friendly database. 2 The policy aims to contribute to increased research uptake by decision makers, better policy choices based on available evidence and thus more value for money. DFID is further committed to influence other donors to head into the same direction. Health is one of 12 themes in DFID’s searchable development database.

Other organisations that promote the systematic use of research evidence in policy-making in low and middle income countries and focus explicitly on health are the Evidence Informed Policy Network at WHO (EVIPNet) within WHO and the Council on Health Research for Development (COHRED) based in Geneva. Both argue that especially when resources are scarce it is even more crucial to address health system challenges based on high-quality evidence in order to use those resources efficiently.

This requires a minimum level of health research capacity (Box 2). Despite early reluctance of ´donor` countries to invest in health research capacity building due to lack of quick results, capacity building in health research is now increasingly seen as an important goal of governments in low and middle income countries (LMIC) and external agencies.

Box 2: Health research capacity

“…is the ability to identify problems, set objectives and priorities, build sustainable institutions and organizations, and identify solutions to key national health problems (Global Forum for Health Research, 2000). This is a broad definition that goes far beyond basic, clinical and other disease-specific research. The main goal of health research is ´the advancement of scientific knowledge and utilization of knowledge to improve health and health equity.” (Sadana & Pang, 2003)

However, there is no consensus how to achieve this in the most efficient way. Capacity building would result in strengthened health research programmes with higher ability to conduct research, use results effectively, and thus also enhance the demand for research (Suwanwela, 2001).

2 Research for Development (R4D): http://www.dfid.gov.uk/R4D/ (accessed 19.03.2013)

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2.2 Which are factors that enable better research    knowledge-to-practice translation?3

“Rarely does research supply an ‘answer’ that policy actors employ to solve a policy problem. Rather, research provides a background of data, empirical generalizations, and ideas that affect the way that policy makers think about a problem” (Davies 2013).

Drafting of joint research is an important knowledge sharing approach. Policy makers and practitioners use findings from research in three different ways:

(1) instrumental use involves acting of research results in ´specific` and ´direct ways`, (2) conceptual use involves using research results for ´general enlightenment`, results influence actions, but in less specific, more ´indirect` ways than instrumental use, (3) symbolic use involves using research results to ´legitimate and sustain pre-determined positions`.

With an increased number of organizations and actors in international cooperation adapting open and enhanced research policies and the principles of knowledge sharing, evidence derived from many research disciplines and composed of several methodological strands is readily available. In an ideal world, all health decisions would be evidence-informed and based on findings generated through high-quality re-search. In the real world setting, however, there are a number of factors other than evidence that influence decision making (Figure 1).

Figure 1: Factors influencing research knowledge-to-practice translation

3 This section is based on a presentation from the LIDC-3ie London seminars by Dr. Philipp Davies http://www.3ieimpact.org/en/events/3ie-london-seminar/3ie-lidc-london-seminar-2013 (accessed 19.03.2013)

Resources

Evidence

Factors Other Than Evidence

Lobbyists &Pressure Groups

BureaueraticCulture

Judgement

Paragmatics &Contingencies

Values andDesicion Making

ContextExperience

&Expertise

Source: LIDC-3ie seminar, February 2013, presentation by Dr. Philipp Davies (Davies, 2013)

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Defining strategies for enhanced knowledge-to-practice translation and research capacity development thus requires an understanding of these factors and beyond that some knowledge of significant features of evidence (Figure 2) as well as barriers to the use of evidence.

Figure 2: Different Notions of Evidence

Critical barriers to uptake of research findings are for example:

• policymakers´lackoffamiliaritywiththeresearchprocess, • researchers´lackoffamiliaritywiththepolicyprocess, • trust(lackoftrust)ofpolicymakersinresearchers(viceversa), • physicalaccesstoevidence, • cognitiveaccesstoevidence(i.e.lackofunderstanding), • lackofclarityinthepresentationofevidence,and • timelinessandavailabilityofevidence. Some features of evidence involve that following:

• evidenceisalmostalways´probabilistic`, • evidenceisoften´contextspecific`, • wefinddisagreementonwhatcountsas´evidence`, • evidenceisalwayscontestable/contested, • evidenceisrarelyself-evident, • notallresearchisofequalvalue/sufficientquality, • singlestudiescanmisrepresentthe´balance`ofevidence,;and • thereisaneedforsystematicreviews/synthesisofevidencerelevanttopolicymakers. In order to bridge the gap between policy makers and researchers and enhance research knowledge-to-practice translation and transfer relevant studies and literature found the following factors to be critical (Lomas, 2000; Petticrew et al, 2004; Lavos et al, 2005; Dobbins et al, 2007; Ouimet, et al, 2009; Rosen-baum, 2010):

Colloquial (Narrative)

Anything that seems reasonable

Policy relevant

Timely

Clear Message

‘Scienti�c‘ (Generalisable)

Proven empirically

�eoretically driven

As long as it takes

Caveals and quali�cations

Policy Makers`Evidence

Policy Makers`Evidence

Different Notions of EvidenceKnowledge

Translation and Transfer

Source: LIDC-3ie seminar, February 2013, presentation by Dr Philipp Davies, and J. Lomas et al., 2005

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• earlyandon-goinginvolvementofrelevantdecisionmakers, • localownership, • interactionsbetweenresearchersandpolicymakersincreasingtheprospectfor research by policymakers, • identifyanduseinterpersonalnetworksandface-to-faceinteractions, • identifywillingandableknowledgebrokers, • separate´strategic`fromoperationaldemandsforevidence, • getpolicymakerstoowntheevidence–notjustthepolicy,and • clearandeffectivecommunication.

2.3 What is the role of health research within German Development    Cooperation? 

Many health programmes supported by German Development Cooperation (GDC) commission a variety of studies (i.e. evaluations, impact assessments, costing studies, background studies, baseline studies, etc.) which produce knowledge and are thus (mostly small) pieces of research. There are some GDC activities of individual or institutional capacity building in research in general through scholarships, exchanges and trainings. Some examples of research and research-to-practice initiatives are shown in Box 1.

However, Germany has not yet developed a comprehensive, open and enhanced research strategy within development cooperation. Germany is only beginning to be part of larger initiatives to strengthen health research capacity in low- and middle income countries such as ESSENCE (Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts, a collaborative framework between funding agencies to scale up research capacity.4

Traditionally, collaboration that enables knowledge transfer and research has happened uni-directionally from rich to poor countries. These relationships are still important since developed countries are often at the cutting-edge of innovation. Though the nature of this collaboration has become more equal, more could be done to ensure that developing countries have equal ownership of any partnership. According to Robert Ridley, Director of the TDR (UNICEF/UNDP/WHO/World Bank Special Programme for Research and Training in Tropical Diseases), evidence suggests that when research is done within lower-income countries, with local leadership and ownership, it generally has greater impact than when it is driven from outside those countries.

4 http://www.who.int/tdr/partnerships/initiatives/essence/en/ (accessed 19.03.2013)

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Box 3: Selected initiatives in German Development Cooperation at the

interface between research and practice KfW Development Research …has the principle objective to help understand interrelationships relevant for development and encour-age rapid integration of new scientific knowledge into policy and practice. Important pillars are research cooperation projects, different publication formats, conferences and lectures to facilitate interaction between researchers and practitioners. To promote excellence in applied development research a yearly prize is awarded. More information: http://www.kfw-entwicklungsbank.de/ebank/EN_Home/Development_Research/index.jsp

PEGNet (Poverty reduction, equity and growth network)…was founded in 2005 as a joint initiative by the BMZ, KfW, GIZ, the Universities of Frankfurt, the University of Göttingen, and the Kiel Institute for the World Economy. The network aims at promoting exchange between scholars and development practitioners and political decision-makers who work on topics relevant to poverty, equity and growth. Beyond virtual communication the annual PEGNet confer-ences on selected topics are an important exchange platform. More information: http://www.pegnet.ifw-kiel.de/ GIZ Research meets practice – international cooperation for sustainable development In 2012 GIZ at its premises on Godesberger Allee in Bonn launched a new series of events covering a wide range of topics at the interface of academic research and development practice and looking at the potential of research and science to contribute to sustainable development. More information: http://www.giz.de/Themen/en/36603.htm Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes in Ger-man Development cooperation (PROFILE) with its component ´Results Measurement and Operational Health Research`

The Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes of Ger-man Development Cooperation (PROFILE) funded by BMZ is a supra-regional sector project with four independent but interacting units (components). As part of GIZ’s Competence Centre for Health (organizational unit OE 4320), the sector programme works on an inter-sectoral and cross-cutting basis. PROFILE´s component ´Results measurement and operational health research` was designed to enhance the quality of results measurement in health and social health protection programmes supported by German Development Cooperation. It provides orientation, instruments and methods for better results measurement and evaluation.

In line with its overall objectives, the component supported activities to measure results of projects in partner countries in the field of health and social protection supported by German Development Cooperation. This included also support in creating conditions for better results measurement because solid baselines are necessary to measure progress. Thus all operational research projects were part of our monitoring and evaluation support as agreed upon with the BMZ.

PROFILE-supported operational research projects have been carried out usually in cooperation between research institutions in the partner countries and German or European academic institutions or consul-tants using a twinning approach. These arrangements always involved both generation and transfer of knowledge as well as capacity development. Together with the systematic processing of evidence from studies and facilitating and promoting contacts between health projects and research institutions, opera-tional research aimed at improving the effectiveness of projects commissioned by BMZ in the long term. An example is shown in Box 4.

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Box 4: Survey of selected sex workers in Zimbabwe A good example of generating new evidence, transferring knowledge and building research capacity is the survey of selected sex worker populations in Zimbabwe, which GIZ commissioned in 2011 as a bio-behavioural survey in order to assess the impact of her involvement in the ´Sisters with a Voice´ HIV prevention programme for sex workers. The programme is being implemented since 2009 by Zimbabwe´s National AIDS Council and the Zimbabwe AIDS Prevention Project (ZAPP). The study was run by a native British researcher working for ZAPP at the Department of Community Medicine, University of Zimbabwe in cooperation with the University College London and the London School of Hygiene and Tropical Medicine, London. She did extensive training for Zimbabwean researchers and field workers during the study. The project was the first representative and scientific data collection on sex workers in Zimbabwe. The study generated data on HIV prevalence and service use of this vulnerable group. Within the planning process for the next GDC project phase the collected data was used to feed into baseline indicators.

Research findings also revealed strengths and weaknesses of the HIV programme. Results were used for adapting the programme in the second phase, which enabled a more effective approach toward HIV prevention among sex workers. Two peer-reviewed publications are being prepared in 2013 to publish the findings which have already been presented at conferences and as part of the GIZ gender week 2013.

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3. Selection and appraisal of research projects funded through the sector project PROFILE 3.1 Process of project selection

PROFILE developed a formal two-step application procedure for research proposals in order to meet transparency and quality requirements. To save resources of all participating partners and to encourage a maximum of programmes to benefit from PROFILE grants, the component `Results Measurement and Operational Health Research´ offered substantial support in all steps of the application and implementa-tion process.

Health and social protection programmes were informed about the research support via email and the Sector Network. For the first application a short proposal form (see Annex VI) had to be used and submitted to PROFILE, where at least one staff member and at least one independent expert assessed the proposal within a period of four weeks. This assessment looked at how far the proposal fulfilled the (core) criteria for research projects, which had been elaborated together with BMZ. Core criteria included a balanced regional focus (Africa and Asia) and thematic focus (HIV/AIDS, sexual and reproductive health and rights, health systems strengthening), direct link to results measurement, the question if evidence gaps are addressed and filled, time horizon, benefits for the partner country, chances of peer-reviewed publica-tions, availability of researchers in the partner country and others (Annex IV). After completion of this assessment, the applicant was either asked to adjust and re-submit the proposal, to submit an elaborated proposal (using long proposal format – Annex VII) with detailed budget information and timeline), or the applicant was informed about why the application was evaluated as not suitable. Short proposals could be submitted throughout the year. As the research project had to be completed by middle of 2013, it was nevertheless recommended to submit the proposal in due time. Those applicants asked to submit a long proposal (due within six weeks after notification) entered the application procedure for PROFILE funding. This type of funding was restricted to a limited number of applicants. PROFILE additionally supported those applicants ineligible for direct PROFILE funding to obtain funding from other institutions. The long proposal format was designed in such way that it could also be used as a research protocol.

On receipt of the long proposal format, an interdisciplinary advisory board assessed the proposal within 4 weeks. The final decision as to whether an application was accepted or rejected has been taken by the BMZ and PROFILE on the basis of the recommendations by the advisory board. Decisions were based on the mentioned criteria (Annex IV) within the scope of the funds available (10.000 – 80.000 EURO). After approval, the respective contracts (between the scientific partners in the country/ in Germany/ Europe and the implementation agency and/or the sector project PROFILE) were prepared, terms of reference were specified and budget allocated.

A summary of the procedure and corresponding responsibilities in the application and execution process as well as the services provided by PROFILE in the respective steps is provided in Figure 3.

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PROFILE offered substantial support in all steps of the application and implementation process. The project provided support in the application process as well as the execution: • supportintheidentificationofrelevantresearchquestionsandthemes, • supportinthemethodologicalandconceptualdesignofthestudy/evaluation, • supportinestablishingcontactswithscientificinstitutionsinGermanyandtheEU, • supportingeneratingadministrativedocuments(e.g.cooperationagreements), • supportingeneratingscientificdocuments, • scientificandadministrativebackstoppingoftheprojects, • supportinpublishingresultsandtransferringresultstootherprojects.

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Figure 3: Procedure and corresponding responsibilities in the application and execution process as well as the services provided by PROFILE

Preliminary clari�cation ofpotential research activities

Submission of short proposal

Preliminary assessment of shortproposal

4 weeks

4 weeks

Submission of long proposal

Rejection

Adjusted resubmission

Externalfunding

PROFILEfunding

Support in identifying scienti�cpartners, study design andcompleting the short proposal

Correspondence with applicantsand noti�cation regardingfunding

Support in identifying externalfunding sources and completingecternal proposal formats

Support in completing the longproposal

For GIZ programmes placementof in -house orders from PROFILE

Support in establishment ofcontracts and backstopping in theexecution/implementationEstablishment of all relevant

contracts and start ofexecution/implementation

Assessment of long proposal byadvisory board

Time frame Procedure Services provided by PROFILE

Support and clari�cation byemail/phone

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3.2 Which kind of support was offered?

PROFILE offered support to cover the following items and activities of the research project:

Staff: • Costsforresearchstaffinthepartnercountry • Fieldworkers’salariesTravel: • Travelcostsandsubsistenceallowancesforscientificexchangeofpersonneland experts participating in the project • Accommodationcosts • CostsforvisaCoordination, Training and Networking: • Activities(e.g.organisationoftechnicalmeetingsandseminars)forcoordination, networking and promoting the exchange of knowledge • TrainingcoursesandworkshopsformutualexchangeofexpertsDissemination or results: • Presentationoftheprojectanditsresultsduringconferencesorworkshops • Draftingofscientificpublicationsincludingthepaymentofnecessaryfees for publication Subcontracting: • Short-termassignmentsofGerman/EU/localexperts • Costsforexternaladvisorsandtrainers • Establishingmonitoringandevaluationsystems • Servicecontracts(e.g.forliteraturereviews,baselinestudies,qualityassurance activities)Other costs: • Costsofconsumablesandsuppliesprovidedtheyareidentifiableandassigned to the project • Localserviceproviders • Printingcosts • Translations.

3.3 Supported research projects: which evidence gaps were    addressed? In Table 1 the research projects are listed with topics, research questions, scientific partners and links to more in-depth information.

Since 2010 a total of 13 operational research studies across 3 continents were initiated and quality assured by the sector project (Figure 4). They covered a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania. Results of 9 studies are reported here. The remaining studies were specific studies in more than one country: (i) a special assessment of a Global Fund support tool co-funded by another sector project, (ii) support for the establishment of an M+E system of a faith-based organization in Malawi, (iii) the development of a research capacity strengthening M+E tool for an EDCTP funded research project , and (iv) and evaluation of the short course „Quality Management in International Health. They are not reported here because the focus of this paper is research capacity strengthening in specific countries with a link to a GDC programme. Besides measuring results or creating preconditions for improving results measurement, an explicit aim of the initiative was research capacity strengthening of local research partners. An overview of all joint re-search projects funded by the sector project can be found in Table 1, while the fact sheets of these research cooperation projects can be found in Annex II (Fact sheets of funded projects).

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Figure 4: Map of PROFILE-supported research projects

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Table 1: PROFILE-supported research projects  

Country / Project Fact Sheets

Topic Study Title / Final Study Report Research Question Scientific partners (international and national)

Bosnia and Herzegovina

✓ SRHR / HIV✓ Youth

The effectiveness of the Join-in-Circuit in changing health-related knowledge and attitudes of young people in Bosnia and Herzegovina/http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=77732742

Does the Join-in-Circuit have sustained effects at six months follow up? Can the effectiveness of the approach be increased by combining it with other information, education and com-munication elements (information sessions and peer education)?

Public health consultant in Bosnia Herze-govina, Charité Berlin - Institute of Social Medicine and Epidemiology

Ghana ✓ Employee wellbing programmes

Health Economic Model for EmployeeWellbeing Programme Ghana

Operational Public Health ResearchStudy Report: Health Economic Model for EmployeeWellbeing Programme Ghana:http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=64740179

CBA Tool for EmployersMonitoring and Evaluation GuideGhana Employee Wellbeing Programme – ReCHT:http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=68406625

Does it pay off from an employers´ perspective to invest in employee wellbeing programmes?

Swiss Centre for International Health (Basel Tropical and Public Health Institute)

Namibia ✓ HIV workplace programmes

Assessment of HIV WorkplaceProgrammes in Public and PrivateOrganisations in Namibia

Final study report:http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=76010607

HIV-related knowledge, attitudes and behav-iour and effects of HIV public and private Workplace Programmes in the Namibian context?

University of Namibia/ German consultant

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Nepal ✓ Local governance in health

Final version of follow-up study not yet avail-able

Baseline study:http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=77918601

University of Potsdam, Political Sciences/ INLOGOS/ SAIPAL (both Nepali public consultancies)

Philippines ✓ Measuring capacity development results

Essential Health Care Program

Master thesis „Effects of capacity development activities of German development cooperation on individual and organizational level as an example of the Essential health care program in the Philippines”:http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=69991125

Annex 1Annex 2Annex 3

In which way do partners learn through the Fit For School-Capacity Development activities? How does this learning change their behaviour? What helps them in their learning process?

German consultant supported by German University (Master’s thesis)

Tanzania ✓ Social health protection✓ Community health funds

Community Health Funds (CHFs) in Tanza-nia: Innovations Study

Final Report:

http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=75389255

What were the innovations and success factors that allowed community health funds in some districts to perform better as compared to others?

Swiss Centre for International Health Swiss Tropical and Public Health Institute with IFAKARA (Daressalaam)

Tanzania ✓ SRHR / HIV Sexual Harassment & Gender-based Violence in the Public Service

Final version not yet available

Sexual harassment at the workplace Research coordination: international public health consultant in Daresalaam, partner: Institute of Development Studies, University of Daresalaam, in cooperation with TACAIDS

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Vietnam ✓ Social pensions

The role of social pensions in improving old age security in Vietnam - a case study

Study Report (GIZ, ILSSA, evaplan):http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=77733110

What is the role of the monthly cash transfers to support the livelihoods of the elderly within the system of social protection in Vietnam? How should the benefit scheme be designed to respond to the basic needs of Vietnams elderly taking into account the country´s fiscal capacity?To what extent should the public administra-tion system in this sector be adjusted to be able to better facilitate the implementation of policies for old aged people?

Institute of Labour Science and Social Affairs (ILSSA), Viet Nam, and evaplan consultancy, Heidelberg

Zimbabwe ✓ SRHR / HIV✓ Sex workers social support networks

Survey of selected sex work populations conducted using respondent driven sampling in the towns of Mutare and Victoria Falls and Hwange

UCL study Report:

http://vm-csfe1.giz.de/dms/livelink.exe?func=ll&objaction=overview&objid=73084868

What are the demographic and behav-ioural characteristics and HIV prevalence of a representative sample of sex workers in the locations in Zimbabwe? What are risk factors of HIV infection and which structural and contextual factors influence risk? How do cognitive, emotional, contextual and cultural factors influence the uptake of HIV preven-tion and care services?

University of Zimbabwe (Zimbabwe AIDS Prevention project within the Department of Community Medicine), University College London, London School of Hygiene and Social Medicine

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4. Evaluation of research projects and lessons learned In the following chapter the results of the formal email- and survey-based evaluation of the nine research cooperation projects are summarized. The questionnaire is available in Annex III. 4.1 Quality of research cooperation between national and   international researcher

Most respondents stated that their research project benefits from a tandem between a national researcher or research group and an international partner. According to the majority of respondents, the major ad-vantage of hiring a tandem of international and national consultants is in the combination of internation-al expertise and methodology (workshops, toolkits, research plans, training inputs) with local knowledge and insights (conditions, feasibilities), which brings the study results closer to reality and better accepted. The national partner is more familiar with the framework conditions in the country and the feasibility to conduct research projects. When national research institutions are involved, there is a better acceptance of research studies through increased country ownership. It is mainly seen as the international partner’s task to give advice on me-thodological questions, select or inform the selection of the methodology and the research design and to comment the drafts of the interviews and guidelines, the research plan and the reports as well as give training inputs on important issues such as planning and study design, data collection, data entry and analysis and structuring the report. The national partner was often expected to design questionnaires, implement the research plan, and organize the practical phase including data collection, processing and analysis of data, report writing, data presentation and interpretation.

In Vietnam joint research activities `on the job´ (such as joint data acquisition and evaluation) were iden-tified as a key driver for a successful cooperation, which created the necessary good atmosphere and a basis for learning. Most respondents hold that it is very important to have a clear and common understanding of the roles and tasks of each partner; this should be written in the TORs. Among the major challenges with regard to the collaborations were the limited physical presence of and direct exchange with the international research partners, reliance on email communication, and delays when partners are not based in the same region. Some national research partners would have appreciated more technical assistance, more support, more resources, more hands-on support, e.g. in data analysis. Some collaboration projects suffered from a shortage of financial resources. In one occasion, language and cultural barriers were present which hampered the start of the project. Different views about the right methodological approach for answering the research questions were mentioned twice. Further problems and challenges identified in the beginning phase and the implementation phase were building confidence and consenting on the different views of the research partners, different understan-dings as to what the project could achieve (in many cases, due to the lack of a controlled design, no causal attributions were possible with regard to effects of interventions, but this was not always clear for all research partners) and a tight time frame. In general, the quality of research cooperation was rated as good, however varied during the different phases mainly due to budgetary limitations and varying degrees of engagement and time spent on the research.

 

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4.2 Capacity building for research partner institutions Joint research projects were seen by most respondents as a good instrument and opportunity for capacity building in health research, but also in project management in general. All joint research projects reported at least moderate, but also some very good benefits with respect to capacity building for research partners. In many cases, the local research partner was not as experienced in data collection, data management, data analysis and report writing as the international partner and benefited from the cooperation. In some cases methods, which were completely new to the local partner, had to be learned through workshops and on-the-job-training. This was particularly true for projects with a mixed methods approach which included both quantitative and qualitative methods. This led to setting up new systems for research projects which helped the whole national research institution. In many cases, research skills of the local partner were not completely clear, and in some projects their skills were overestimated. In two cases, the contract with the first local research partner had to be terminated due to insufficient data collection and analysis (Nepal and Tanzania), which resulted in contracting a new partner (in one case international, one case national). Many respondents stated that both sides benefitted from the research, particularly in those cases where there was a good information exchange among partners working on different levels (international scien-tific, national scientific, national practical). Participation in joint (methods) workshops and on-the-job-training was the most often used capacity building measure. In some cases, basic M+E skills needed to be transferred. It was also important to have an understanding of the capacity building needs of the national partners very early in the process. There was a consensus that research institutions of the North should not only backstop the activities of the national partner but joined data acquisition and evaluation should be fore-seen. Moreover, open questions should be discussed “among peers” and backstopping should not result in too many specifications from the North.

 

4.3 Benefits for the country health system / other sectors Most respondents thought that the results of the research project had some benefit for the whole partner country. It is, however, difficult to quantify the effects. Only half of the research results have already been presented at the policy level of the partner country. Only one respondent did see only a minimal influence on the partner country, but this was attributed to a major power struggle in the relevant ministries.

Two studies (the study on sexual harassment in Tanzania and the study on sex workers’ HIV status and health seeking behaviour in Zimbabwe) were the first studies exploring the issue in the respective coun-tries and are expected to have country-wide influence and publicity. In Zimbabwe, robust data on HIV prevalence in the target population could be obtained that can further be applied to other settings and used to estimate likely prevalence nationally.

In the study on old persons’ views about pensions in Vietnam, the results from interviews and the quali-tative approach of the study are regarded as additional information for policy decisions. The participation of a national research partner ensured a proper consideration of the framework conditions and helped to understand which measures proposed by the research are feasible to be further implemented. As a topic of currently high policy relevance in Vietnam, the study was seen as having high chances for consideration in ongoing policy processes. According to the cooperation partner (ILSSA in Vietnam), the results and the final report were disseminated to agencies and different stakeholders and were highly appreciated by the association of the elderly. However, the scope of the research was regarded as too small to create solid evidence and there were challenges concerning the acceptance of qualitative research methods because they are not widely known in the country which is mainly focused on quantitative data.

The health economic model for Employee Wellbeing Programmes in Ghana, which quantifies and priori-tizes the most important causes for productivity losses due to morbidity and mortality in Ghana, turned

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out to be very flexible and thus may lead to replications in other countries like South Africa, Tanzania and Kenya. The model developed by the consultants was widely disseminated and is likely to influence different employers’ decisions with regard to the establishment and expansion of work place programs.

The study on success factors for Community Health Funds (CHF) in Tanzania is seen by the respondents as instrumental for the national reform debate on National Health Insurance Funds (NHIF) and the health financing strategy in general. Although no robust evidence could be generated with the resour-ces invested, the “best practice” report with the recommendation to develop a comprehensive overall approach for CHF reform gives important inputs into the currently ongoing discussions on the national health financing strategy.

Although there is a problem of transferability to other settings, the study results from Nepal focusing on the impact of the Local Health Governance Strengthening Programme are seen as helpful for the whole country if widely disseminated and launched together with other development partners. It became clear that research results generated by national partners have higher probability to be taken up by policyma-kers, but only when of high quality.

In general, the results of the joint research project may be used in two ways. On the one hand concrete results and data for decision-making in the country are generated, which might be used by German Development Cooperation or within existing research-to-policy-transfer platforms in the country, thus influencing decision making processes. Secondly, the communication with the partner on the national level might be strengthened via joining the study steering or technical working group or via contributing to the regular communication between the partner agencies and GDC.

  4.4 Value added for implementation of German development    cooperation programmes?

The benefits for GDC programmes were seen as manifold, ranging from a strengthened collaboration within the programme and an enhanced basis for the political dialogue with the partners to the concrete generation of baseline data for results measurement.

In the Philippines, the research programme helped to translate the subjective experiences of the pro-gramme staff into a scientific framework as a basis for better communication with partners. Through this, changes and adaptions of the programme can easier be justified and are better accepted. In Vietnam, the cooperation between GIZ and the national research organization (where CIM staff had already been working) could be strengthened and the potential for further cooperation increased with dissemination of findings and GDC involvement in possible research-to-policy processes.

The study on Community Health Funds in Tanzania appeared to positively influence cooperation pro-cesses with partners by “facilitating the expressions of ideas and concerns and coaxing partners out of their shell”. The main benefit from the study, however, was referred to in terms of the political dialogue and the specific political advisory services of the GDC programme. Moreover, the close collaboration with a national research partner ensured a better access to national data as well as the proper consideration of the national background in planning a research project.

In Ghana the health economic model for employee wellbeing programmes could be used as an advocacy tool (supporting to make business cases for GDC-supported workplace programmes) and a tool for influ-encing decision-making processes and for acquisitions. With the study in Zimbabwe, GDC positioned its-elf as innovative and as a development partner which generates high-quality evidence in stigmatized areas. The study provided critical evidence to inform health policy. At the same time the study generated solid baseline data for results measurement of the programme. In addition, the study implementation process itself had positive influences on the uptake of the services the programme supported (because sex-works were informed by field workers on the services).

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Measuring the impact and other results of GDC programmes was not a direct focus in many research projects. Rather more, in many cases it contributed to generating data for baseline indicators and created the basis for future results measurement. In some cases data on target groups were made available which informed the programme about future design of interventions and support. In Tanzania for example, suc-cess factors for CHF schemes could be identified which informed the future work of the health financing component of the Tanzanian-German Programme to Support Health (TGPSH). A further benefit for GDC was the experience gathered with contracting and cooperating with national research partners in a structured way, to learn about the selection of research partners and about assessing their research skills.

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5. Recommendations and conclusions  

5.1 Recommendations Joint research should be based on three principles: (1) spirit of cooperation, (2) good (research) gover-nance and management and (3) a clear framework and standards.

Spirit of cooperation: 

Success factor 1: Joint research needs timeResearch projects should be planned timely. Designing a research study should already begin with the pro-cess of programming a new cooperation project or in the planning of a new phase. A good starting point would be a project appraisal mission, project progress report mission or other planning activities. Time for building confidence between research partners is a key challenge and precondition for success. It should be ensured that sufficient time is foreseen for joint planning, implementing and data evaluation and therefore for joint learning between Northern and national partners on the ground. Success factor 2: All partners need a common understanding of the methods, the outcome and the benefit of the researchThis concerns both the rationale and usefulness of a joint research cooperation for the country, the health or social protection programme as well as the required capacity of national research partners.In order to achieve a positive work environment and climate, a common understanding of the change to which a research project wants to contribute should be sought. Partners should feel free to state potential gaps in their own research capacity and develop a willingness to learn from each other. Planning a joint research project should be guided by the expected outcomes. It should be assessed in how far the project would be able to contribute to results orientation and/or results measurement of the GDC country programme and/or the cooperation. There should be a clear aspiration that the results of the study should be transferred into policy and thus be relevant for the partner country.A strong focus should also be laid on research methods. Often, partners have a different understanding of qualitative and quantitative methods. The discussion about the appropriate methodological approach should result in a clear and concise research protocol.Relevant external players (political decision makers, heads of the national research institute, representa-tives of relevant Ministries with their respective department in charge) should be involved at an early stage through creating a Steering or Technical Working Group to ensure a certain alignment of the project to national health strategies, to create ownership, to clarify the future use of the research results and increase engagement, accountability and commitment in the country. Success factor 3: The assessment should be viewed as the first phase in the implementation of the joint research An assessment phase should be implemented in order to get a picture of strengths and weaknesses of each participating research partner with regard to methodological skills, research management, human resource capacities, funding requirements, infrastructure etc. in order to gain a shared understanding of capacity building. This is the basis for transparency and mutual support as well as insight into each other’s work culture. The joint preparation of the project design should be viewed as a first phase in the implementation of the research with sufficient funds being available for these activities. It is essential to ensure that the project design is already completed prior to the implementation. During a “warming-up phase”, discussing the “guidelines” and understanding the “research logic” of the partner in the South are very important. The availability of sufficient funds (e.g. for translation, on-site availability of consultants) is a main success factor for this.

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Good (research) governance

Success factor 4: There should be a clear division of labour between all partnersThe joint collaboration should be at eye level and not just being seen as a support of national partners. In terms of maximum ownership the national research partner should get in the lead and Northern/interna-tional partners should provide backstopping. The joint elaboration of the concrete terms of reference (ToRs) for both research partners should be used to clearly allocate the roles and responsibilities together with the interests with all partners. Milestones should be foreseen so that problems can be identified early in the process and steering by the GDC pro-gramme is possible. Data collection will generally be the task of the national partner. There should, however, be intense back-stopping. Experience shows that quite a lot of resources should go into the design of good data collection instruments. The same is true for data entry and evaluation. Good instruments for this type of metho-dological research capacity strengthening are workshops, direct exchange within the institution in the partner country and additional joint workshops as a platform for discussions.The communication strategy and the communication channels should be explicitly clarified and be part of the ToRs. Regarding these clear steps, milestones (e.g. sanctions, consequences) and communication rules should be formulated. Research results should be presented in Workshops, launched in the partner country. The GDC program as a beneficiary of the research should be closely involved in the implementation and should be responsible for supervision in order to circumvent the risk of “failure”. One person in the GDC programme should be a focal point.In order to foster the acceptance and the quality of the joint research, national decision makers as well as the management of the national research institution should be represented and integrated into decision-making.

Success factor 5: Joint research needs resources and flexibilityThe research project’s implementation schedule should not follow too tight timelines. Moreover it should be possible if required and comprehensible, to adapt the budget for the research project. Although the re-search design, research protocol and plan should be as detailed as possible it is not possible to foresee how the research project develops. There should be some flexibility in the budget as well as the time frame.

 

Clear framework and standards:

Success factor 6: Joint research needs continued internal supportEven though many results will not sail under the flag of “research”, “studies” and “evaluations”, it is very useful for joint research within GDC programs that information on current “research” projects is systema-tically collected and compiled. As all GDC programs contain valuable information relevant for knowledge management and production and many have collected experience with commissioning or conducting studies, mutual learning will be facilitated and more exchange will be achieved. It appears that this kind of knowledge management would require a better GDC health platform and more support dedicated specifically to this task. Success factor 7: Use standardized forms for application and assessment of research proposals and studiesApplying for a grant and assessing proposals, as well as planning and designing the joint research project, should be executed with standardized forms/formats. These forms should have a strong focus on me-thodology and include particularly the following key questions: Is the research design able to answer the research questions? Can the research answer questions of causality or just look at associations? Is there enough methodological expertise available, and if not, who will implement research capacity strengthe-ning and do quality assurance? Is the time schedule realistic?Within the operational research conducted by the sector programme PROFILE, a set of specific and detailed standardized formats have been elaborated and piloted which are attached in Annex VI: Short proposal format, in Annex VII: Long proposal format and in Annex VIII: Assessment long proposal.

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Success factor 8: Research partners (international as well as national/local) should be carefully selected Although many joint research projects have a strong capacity building element, the expected outcomes of the research projects requires skilled researchers. It has been proven that with partners being experienced with joint research projects (e.g. research excellence centers or programme - supporting universities in Germany) more successful research capacity strengthening and better research outcomes can be achieved. Based on the experience of the Sector Programme PROFILE, some criteria for the selection of research partners have been elaborated and are attached in Annex V: Proposed criteria for the selection of research partners. Success factor 9 Monitoring and Evaluation capacity is necessary Besides monitoring the research project and assessing if it is achieving the expected goal, monitoring and evaluation of research capacity building should be explicitly addressed. Research capacity building M+E faces the challenge of capturing learning outputs and outcomes through the use of a simple log frame wi-thout posing a too heavy M+E burden on research partners. Only some key process and output indicators should be used for capacity building M+E. These indicators should fit into the research organizations’ own performance assessment framework. In this respect the sector programme PROFILE with the ESTHER partnership programme is currently piloting a collaborative framework for Monitoring and Evaluation of research capacity elaborated by ESSENCE/TDR. This may be used for joint research projects as a primer.

 

5.2 Conclusions  To establish, to commission and to implement a joint research project is a true alternative to contracting a consultancy from the North. With one budget, capacity building can be addressed in addition to gene-rating data and evidence. Even if additional funds for training, trips and joint workshops and other joint activities of international research partners or translation activities have to be provided, this investment is supposed to be cost-effective. Research results achieved and published by national research partners have a higher probability to be taken up by policymakers in the partner country. Research capacity building may not be seen as an additional element to health programs of German Development Cooperation, but rather a core element. There may be some uncertainty with regard to the skills and research capacity of national research orga-nizations as compared to a well-known consultancy. Therefore, it has to be understood, that successful capacity building has a lot to do with less tangible elements like ownership (research organizations, coun-try), identity, legitimacy, values and motivation and that joint research always means capacity building for research on-the-job. Capacity building initiatives must be planned and implemented by both partners. German Development Cooperation must tackle the challenge to achieve local ownership along with a high quality standard of research. To ensure this, capacity building steadily requires an assessment of needs and resources (writing skills, exposure to new research methods, IT). If on-the-job training of local partners and regular communication and exchange between both partners cannot be guaranteed and no quality assurance is possible, a joint research project runs the risk of not being successful. To improve the quality of studies and joint research within programmes of German Development Coope-ration, an internal support structure should be created. This unit located in implementing organizations such as GIZ should collect information on all ongoing research projects, provide standards and forms and foster their adherence. The unit should be able to provide methodological and research management support. It should promote the concept of joint research projects among GDC programme managers, develop common and uniform publication formats and support the publication of research results in peer-reviewed journals. A publication policy may be helpful.

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German Development Cooperation should engage more in health research capacity strengthening as this will also contribute to health systems strengthening. Thereby, efforts should be focused on health priority countries (e.g. Kenya, Malawi, Tanzania, Cameroon, South Africa, Nepal, Cambodia, and Bangladesh). Aside from the collaboration with the local and national partners, GDC in the health sector needs to ex-change with other donors and international initiatives in this area to strengthen research capacities (TDR, HRP, COHRED, ESSENCE network etc.). For Germany it is advisable to coordinate and cooperate with the German Federal Ministry for Education and Research (BMBF) and to increase cooperation between the health and education sector in general.

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6. References Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung (BMZ), 2009. Wissen für Ent-wicklung: Hochschulbildung und Wissenschaft in der deutschen Entwicklungspolitik. Ein Positionspapier des BMZ. BMZ SPEZIAL 161. Available at: http://www.bmz.de/de/publikationen/reihen/strategiepapiere/spezial161pdf(accessed 11 March 2013) Commission on Health Research for Development, 1990. Health Research – Essential Link to Equity in Development. Oxford, Oxford University Press Conway, G. and J. Waage, with Sara Delaney, 2010. Science and Innovation for Development. Published by UK Collaborative on Development Sciences, available at: http://www.ukcds.org.uk/publication-Science_and_Innovation_for_Development-172.html (accessed 11 March 2013) Costello, A. and A.Zumula, 2000. Moving to research partnerships in developing countries. BMJ 321(7264): 827-9 Council for Health Research and Development. Beyond aid. Research and development as key drivers for health, equity and development. Forum 2012, 24-26 April Cape Town, South Africa. Available at: http://www.cohred.org/wp-content/uploads/2011/04/COHRED_forum2012_web2-copy-high-res-final.pdf Decoster, K., Appelmans, A. and P. Hill, 2012. A Health Systems Research mapping exercise in 26 low- and middle-income countries: Narratives from health systems researchers, policy brokers and policy-mak-ers. Background paper commissioned by the Alliance for Health Policy and Systems Research to develop the WHO Health Systems Research Strategy. Available at:http://www.who.int/alliance-hpsr/alliancehpsr_backgroundpapermappingexercise.pdf Davies, P., 2013. From evidence to policy - Getting Evidence into Policy. Presentation. Available at: http://www.3ieimpact.org/en/events/3ie-london-seminar/3ie-lidc-london-seminar-2013/evidence-policy/?preview (accessed: 11 March 2013) Department for International Development (DFID), 2010. How to note Capacity Building in Research. A DFID practice paper. Department for International Development (DFID) Research Open and Enhanced Access Policy,2012. Available at: http://www.dfid.gov.uk/Documents/publications1/DFIDResearch-Open-and-Enhanced-Access-Policy.pdf (accessed: 11 March 2013) Dobbins et al, 2007. Public Health Decision-Makers’ Informational Needs and Preferences for Receiving Research Evidence, Worldviews on Evidence-Based Nursing, 3rd Quarter, 156-163, New York, Wiley Inc.

Global Forum for Health Research, Yvo Nuyens, 2005. No Development Without Research. Available at: http://www.sdh-net.eu/data/uploads/publications-library/no-development-without-research.pdf (accessed: 11 March 2013)

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Koon, A.D., Nambia, D. and K. D. Rao, 2012. Embedding of research into decision-making processes. Background paper commissioned by the Alliance for Health Policy and Systems Research to develop the WHO Health Systems Research Strategy. Available at: http://www.who.int/alliance-hpsr/alliancehpsr_backgroundpaperembeddingresearch.pdf (accessed 11 March 2013) Lavis et al, 2005. Towards systematic reviews that inform health care management and policy-making, Journal of Health Services Research and Policy, 10, Suppl 1 July 2005 S1:35. Lomas, J., 2000. Connecting Research and Policy, Canadian Journal of Policy Research, Spring, 140-144 Nuyens, Y., 2007. 10 best resources for... health research capacity strengthening. Health Policy Plan 22(4): 274-6.

Ouimet, M., Landry, R., Ziam, S., and Bédard, P., 2009. The absorption of research knowledge by public servants, Evidence and Policy, 5, 4, 331-350.

Petticrew, M., et al, 2004. Evidence for public health policy on inequalities: 1: The reality according to policymakers, Journal of Epidemiology and Community Health 2004;58:811-816

Rosenbaum, S.E., et al, 2010. Evidence summaries tailored to health policy-makers in low- and middle-income countries, Bulletin of the World Health Organization, 89, 1, 54-61.

Sitthi-Amorn, C. and R. Somrongthong, 2000. Strengthening health research capacity in developing countries: a critical element for achieving health equity. BMJ 30; 321(7264): 813-7 Suwanwela C. and V.Neufeld., 2001. Health research for development: realities and challenges. In: Neufeld V., Johnson N.(edts), 2001. Forging links for health research: perspectives from the Council on Health Research for Development. Ottawa: International Development Research Centre: 245-8. Viergever, R.F. and A. Ghaffar, 2011. Reviews of WHO Documents on Health Research. Background paper commissioned by the Alliance for Health Policy and Systems Research to develop the WHO Health Systems Research Strategy. Available at: http://www.who.int/alliance-hpsr/alliancehpsr_backgroundpaperreviewsdoc.pdf (accessed 11 March 2013) World Health Organization (WHO), 2012. Changing Mindsets. Strategy on health policy and systems research. Available at:http://www.who.int/alliance-hpsr/alliancehpsr_changingmindsets_strategyhpsr.pdf (accessed 11 March 2013) Zoellich, R., 2011. Beyond Aid. Speech by World Bank Group President Robert B. Zoellick. September 14 2011. Available at: (http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23000133~pagePK:34370~piPK:42770~theSitePK:4607,00.html) (accessed 11 March 2013)

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Annex I: Definitions of widely used terms

Research can be defined as the generation of new knowledge using scientific methods. Health research is best viewed as a broad and robust concept that includes not only biomedical and clinical research but also epidemiological and related community health research, health systems research, health services research and operational research. According to the Commission on Health Research for Development (Commission on Health Research for Development, 1990), health research serves four main purposes:

(1) to identify and set priorities among health problems; (2) to guide and accelerate application of knowledge to solving health problems; (3) to develop new tools and fresh strategies; and (4) to advance basic understanding and the frontiers of knowledge. Health research can be conducted not only by trained scientists, but also by governmental and non-go-vernmental agency staff, district health managers, and the communities under study themselves as in the case of participatory research provided they use valid scientific methods. The Commission on Health Research for Development identified four components as “essential health research” (Commission on Health Research for Development, 1990): (1) Analysis of the burden of illnesses and their determinants to identify and set priorities among health problems; (2) Research to guide and accelerate the implementation of research findings to tackle key health problems (for example, the cost effectiveness of preventing death from malaria among poor rural population); (3) The development of new tools and methodologies to measure and promote equity (a project to promote trust between the government and rural poor in Brazil resulted in improved maternal and child health); and (4) Basic research to advance understanding of disease and disease mechanisms and to develop orphan drugs and vaccines

Health policy and systems research (HPSR) more explicitly than any other type of public health research addresses the challenge that health systems are highly complex, multi-layered and non-linear. Knowledge about which component of the system potentially bears high leverage effects with regard to increased health return on investment is therefore crucial (also to avoid domino effects when any com-ponent of the system is malfunctioning). HPSR is increasingly being distinguished by its feature to focus on solving problems rather than testing hypothesis. Lessons drawn are generated from existing practices and add to knowledge obtained from designed research studies (WHO, 2012, Bejing Background Paper Changing Mindsets).

Health research capacity is the ability to identify problems, set objectives and priorities, build sustainable institutions and organizations, and identify solutions to key national health problems (Global Forum for Health Research, 2000). This is a broad definition that goes far beyond basic, clinical and other disease-specific `research´. The main goal of health research is the “advancement of scientific knowledge and utilization of knowledge to improve health and health equity” (Sadana & Pang, 2003).

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Annex II: Factsheets of funded projects

v

Education, Health, Social Protection

Bosnia and Herzegovina

The role of the Join-in-Circuit in changing health-related knowledge and attitudes of young people

Background

The concept of Join-in-Circuit on Aids, Love and Sexuality (JiC) was first introduced in Germany by the Bundeszentra-le für gesundheitliche Aufklärung (BZgA – German Federal Centre for Health Education) in 1987 and has since been locally adapted and implemented in more than 18 GDC partner countries as diverse as Russia, Mongolia, El-Salvador and Mozambique. The original aim was to serve as an HIV prevention tool. However, the JiC is increasingly been used for other preventive activities. It uses interactive exercises, visualisation of examples and pictures to give young people from the age of 15 years information and knowledge and to motivate them to change their behav-iours.

In Bosnia and Herzegovina (BiH) 20 municipalities were selected to participate in the new Health Awareness Raising for Youth at Local Level project during 2009-2011 applying the JiC approach in combination with other IEC elements, such as health information points and peer sessions in schools. The JiC approach was adapted to discuss 5 major topics at the JiC stations. 1: Contraception and Condoms, 2: Transmission of HIV, 3: Love, Sex and Gender roles, 4: Risky Behaviour, and 5: Healthy Living.

Evidence gap addressed by the research

The study aimed at assessing the effectiveness of the JiC approach in combination with other IEC elements (infor-mation points and peer-to-peer sessions) compared to only using the JiC approach or having no intervention at all. Effectiveness regarding increased knowledge and changed attitude was measured concerning:

1. Sexually transmitted infections (STIs)

2. Contraceptive use

3. Physical and sexual violence as a major health hazard among youth in BiH.

Research partners

Public health consultant in Bosnia Herzegovina, Charité- Institute of Social Medicine and Epidemiology

Methodological approach

The study was designed to evaluate the impact of the inter-vention. Two treatment (intervention group A: JiC with other IEC elements, intervention group B: only JiC) and one control group (no intervention) from 15 schools across 5 regions in BiH were identified by purposive sampling. Since randomization was not possible due to political rea-sons, the groups were matched on employment, average income, population, size of municipality area and number of pupils in elementary and high school to assure a minimum comparability. The study aimed at including approximately 100 adolescents per municipality. This resulted in 500 pupils per group and, with three study groups, a total study sample of 1500.

Data was collected before and after the JiC as well as 6 months later through self-administered class room ques-tionnaires that were appropriate for the age group of 14 -16 year olds. Baseline data (t0) for all three groups and post-JiC data (t1) for intervention A and B groups was collected in February / March 2011. A six months follow up survey (t2) in all three groups was done in September 2011. This set-ting was chosen to allow a “before and after” comparison with the control group, by which baseline data, data right after the intervention and at the time of the study from the treatment and a control group is evaluated. However, dur-ing the implementation of the study and in the analysis phase, some limitations concerning data quality were dis-covered:

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

Municipalities were matched on observables so that some bias due to unobserved heterogeneity may remain. Data analysis pointed out some problems of data quality including implausible and inconsistent, spurious data, inac-curate unique participants´ identification, questionable changes for different time points, and implausible entries for missing or non-missing data. Due to the lack of access to original data (paper questionnaires), many data quality issues could not be resolved. Thus, for the data analysis doubtful values were set to missing, and some participants needed to be excluded. Of originally 1374 participants in-cluded in the study, data for only 1169 could be analysed. Due to these limitations, the findings should be interpreted with caution.

Results

The study clearly indicates that some gains could be made with regard to knowledge about ways of HIV transmission. Improved awareness of risky behaviour - especially con-cerning HIV protection – though is not visible. It seems that the JiC approach in combination with other IEC ele-ments is most effective in raising awareness on HIV preven-tion on a short term right after the intervention. Sustainabil-ity at six months follow up seems to be most effective when using the JiC as a standalone approach. Apart from that, both intervention types achieve knowledge increase on STI, HIV transmission and HIV testing.

Significant knowledge-behaviour gaps remain concerning risky sexual behaviour, especially non-use of condoms. None of the intervention types achieved a behaviour change concerning use of safe contraceptives.

An increased willingness of respondents to get an HIV test is visible for both approaches, this not seeming to be a problematic point in BiH.

Awareness on sexual violence and reduced tendency to accept and use sexual violence was achieved only on the long run with intervention B. Intervention A showed no effects here, thus leaving room for further improvement.

Implications / Value added for partners and GDC

The findings of this study provide information on the effec-tiveness of the JiC approach in increasing knowledge and changing attitude with regard to STIs, contraceptive use as well as sexual and physical violence. However, data quality was low so that further research is required to gain scientific proof on the JiC approach.

Contact

Dr Stefan Weinmann E stefan.weinmann@giz.de T +49 30 408190-394 I www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-

ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Ghana Health Economic Model for Employee Wellbeing Programme

Background

The growing double burden of diseases faced by low-income countries due to ever-present infectious diseases on the one hand and the steadily growing prevalence of non-communicable diseases on the other hand severely strains most public health services and causes enormous economic losses in addition to human suffering. This crisis has also challenged non-healthcare sector players to become in-volved in order to stem the tide of losses. Thus, employers both in the public and the private sector have been invest-ing in the health and wellbeing of their employees as a way to dampen the productivity losses caused by this enormous burden of disease. However, tools for enabling these non-healthcare specialists to make informed, evidence based investment decisions to safeguard and improve the health and well-being of their human resources and further to support the business case for these investments have so far been lacking.

Evidence gap addressed by the research

The GIZ in Ghana has commissioned this study to explore the profitability of existing employee wellbeing programmes in Ghana and to support the development of an economic model which translates the epidemiological profile of the employees into understandable measures of productivity losses and which enables employers to carry out a cost-benefit analysis of interventions being considered to allevi-ate these losses.

Research Partners Research partners: Swiss Centre for International Health (SCIH)

Methodological approach

In order to conduct the cost-benefit analysis, an Excel tool was developed that implements the model algorithms used to calculate costs due to absence days and presenteeism (i.e. remaining at work when ill due to fear of losing one’s job) based on the specific epidemiological profile of the employ-ee and data related to disease treatment. It allows the user to specify a set of input parameters such as data related to employees, disease-specific scaling factors and global set-tings. It consists of several work sheets which are grouped into various categories related to user input, the display of model predictions, and tables of baseline data. This model has then been used to analyze examples of best practice interventions within the GIZ and other employers.

Results The study shows that there is a positive net benefit to be realised by employers within a viable (business) time-frame from investing in needs-based, best practice health and wellbeing interventions for its employees. Furthermore, the results indicate that, based on very conservative assump-tions of productive work days lost, for many interventions employers can recoup most or all of their annualized in-vestment within each year.

The model succeeded in quantifying and prioritizing the most important causes of productivity losses due to mor-bidity and mortality. The main findings indicate that top five causes or diseases account for well over half of the losses:

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

Number Top five causes of productivity losses

Percent %

1 Malaria 24.99 % 2 Hypertension 12.42 % 3 HIV/AIDS 7.34 % 4 Skin diseases 5.87% 5 Obesity 5.65%

Total 56.27 %

Table 1: Top five causes of productivity losses, percentages of total.

The remaining top causes of productivity losses individually account for less than 5% of the total, which indicates that investments in interventions to alleviate them will also need to be modest in order to achieve a net benefit.

Implications / Value added for partners and GDC

The economic model developed permits employers to "test" any intervention targeting any of a wide range of priority causes of morbidity and mortality affecting its human re-sources. The testing allows great flexibility to change inputs for variations of interventions in order to calculate cost benefit ratios and the net benefit for each. This way the study renders an important contribution to making econom-ic benefits of health plans visible to employers and creates incentives for their implementation and expansion. Contact

Dr Stefan Weinmann E-mail stefan.weinmann@giz.de Tel. +49 30 408190-394 Internet www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Namibia Assessment of HIV workplace programmes in public and private organisations Background After the first reported case in Namibia in 1986, HIV rapid-ly became a generalised epidemic in the country, with preva-lence in pregnant women rising from about 4% in 1992 to about 19% in 2010. Accordingly, HIV has been estimated to be accountable for over 50% of all deaths in Namibia in 2002, and even though this number has dropped since then to about 23%, most likely because of the high coverage of antiretroviral therapy of about 90% nowadays, the disease still is one of the major causes of illness and death in the country. In the framework of the Namibian HIV response, a strong-ly targeted area of non-medical HIV interventions is work-places. Employees are relatively easy to access and, given the limited human resources of the country, it is essential for every employer and the nation as a whole to protect the working population. Accordingly, the establishment of Workplace Programmes (WPP) is an integral component of the National Strategic Framework for HIV/AIDS (NSF) of 2010, in order to respond systematically and effectively to the causes and effects of HIV and AIDS at the workplace. Quantifiable output and outcome parameters for the re-sponse to HIV and AIDS have been defined and the need for evidence based planning has been highlighted. Evidence gap addressed by the research Taking the evidence given so far, there is little published literature evaluating WPP, and results are equivocal, giving no clear answer on the impact of WPPs. Thus, it is of ut-most importance to evaluate the preventive effects of WPPs in Namibia as a basis for further planning and tailoring the HIV prevention strategy in the Namibian and Southern African contexts.

Research partners

Ministry of Health and Social Services (MoHSS) University of Namibia (UNAM). Methodological approach This study was performed as a cross-sectional evaluation of different WPPs in Namibia in the public as well as the pri-vate sector conducted between January and March 2011. In the public sector, the capital was compared to regional settings. In the private sector companies with established WPP were compared against companies with WPP only being steadily initiated in the year before the study was conducted. The assessment is based on a knowledge, atti-tude and behaviour (KAB) survey among employees and an additional survey on implementation status of and percep-tion regarding WPP among key management staff of the participating organisations. The cross-sectional assessment is used as a baseline against which a planned follow-up assessment within two to three years can be compared. The two ministries were selected as partners of the German Development Cooperation. Both have a WPP implemented and departments in all regions of Namibia. Regions were selected in order to represent the different settings of the country, covering high to low HIV prevalence regions. Results The study found WPPs to have an impact on testing rates in the evaluated companies, but at this point of time and im-plementation status no clear evidence for a general impact of WPPs on knowledge, attitude and behaviour of the workforce. There was no clear evidence that WPPs in-creased HIV related knowledge and information that was already provided at a large scale by other sources in Namib-ia, particularly in Windhoek (via radio, TV, newspapers, etc.); as it is done in Namibia. Given these findings, WPP’s

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

may add value by complementing the national multi-sectoral approach targeting sector-specific challenges and needs. Efforts should focus on practical support for the workforce, facilitating coverage of male and female condoms, provide approachable and well-known contact persons, offer volun-tary counselling and testing (VCT), and improve working conditions. General HIV education should be limited to facilitating extern (e.g. national) campaigns in the organisa-tion. In this regard, WPPs can be a strong partner for na-tion-wide campaigns, facilitating and leveraging external campaigns by procuring the WPP infrastructure. This is especially true for ministerial WPPs, also potentially cover-ing difficult-to-reach regions of the country. Furthermore, an urgent need for clear and well-communicated workplace strategies, covering HIV and AIDS, gender and occupational health, in all evaluated organisations was identified. The workforce as well as the management need to know rights, responsibilities and con-tact persons to make WPPs a success. The study also revealed implementation gaps in all evaluated WPPs. This highlights the urgent need for cost-effective monitoring and evaluation (M&E) systems, to discover undesirable developments early and guarantee effectiveness of the programmes. In the public sector, no clear differences could be shown between the Windhoek and the regions. Nevertheless, at the managerial level (directorates and regional heads of offices) a remarkable lack of involvement and understanding regard-ing the WPPs became evident. As successful programmes need a committed and supportive management, more effort

is needed to have the management in the driving seat of the organisational programmes. In the private sector, a higher need for information could be shown for the low educated and low-income groups, mak-ing a big part of the workforce in the private transport sector. In this regard, the study revealed a remarkable mis-conception regarding HIV transmission and found some tendencies to discriminate people living with HIV/AIDS. For the whole study population several needs for better education were identified. These needs are not likely to be sector-specific, and thus concern the Namibian population in general.

Value added for partners and GDC

The study was part of the Namibian HIV Research and Evaluation Agenda assessing the current status of WPPs in the country. The findings of this study show strengths and weaknesses of the workplace programmes in private and public organi-sations and thus allow policy makers evidence-based ad-justments. The results of the study are meant to give a baseline for upcoming evaluation studies, which are planned in the fu-ture on a regular basis, as stated in the NSF.

Contact

Dr. Stefan Weinmann E stefan.weinmann@giz.de T +49 30 408190-394 I www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Philippines

Outcomes on individual and organizational learn-ing within the Essential Health Care Package

Background

The Essential Health Care Package (EHCP) in the Philip-pines is a school health programme that aims at improving health and educational status of children in public schools. It follows the approach of the Philippine NGO Fit for School (FIT) - supported by GIZ - who offers various capacity development activities in order to strengthen the capacity of their partners to implement and manage school health programmes such as EHCP. The variety of FIT’s CD activities ranges from trainings to the development of moni-toring tools, manuals, and films. The Department of Education (DepEd) as well as Local Government Units (LGU) represent the key partners in the EHCP. Whereas DepEd is implementing the EHCP and is providing the manpower to run the programme, LGUs are responsible for allocating financial resources. Evidence gap addressed by the research

The implementation of the EHCP programme by the Phil-ippine partners seems to be successful according to prelimi-nary results of research and evaluation on children’s health status. It can therefore be assumed that the accompanying CD-activities have effects in terms of strong competences of partners. However there is only little knowledge about the ‘real’ outcome of various CD-activities on different levels. As many factors contribute to sustainable development processes it is always a challenge to draw links between causes and outcomes of CD-activities. Therefore in more systemic approaches development processes and their out-comes have to be analysed in depth respecting various and complex facets. Outcomes are considered as changes in behaviour and as learning processes of people and organisa-tions directly involved in the development process. Transferred to the background some general questions can be formulated:

In which ways do the partners learn through FIT’s CD-activities? How does this learning change their behaviour? What helps them in their learning process? The aim of this study project was to get a detailed and at the same time holistic view about the contribution of FIT’s CD activities to learning processes and behavioural changes of key partners that lead to strong competences of their indi-viduals and organisations. Research partners

Department of Education (DepED), Fit for School (FIT), Postgraduate study centre on adults’ education, Technical University of Kaiserslautern. Methodological approach

Especially learning processes and changes in behaviour can be subject to a deeper analysis when using qualitative and adaptable methods that allow a more in-depth view of pro-cesses. The research and the applied methods are therefore aimed at conceiving causal or potential relations of the ‘outcome’ of CD activities offered by FIT to partner organi-sations and their individuals. Methods of empirical social research were used for data col-lection such as guideline-based interviews and group discus-sions. By using these open and quite unstructured types of interviewing techniques without standardised answers the interview and discussion partners had the possibility to add a lot of own estimation, experience or opinion. The recorded interviews and discussions were subject to transcription. The resulting text material was analysed ac-cording to principles of qualitative content analysis. The aim of this analysis was to reduce and structure comprehensive data towards essential contents to be interpreted with refer-ence to the research questions. Data were collected in Camiguin (Northern Mindanao) as EHCP is implemented there and FIT is offering CD activities to partners. A longi-

tudinal study about health and education indicators of school children shows first positive results of EHCP in the area. DepEd and LGU staff members on different levels and with different responsibilities were selected as relevant partners to be interviewed – ranging from school nurses and school health programme, the German GIZ sector initiative Applied Research in Health Programmes of German De-velopment Cooperation and the postgraduate study centre on adults’ education, Technical University of Kaiserslautern. Results The findings on the effects of the CD activities conducted by the NGO FIT within the framework of EHCP show that a range of learning and change processes occurs at individu-al and organisational level. The NGO FIT and all its capaci-ty development activities can be seen as the driving force for many of these change processes. FIT plays an active role of coach and assists the partners in developing instruments or materials (e.g. manual, M&E-tool). Of special importance is the facilitation of communi-cation and exchange within and between partners. Formal CD activities are considered less important and are seen more as an impetus for learning processes. More im-portance is attached to experiential learning in real decision-making situations. Overarching values such as trust, motivation and commit-ment are key factors for all actors. They form the basis for learning processes at different levels and determine the concrete success of implementation. A clear framework, well-defined roles and responsibilities, the institutionalisation of the programme and reliable re-sources help foster an atmosphere of security, transparency and openness. The EHCP approach as such provides the

framework within which relationships between the actors can be built and which can also be transferred to other school health programmes. Implications / Value added for partners and GDC The qualitative study approach allows an in-depth under-standing of the broad and complex learning processes going on when offering CD activities to partners. The findings of this research - addressing also challenging areas of cooperation between FIT and its partners - will be supportive for their future work. Concrete options become clear for further qualitative or quantitative analysis of interesting sub-areas: The findings deliver a basis for further development of CD indicators and they can be used to draw up a competence profile, so that measures for the partners can be more target-oriented. Contact Dr Stefan Weinmann E stefan.weinmann@giz.de T +49 30 408190-394 I www.giz.de

Published by

Deutsche Gesellschaft für

Internationale Zusammenarbeit (GIZ) GmbH

Registered Offices

Bonn and Eschborn, Germany

Dag-Hammarskjöld-Weg 1-5

65760 Eschborn

Phone +49 61 96 79-6464

Fax +49 61 96 79-806464

Email wissen@giz.de

Internet www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Tanzania Community Health Fund (CHF) Innovation Study

Background

The health care system in Tanzania is mainly financed by taxes. In addition, several health insurance schemes exist: The mandatory National Health Insurance Fund (NHIF) covers all public servants; The Social Health Insurance Benefit of the National Social Security Fund is open to all formal employees. The informal sector is addressed by Community Health Funds (CHFs), district-based health insurance schemes with one CHF in every district. The CHFs are part of the health financing options of Tanzania and operated by within the government structures. The strengthening of alternative health financing options such as the further implementation of CHFs is a focus of the GIZ’s advisory work in Tanzania. Evidence gap addressed by the research

The CHF innovations study was commissioned by the GIZ in order to explore the innovations and good practices which have allowed some district CHF schemes to perform relatively better than others. This was done with a view to further the national discussion for improving the schemes generally and to provide creative impulses to districts where the schemes are performing relatively less successfully.

Research partners Swiss Tropical and Public Health Institute http://www.swisstph.ch

Tanzanian German Programme to support Health (TGPSH) http://www.tgpsh.or.tz/

Methodological approach

The study comprises an extensive literature review regarding documented innovation efforts as well as a survey of key stakeholders and informants in selected districts of Tanza-

nia. The selection was based mainly on the success criteria of relatively high enrolment rates and receipt of relatively high matching grants based on data available from the Na-tional Health Insurance Fund. Apart from such objective membership data, the research team was interested in as-sessing success stories reported from experience. Key stakeholders and key informants at national level were therefore asked to identify known examples of good prac-tice or innovation concerning the CHF schemes. Each district was surveyed on the basis of standardized semi-structured questionnaires. The questionnaires were based on a matrix of performance parameters (management and use of CHF funds, matching grants, benefit package, portability, pro-poor enrolment, governance and administration, inno-vations) and CHF problem areas (design, enrolment, servic-ing, sustainability). The data collected was then summarized by district and collated in a master summary table along the problem areas addressed by specific practices. Results

The study reveals that the following factors explain why certain CHF schemes in Tanzania are relatively more or less successful than others:

Dedicated people in key positions are a precondi-tion for success, but can also create fragility in the system once people are transferred.

Quality of health services, first and foremost, the continuous availability of required medicines and supplies.

Innovative approaches for social marketing and enrolment, including group enrolments, village en-rolments, enrolment of (user fee) exempted popu-lations, better timing of enrolments to fit harvest periods, and introduction of waiting periods for service utilisation.

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

Follow up of renewals. However, this was nearly made impossible by the lacking health insurance management information system.

Inclusion of hospital care into the benefit package, with a variety of regulations concerning referral letters, ceilings for service provision, service agreements for hospitals owned by Faith Based Organizations (FBOs), and a mix of funding the service provision including being not reimbursed at all.

Successful matching of grant applications. Howev-er, this is severely hampered through the lacking health insurance management information system, leading to excessive efforts to collect the required information and documentation.

Successful pro-poor enrolment, which, however, is not at all well developed or in any way sustainably financed.

There were no clearly successful innovative "re-designs" of the scheme, though one attempt in Kyela district (where the scheme membership management was outsourced to an NGO). All of the reported "innovations" could be classified as "tinkering" with the business process rather than "re-tooling" it.

Implications / Value added for partners and GDC The study has revealed a number of promising approaches for addressing critical problem areas of Community Health Funds. However, all the positive achievements seem to remain rather fragile and short lived, depending on the personal motivation and engagement of key stakeholders

(especially District Medical Offices and CHF coordinators), as long as two structural problems are not addressed:

First, there is no solid organisational system specifically for CHF administration in place, but rather the management of CHFs is done as a “side-job” of health care providers.

Second, as the CHFs are operated by the health care pro-viders themselves, the system has only very limited potential for building up “voice” mechanisms for the population / clients towards the health care providers.

It therefore can be concluded that the deeper structural problems hindering the CHF schemes to capitalize on their strengths and become fully successful need to be addressed. A professionalized structure, with dedicated full-time staff, supported by an adequate management insurance system, and organised in a provider-purchaser split independent from the District Medical Office, seems to be a way for-ward. Then the innovative approaches described in this study can be taken up and more fully implemented within a strengthened organisational structure.

These findings render valuable guidance for the Tanzanian German Programme to Support Health (TGPSH) in effec-tively advising the Ministry of Health and Social Welfare (MoHSW) in its health financing strategy.

Contact

Dr Stefan Weinmann E-mail stefan.weinmann@giz.de Tel. +49 30 408190-394 Internet www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-

ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Tanzania

Assessing sexual harassment and gender-based violence in the public service

Background

Sexual harassment and violence against women is part and parcel of gender-based violence and affects the attainment of gender equality and equity as well as sustainable devel-opment. In Tanzania, sexual harassment and gender-based violence affect the lives of many women and have been associated with HIV and AIDS. Increasing awareness on these concerns through strong advocacy, lobbying and pressuring governments and other development actors has led to in-creased efforts in addressing the issues. At global, regional and sub-regional levels for instance there are con-ventions and agreements which are tangible political com-mitments made by states within the UN ambit and other existing blocks (like AU, SADCC and EAC). At national levels policies, legal reforms and strategies have been de-signed and adopted to guide the processes of dealing with this human rights’ violation.

Sexual harassment and violence against women though present at public work places have remained hidden behav-ioural problems challenging the effort to fight HIV and AIDS.

Evidence gap addressed by the research

The study was the first to investigate the subject of sexual harassment, gender violence and HIV and AIDS at the workplace in Tanzania, and aimed at:

1. Assessing the accomplishments of the workplace pro-gramme (WPP) interventions supported by German Devel-opment Cooperation with regard to gender-based violence.

2. Measuring the magnitude of the problem of sexual har-assment and gender violence as well as the consequences for all involved (abused and the abuser, family, organiza-tion).

3. To develop a better understanding of the causes underly-ing sexual harassment and gender-based violence at public places of work.

4. To explore possible links between sexual harassment and the transmission of HIV and other sexually transmitted infections (STIs) at the work place.

Research partners

Institute of Development Studies (IDS) based at the Uni-versity of Dar el Salaam

Methodological approach

The study was carried out in the context of the GIZ sup-ported HIV and AIDS Public Sector WPP focusing on Mtwara region in Tanzania.

It was conducted in late 2011 and early 2012, applying a mixed methods approach.

Data collection tools comprised of:

1. Literature research & analysis

2. Guided interviews at ministries, departments, districts and wards in Dar el Salaam with senior managers, some of whom have worked with the WPP in leadership roles as contact persons and peer educators.

31 focus group discussions (FGD) with male and female employees in ministries, departments, districts and wards who had participated in the WPP. Issues covered were the frequency of sexual harassment and violence, policies and management strategies that might have encouraged or dis-couraged sexual harassment and violence and the likelihood of the transmission of HIV due to this gender-based vio-lence. Anonymous individual survey in Kiswahili with a representative sample of 629 female (out of 4.500 in total) and 964 male employees (out of 3.500 in total) of 4 councils of Mtwara region working at the district, ward or village level stations.

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

Results

The study found that the WPP was the main source of information on the Tanzanian code of conduct and ethics for public servants and had enhanced the awareness of the respondents on the problem of sexual harassment (SH) and gender-based violence for women (GBV) as well as their individual rights and knowledge on HIV and AIDS. Public servants who had participated in the WPP knew better how to handle the infringement including reporting to the ap-propriate authority. There had been little information from the institutional leadership relating to SH-GBV.

The study revealed that both women and men are victim-ized, with women suffering more than men. The frequency of sexual harassment and violence is high, assuming a zero tolerance situation. The percentage of women indicating to have experienced sexual harassment and GBV in urban and rural areas was 17% and 22.5% respectively. The most common form of sexual harassment experienced by women was calling dirty names followed by touching and fondling. Trying to force sex came next while rape was also experi-enced but by a small number of women workers. On the other hand, 11.2% (urban) and 12.8% (rural) men indicated having experienced SH-GBV. Males mostly reported on other forms of sexual harassment which included: indecency dressing, bending in front of men to show the private parts (calculated seduction), being called dirty names followed by touching and petting but a few were also aware of rape cases for men.

FGD showed that the consequences of SH-GBV are grave. Sexual harassment and violence leads to moral degradation in the work environment; women indicated that they suffer physically and psychologically and lose self-confidence; it causes frustrations with regard to unfulfilled promises by the perpetrators (e.g. not transferred to an urban work station); it impacts on marital stability, family integrity and in some cases leads to economic losses by the victim

FGD show that causes underlying sexual harassment and violence at public places of work are manifold. These be-haviours result from traditional norms, beliefs and practices and socio-economic in-equalities that deny women rights and privileges that are enjoyed by men. The perpetrators are perceived as high-ranking men with administrative power and in some few cases colleagues in the workplaces who take advantage of their position. The informal approaches to cope with SH and GBV included: avoiding exposure to a risky environment (38.7%), avoiding abusers (27.8%), and use of friends to warn abusers (16%). Formal approaches included lodging complaints with appropriate officers (18.8%), changing of working hours (9.2%), asking for transfers (8%), and reporting to the police (8%).

Concerning the transmission of HIV SH-GBV leads to mostly unsafe sex and thus potentially contributes to infec-tion with HIV and other STDs. The women’s self-assessment showed that in urban areas, about 0.4% of the respondents believed to have contracted HIV and 2.5% believed to have contracted an STD as a result of SH-GBV. In rural areas 0.4% of the women attributed their HIV infection and 2.7% their STD infection to an episode of SH-GBV.

Implications / Value added for partners and GDC

The findings of this study provide information on the sub-ject of sexual harassment and gender-based violence at the workplace.

The results and recommendations of the study will be used for planning of advisory services in the context of WPP.

Contact

Dr Stefan Weinmann E stefan.weinmann@giz.de T +49 30 408190-394 I www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

The role of social pensions in improving old age security in Viet Nam Case Study

Background

As a result of higher life expectancy as well as declining fertility and mortality rates, Viet Nam is facing the challeng-es of a rapidly ageing population. By 2049, the proportion of people aged 60 and above is projected to reach 26.1%. In order to address the social dimension of this demographic development a number of policies on social protection have been promulgated and revised in the recent years.

In 2011, the general eligibility age for the social pension scheme has been lowered to 80 years. Additionally, elderly aged 60 years and above living alone without income or other sources of financial support shall be assisted with monthly cash transfers. People with serious disabilities are also eligible as beneficiaries. At the same time, the level of benefits has been raised in accordance with the state’s fiscal capacity. The monthly social pension has been increased from 120,000 VND in 2007 to currently 180,000 VND per person (equivalent to around 6.80 EUR).

Despite these improvements, the coverage of the pension scheme remains limited, the monthly benefit level is still too low and hardly enough to cover the subsistence needs of old aged people. Evidence gap addressed by the research The study aimed at analyzing the impact of the monthly social pension on the household economy of the elderly. It further explored policy practices with regard to social assis-tance programs for the elderly and the role of such pension schemes within the Vietnamese social security system. Moreover, the study intended to generate information in terms of which social pension policies could be adapted and refined.

Thus, the study addressed the three following questions:

1. What is the role of monthly cash transfers in supporting the livelihoods of the elderly within the system of social protection of Viet Nam?

2. How should the benefit scheme be designed to respond to the basic needs of Viet Nam’s elderly taking into ac-count the country’s fiscal capacity?

3. To what extent should the public administration system in this sector be adjusted to be able to better facilitate the implementation of policies for old aged people?

Methodological approach & research partners

Through a mixed methods approach, the study is the first to link the results of quantitative research to a qualitative as-sessment of the underlying phenomena. In order to test the hypothesis formulated on the basis of the literature review as well as the analysis of secondary data, Dong Son district in Thanh Hoa province was selected for a case study offer-ing favourable conditions in terms of representative socio-economic and demographic patterns.

Different research instruments were employed to collect information on policy interpretation and administrative practices as well as on the perceptions and needs of the elderly with regard to social pensions. Six semi-structured, open-ended interviews were conducted with leaders of three provincial and district authorities (Department/Division of Labour, Invalids and Social Affairs, Department/Division of Finance, Provincial/District Association of the Elderly). Further information was gathered from focus group discus-sions (FGD) with 10 to 12 stakeholders from different organizations such as the Communist Party, the People’s Committee, the Association of the Elderly, the Veterans’ Association and the Fatherland Front in the communities of Dong Thinh, Rung Thong and Dong Anh.

The core part of the study consists of 121 structured inter-views conducted with the elderly population in the three selected communities to collect data on the economic situa-tion, entitlement, access to and use of social benefits. Inter-viewees further assessed the adequacy of social pensions with regard to their level and eligibility age.

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Registered Offices Bonn and Eschborn, Germany Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

The study was conducted as a cooperation project between the Vietnamese Institute for Labour Science and Social Affairs (ILSSA), evaplan GmbH at University of Heidel-berg, the Vietnamese GIZ Social Protection Programme, and the GIZ Sector Initiative PROFILE commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ). Results

The findings show that a great number of the elderly is still economically active until the age of 80 (60-69 years: 55.6%; 70-79 years: 33.3%; 80+ years: 2.9%). Around 51% of the interviewed elderly receive some kind of social pension. Since the majority of beneficiaries of social allowances is not able to engage in income-generating activities, social allowances constitute a significant and reliable contribution to their livelihoods, next to support from children and in-come from leasing assets.

The average total income of the elderly receiving a social allowance amounts to 351,000 VND, which is significantly below the minimum living standard of 862,100 VND for food and non-food items calculated by ILSSA. Recipients report on usually spending their allowances on food, medi-cal services and daily needs, which indicates a responsible use of the additional resources. The vast majority of the beneficiaries (93.1%) state that the social allowance only meets their material needs partly or to a small degree.

In general, most of the respondents do not perceive the process of applying for social allowances to be complicated. However, the submission process may take rather long and, occasionally the transfer of payments may be delayed be-cause of slow transfer of the budget to the local authorities.

However, more than 50% of the elderly recommend that the eligibility age for social transfers should be lowered to

75 years and 85.4% suggest to increase the amount of social transfers in order to ensure a minimum living standard for the elderly.

Overall, representatives of the local and national authorities are aware of the importance of social pensions in the light of population ageing in Viet Nam. The majority of the interviewees support the increase of the benefit level and suggest setting a standard social transfer amount on the basis of the minimum wage or poverty line. Similarly most of the representatives realize the need to further lower the eligibility age, however, in the light of limited state budget capacity the implementation of such a policy in the near future is not very likely. Value added for partners and GDC

The findings of this study provide information on the per-ceptions of the elderly with regard to social pensions. Both the elderly themselves and the representatives of the author-ities contribute valuable suggestions for the future devel-opment of a social pension scheme. An assessment of the research cooperation revealed that ILSSA appreciated and benefited from research capacity strengthening activities within the project. The results and recommendations of the study may also be used for the planning of advisory services in the framework of the GIZ Social Protection Programme. Contact

Dr Stefan Weinmann E stefan.weinmann@giz.de T +49 30 408190-394 I www.giz.de

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE)` to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of 9 accompanying research studies across 3 continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

v

Education, Health, Social Protection

Zimbabwe Survey of selected sex worker populations

Background In 2009, Zimbabwe’s National AIDS Council commis-sioned the Zimbabwe AIDS Prevention Project (ZAPP) to establish the ‘Sisters with a Voice’ HIV prevention pro-gramme for Sex Workers (SW) as part of its National Be-haviour Change Programme. ‘Sisters’ now operates in 16 sites around the country and is financially supported through United Nations Population Fund (UNFPA) includ-ing contributions from bilateral development partners. In 2011, the Deutsche Gesellschaft für Internationale Zusam-menarbeit (GIZ) GmbH provided funding to enhance the programme by intensifying community mobilisation and by training health care workers at general clinics to be more sex worker friendly. This will contribute to increased protective behaviour among sex workers and increased use of adequate health services. In order to assess the impact of this pro-gramme, GIZ commissioned a baseline (bio-behavioural survey) to be conducted prior to start of programme activi-ties in each site, complemented by in-depth qualitative data collection. These data will be used to i) feed into baseline indicators against which impact can be assessed; ii) inform programmatic activities and iii) inform program monitoring and evaluation. The study will be repeated in 2014 to assess changes over time.

Evidence gap addressed by the research The overall goal of this research was to describe the charac-teristics of three sex worker populations in Zimbabwe prior to implementation of the sex worker programme planned by GIZ.

The specific research objectives were:

i) To describe the demographic and behavioural characteris-tics plus HIV prevalence of a representative sample of sex workers working in three locations around Zimbabwe. The data was collected using respondent driven sampling (RDS).

ii) To determine the risk factors for HIV infection among sex workers in these three sites, in particular to explore how structural and contextual factors influence this risk.

iii) To conduct in-depth qualitative interviews with sex workers at each site to gain to understand the behavioural, cognitive, emotional, contextual and cultural factors that are unique to this vulnerable population and how these factors influence their uptake of HIV prevention and care services.

Research partners University College London, London School of Hygiene and Tropical Medicine, Zimbabwe AIDS Prevention Project (ZAPP)

Methodological approach Rapid ethnographic mapping of the three sites was con-ducted to inform implementation of a bio-behavioural sur-vey conducted using respondent driven sampling. The sur-vey was implemented in each site. Each survey participant was asked to complete an interviewer administered ques-tionnaire and provide a finger prick blood sample for HIV testing. Data were weighted to take account of respondent driven sampling. A sub-sample of participants from each site underwent in depth qualitative interview. Data were analyzed using Stata 12.

Results 370 women were recruited form Mutare; 237 from Hwange and 229 from Victoria Falls (total N= 836). Women ranged from 18 years to over 60 years old. The primary site for solicitation was bars or night-clubs. Sex workers in Victoria Falls were younger and more recently started in sex work than SWs from Mutare and Hwange. Knowledge of modes of HIV transmission was high (over 90%). Around 40% of women reported having 5 or more clients a week; reported

Published by

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH

Registered Offices Bonn and Eschborn, Germany

Dag-Hammarskjöld-Weg 1-5 65760 Eschborn Phone +49 61 96 79-6464 Fax +49 61 96 79-806464 Email wissen@giz.de Internet www.giz.de

condom use with clients at last sex was over 90% at all sites but only 70-85% reported al-ways using condoms with clients in the past month. 75% of women said they had at least one permanent partner and reported condom use at last sex with these partners was around 55%, whereas con-sistent condom use over the last month was lower at only 33%. With regards HIV testing, 78% of women in Mutare, 71% in Hwange and 82% in Victoria Falls reported ever having an HIV test. The proportion testing in the previous 6 months was 42%, 38% and 21% respectively. Among those who had tested 35%, 34% and 45% reported being HIV antibody positive. In Mutare 75% of HIV positive sex workers said they were receiving antiretroviral treatment (ART) as did 52% in Hwange and 53% in Victoria Falls. Overall of the 804 women tested for HIV, 480 were HIV positive (HIV seroprevalence 59.8% 95% CI 56.4-63.1). RDS weighted HIV sero-prevalence varied by site (50.6% in Mutare, 50.6% in Hwange and 69.6% in Victoria Falls). A substantial proportion of the HIV positive women are una-ware of their HIV status.

Qualitative data suggest that poverty and lack of social support are the main reasons for initiating sex work. Wom-en reported being paid more for condom-less sex. In addi-tion to the difficulties faced by the general population when accessing ART care, women reported that the discrimina-tion they faced at health centres was a deterrent to seeking care. Women reported being networked and providing support to each other.

Implications / Value added for partners and GDC

• Findings clearly indicate both a need for and inter-est in increased access to clinical sexual health ser-vices. Sex workers also expressed an interest in a social component for them. The GIZ approach to improving availability and quality of care for sex workers is relevant and timely.

• The strong social networks reported by women suggest that community mobilisation should be feasible and can be used as a means of bringing more hidden SWs into services.

• The sex worker clinics run through the ‘Sisters with a Voice’ programme appeared to be appreci-ated and popular.

• HIV prevalence is high (around 4 times higher than among antenatal clinic attendees).

• A substantial minority of positive women are una-ware of their status.

Contact

Dr Stefan Weinmann E-mail stefan.weinmann@giz.de Tel. +49 30 408190-394 Internet www.giz.de/your-link-here

The growing emphasis on results-based management, evidence-informed policy making, effectiveness and value for mon-

ey of different interventions and strategy options in international cooperation, requires that programmes and projects incorporate methodologically improved impact assessments and findings from sound operational research. The German Federal Ministry for Economic Cooperation and Development commissioned the sector project ´Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes (PROFILE) to promote activities seeking to close relevant evidence gaps and improve insights into the impact of German Development Cooperation in the field of health and social health protection. Since 2010 a total of nine accompanying research studies across three continents covering a wide range of topics from social pensions in Vietnam to gender-based violence at the workplace in Tanzania have been initiated and quality assured by the sector project.

 49

Annex III: Questionnaire for assessment of research projects

Sector Project PROFILE “Lessons learned and recommendations for operational research in health programmes”

Questionnaire (Questions are to be answered by GDC programme managers and research staff (nati-onal and German/international). Questions have to be tailored towards them). General: Title of research project: ______________________________________________________ Programme of implementing agency (as specified in BMZ offer):_______________________ A. Results of the research project as a whole

A1. According to your view, did the research project achieve the expected results (vis-à-vis the ex-pected objectives of the project)? Could relevant hypotheses been tested (proofed or refuted)?

A2. Which were the main problems during the planning phase of the research project?

A3. Which were the main problems during the implementation phase of the research project?

A4. Please rate in how much the research project achieved its objectives:

More than achie-ved objectives

Did achieve its objectives quite

well

Moderate achie-vement

Only minimal Not at all

B. Benefit for the country health system/ other sectors: B1. Are the results of the research projects helpful and useful for the country/ have they been used? How?

B2. How do you assess the feasibility of the recommendations from the joint research with regard to the country? B3. Do you think results can be applied to other settings?

B4. Which joint or other measures have/ will been taken to disseminate and implement the results including possible scientific publication?

B5. Please rate the benefit of the research project for the country

Substantial bene-fit, important for

the sector

Good benefit Some benefit, but limited

Minimal benefit No benefit at all

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C. Benefit for implementation and impact measurement of GDC programmes:

C1. Was or is the joint research project helpful for implementation of your health (social protection) programme? How?

C2. Could an evidence gap (GDC and/or partner country related) be filled through the research project? Which?

C3. Did the joint research project help in measuring or demonstrating impact of the cooperation programme (or create better conditions for measuring impact, e.g. through baselines …)? How?

C4. Please rate the benefit of the research project for impact measurement of GDC:

Substantial benefit, very im-

portant for results measurement

Good benefit Some benefit, but limited

Minimal benefit No benefit at all

D. Quality of research cooperation between national and international researcher:

D1. Which might be the advantage to commission a joint research instead of hiring an international consultancy? (e.g. is there a higher acceptance of such studies in the partner countries?)

D2. How was the concrete division of labour in the setting-up, implementation and dissemination of the study?

D3. What went well in the cooperation? Which were the main shortcomings/ challenges? What would you do next time different?

D4. What should be taken into consideration when planning a joint research?

D5. Please rate the quality of the research cooperation

very good good average poor very poor

E. Capacity Building for research partners institutions:

E1. Which challenges did you face concerning data collection and analysis?

E2. In which way could capacity in the partner country and in the partner organization be strengthened? What experience/ skills/ capacity did you take from the scientific cooperation?

E3. What are good instruments for capacity strengthening through joint research?

E4. Please rate the benefits of the research project for capacity strengthening

very good good average poor very poor

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Annex IV: Proposed criteria for the selection of research projects PROFILE used the following core criteria to assess research proposals submitted for funding. The criteria were assessed by two independent members of an advisory board: 1. Is it a study/evaluation to measure the outcome or the impact (including health- economic effects) of an activity or a programme component which is supported or run by a German implementing agency (GIZ, KfW) and implemented in a partner country where there is a cooperation with Germany in the health sector? 2. Is it an activity which may substantially contribute to the overall effects of the program or the program component? 3. Are the effects of the activity measurable with sound scientific methods (either by means of quantitative or qualitative methods): is measurement beyond self-assessment possible? 4. Does the activity have a certain strategic relevance for German Development Cooperation? 5. Is it possible to transfer and apply the results in other partner countries (i.e. are the results transferable to other countries/regions)? 6. Is it an activity or a programme component for which there is some lack of evidence regarding its effectiveness and its impact, i.e. positive effects on the target population are not clear? The submitted proposals had to clearly describe 1.) the principal research questions to be addressed, 2.) the working hypothesis and 3.) the design to be used in order to answer the research questions including the respective methods. Partnership-based projects were encouraged to apply and projects should - wherever possible - be jointly designed, applied for and implemented. The responsibility was expected to be shared. In order to boost self-responsibility, both the German partner and the scientific organisation in the partner country were to contribute their own input to the partnership. In this respect measures to develop the capacity of the organisation in the partner countries ought to be thought along where possible and reasonable. Twinning arrangements had to be supported not only by individual actors, but also by the management/directors of the organisation. To assure that operational research and evaluation results are better accessed and used more systemati-cally, in projects and programs in the field of health and social health protection of GDC and in order to improve the visibility of German contributions to the international discussion, the dissemination of results ought to be considered when setting up the activities.

 52

Annex V: Proposed criteria for the selection of research partners Among the most important criteria for assessing national research partners are: 1. Previous research expertise in the area of the study, including methodological expertise 2. This is documented in the list of publications (preferably peer-reviewed), the lists of published or non-published reports from previous research which should be solicited, and from personal reports and referees’ appraisals 3. Biographical data (CVs) of the researchers should be available and demonstrate academic proficiency 4. Is the national research partner able to implement data collection including training of field workers? 5. Does the research partner have adequate resources (computers? Trained staff, other infrastructure?) 6. Has the national research partner participated in similar cooperation projects? 7. Has there been a previous collaboration between the national and the international partner? 8. Does the national research partner have a reputation in the country; and does he have at his disposal ways to disseminate the results and approach policy makers?

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Annex VI: Short proposal format

PROFILE can offer substantial support in all steps of the application and implementation process. Please feel free to request and use our support and contact us at any time.

Short format for research proposals

Title of research project

Programme of implementing agency (as specified in BMZ offer)

Contact person 1

Email:Tel.:

Contact person 2

Email: Tel.:

(Possible) research partner organization Germany/ EU

(Possible) research partner organization Partner country

Areas of support requested from PROFILE (multiple answers possible)

Support in the methodological and conceptual design of the research project Financial contribution Support in establishing contacts with scientific institutions in Germany and the EU Others, namely:

 

Proposal (1-2 pages) The submitted proposals should clearly describe

1. the principal research/evaluation questions to be addressed 2. the working hypotheses with regard to the (development) intervention, and 3. the design and methodology to be used in order to answer the research questions

 54

1. Short description of the GDC programme/relevant component of implementing agency (as specified in BMZ offer) where the research takes place 2. Short description of the health intervention to be evaluated [e.g. HIV/AIDS workplace programme in the private sector; antenatal care voucher programme etc.] 3. Research questions - Overall objective [e.g. assessment of the effectiveness of a peer education intervention in HIV/AIDS prevention among migrant workers in Namibia] - Specific objectives [e.g. a.) investigate the impact of community-based health insurance on health status of informal workers as measured by EQ-5D instruments, b.) determine the risk factors for HIV infection among sex workers in … areas] 4. Planned research activities 5. Methodology (a. study type; b. methodological approach, c. data collection, d. data analysis) 6. Scientific research partners (if already known)

7. Estimated budget

8. Estimated time frame

9. Benefit of the research project for German Development Cooperation [Measurement of impact? Baseline study for future impact measurement? Other?]

10. Applicability and transferability to other programmes/projects

11. Possible risks

 55

Annex VII: Long proposal format

This annex provides a template to help you structure your proposal and to collect relevant information for a proper evaluation. Even though no page limits are given please keep your text concise. Programs, projects or other initiatives of implementing agencies of German Development Cooperation can apply through the officer responsible for the contract and cooperation (AV) who has to assure that the respective country manager and BMZ unit is informed about the application. PROFILE can offer substantial support in all steps of the application and implementation process. Please feel free to request and use our support and contact us at any time.

1 Overview

Title of research project

Programme of implementing agency (as specified in BMZ offer)

Contact person 1

Email:Tel.:

Contact person 2

Email: Tel.:

(Possible) research partner organization Germany/ EU

(Possible) research partner organization Partner country

Areas of support requested from PROFILE (multiple answers possible)

Support in the methodological and conceptual design of the research project Financial contribution Support in establishing contacts with scientific institutions in Germany and the EU Others, namely:

The submitted proposals should clearly describe 4. the principal research/evaluation questions to be addressed 5. the working hypotheses with regard to the (development) intervention, and 6. the design and methodology to be used in order to answer the research questions

 

 56

2  Main research field and objectives

2.1 Short description of the GDC programme/relevant component of implementing agency (as specified in BMZ offer) where the research takes place 2.2 Description of the health intervention to be evaluated [e.g. HIV/AIDS workplace programme in the private sector; antenatal care voucher programme etc.]

2.3 Study/research objectives - Overall objective [e.g. assessment of the effectiveness of a peer education intervention in HIV/AIDS prevention among migrant workers in Namibia] - Specific objectives [e.g. a.) investigate the impact of community-based health insurance on health status of informal workers as measured by EQ-5D instruments, b.) determine the risk factors for HIV infection among sex workers in … areas] [What is the novel aspect that will be investigated by the proposed study? Which difference do research results make? Please indicate how the results of your study will be used. Are the results needed for further cooperation, development or research?

2.4 Evidence already available on the topic [What is known, and why is current knowledge insufficient? Give references to relevant publications and other studies, including (own) pilot studies and/or feasibility studies]

2.5 Working hypotheses [On which working hypotheses is the study based on? Which working hypotheses you want to proof with your study?]

 

3  Methodology and study design 

 3.1 Study type/methodological approach

[Give an overview of the design you want to use in order to answer the research questions above. Explain why you have chosen this study design. Detail and justify the methodical approach you have chosen.]

3.2 Target/study population, inclusion/exclusion criteria and sampling

[Specify the population to be studied. Which are the inclusion and exclusion criteria for study participants, which is the proposed sample size and which is the justification for this? Describe and explain your selection decisions and the sampling strategy.]

 57

3.3 Outcome measures

[Specify one primary outcome measure/indicator and, if applicable one or more secondary outcome measures/indicators. Outcome measures/indicators should be SMART: S-pecific, M-easuralbe, A-chievable, R-elevant, T-ime-phased. Give a brief overview of the expected outcomes and results and their scope and significance]

3.4. Field access and feasibility justification

[Describe and justify your approach to get access to the necessary study participants or data. Please provide details on how to overcome access barriers. Demonstrate conclusively the potential for recruiting the required number of study participants (the best piece of evidence being pilot data collections and studies in a similar population/institution) or data(bases)]

3.5 Data collection

[Describe your methods of data collection, e.g. use of questionnaires. Give the theoretical background and expla-nations for the data collection method chosen. How do you document the data?]

3.6 Data analysis

[Illustrate your method of data analysis: Who will analyse data? Which is the proposed strategy of statistical ana-lysis or other type of analysis in the case of a qualitative study? Which data items and variables will be included in the analysis? Which are the independent and dependent variables? Which additional information will be documented to adjust for confounding? Please provide examples of the statistical models and software package and/or of other assumptions.]

3.7 Bias

[Describe how you will address bias (e.g. concerning selection of participants in intervention- and control group). Please comment on anticipated non-response and missing data.]

3.8 Quality assurance

[Which are the proposed measures for quality assurance during the research process? Comment on the necessity of an external quality assurance/monitoring. If applicable, please specify how you will ensure that results are verifiable intersubjectively]

3.9. Gender and poverty aspects

[Indicate how gender and poverty specific aspects are addressed within your study regarding the research que-stions, the analyses, and the relevance of the results. If you find that gender and/or poverty aspects do not apply to your research questions, please justify shortly]

3.10 Ethical and legal considerations

[Give a description of ethical considerations relating to your investigation (assessment of risks and benefits, care and protection for research participants, protection of research participants’ confidentiality, informed consent

 58

process, and crisis intervention) and specify how to address them adequately. Indicate if an ethical review board will be involved]

3.11 Capacity Development [Indicate in how far the proposed measures and outcomes develop capacity in the partner country and in the partner organisation]

 

4  Planned activities and estimated time frame [How is the study put into practice? Illustrate the necessary steps and responsibilities, including time lines. Please provide a proposal of milestones reflecting preparation, data acquisition, recruitment, data clearing/analysis, reporting and dissemination, if applicable.

Please use the respective format (Timeline)]

 

5  Benefit to German Development Cooperation 5.1 Benefit of the research project for German Development Cooperation

[Which evidence gap and which issue relating to health and social health protection in German Development Cooperation is being addressed?

Does the study contribute to impact measurement of projects supported by GDC? Or is it a baseline study which can be used for later impact measurement? Why is a study with such a methodological design and thematic focus needed (particularly with regard to German Development Cooperation and development goals such as the Millennium Development Goals)? 5.2 Applicability and transferability to other programmes/projects within German Development Cooperation?

[Specify in how far the results can be applied and transferred to other settings]

5.3 Possible risks

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6  Scientific Partners and Study Management 

 Name Affiliation

(only institution and city, no complete address)

Responsibility / Role (e.g. coordinating inve-stigator; responsible for work package x; responsi-ble for quality assurance; for data management; responsible for special methodological aspects; statistics)

Programme/ Project of implementing agency

Scientific partner Ger-many/ EU

Scientific partner in partner country

Coordinating Investigator

Please indicate roles of major participants, including persons responsible for special methodological aspects. The role of the coordinating investigator has to be defined as specific as possible. It is important that his/her role can be distinguished clearly from the roles/functions in the project. Furthermore, indicate the expertise of all above-mentioned participants by citing own relevant publications and/or specifying their major role in ongoing comparable studies (e.g. list relevant publications of the last 5 years, max. 5 publications per person). Give the professional background of all participants. Ensure that the team of investigators has the necessary ranges of disciplines and expertise to carry out the study.

Include tabular scientific Curricula vitae (max. 1 page per person) for academic staff members playing a leading role (i.e. applicant and co-applicants, methodological expert).

 

7  Estimated Budget  

[Please include a detailed and convincing description of expected costs for every partner in the project following the corresponding format (Annex I Budget form)]

 60

8   Dissemination and implementation 

[Please outline intended measures to disseminate and implement the results with reference to German Deve-lopment Cooperation, health and social protection including possible scientific publication. Describe what the results are used for and the actors involved.]

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For further questions please do not hesitate to contact us any time:

Stefan Weinmann Ekkehardt LangProject office Eschborn Project office Berlin T + 49 6196 79-1189 T + 49 30 72614 309 E Stefan.Weinmann@giz.de E Ekkehardt.Lang@giz.de

Project office Berlin Jasmin DirinpurT + 49 30 72614 326 Project office Eschborn T +49 6196 79-1358 E Jasmin.Dirinpur@giz.de

Core criteria in order for the application to be successful

1. Is it a study/evaluation to measure the outcome or the impact (including health- economic effects) of an activity or a programme component which is supported or run by a German implementing agency (GIZ, KfW) and implemented in a partner country where there is a cooperation with Germany in the health sector? 2. Is it an activity or a programme component for which there is some lack of evidence regarding its effectiveness and its impact, i.e. positive effects on the target population are not clear? 3. Are the effects of the activity measurable with sound scientific methods (either by means of quantitative or qualitative methods): is measurement beyond selfassessment possible? 4. Does the activity have a certain strategic relevance for German Development Cooperation? 5. Is it possible to transfer and apply the results in other partner countries (i.e. are the results transferable to other countries/regions)? 6. Is it an activity which may substantially contribute to the overall effects of the program or the program component?

 62

Annex VIII: Assessment long proposal

Name of research proposal:

Name of GDC programme:

Country:

Form and content check, pre-check for methodology Result

Is all relevant information concerning the study design included? Yes: No:

If no, what’s missing?

General relevance of the research topic for German Development Cooperation?

Comments:

Yes: No:

Is the current state of research/ available evidence described in an adequate way?

Comments:

Yes: No:

Is the research project suitable to fill an evidence gap?

Comments:

Yes: No:

Are the research questions clearly described?

Comments:

Yes: No:

Does the chosen research methodology (study design, data collection etc.) make sense?

Comments:

Yes: No:

Is the data collection properly described and adequate?

Comments:

Yes: No:

Are ethical and Legal considerations considered?

Comments:

Yes: No:

Are planned research activities realistic and realizable?

Comments:

Yes: No:

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Is the Work plan feasible?

Comments:

Yes: Yes, but with adaptations: Minor adaptations needed: Major adaptations needed:No:

Does the budget estimates appear realistic according to given restric-tions / possibilities?

Yes: No:

If no, please comment: Too high: Too low:Unclear:

Can the project be realized within the given time frame?

Comments:

Yes: No:

Quality of scientific partner 4 (very high):3 (high) :2 (medium) :1 (low) :0 (unknown)

Applicability and transferability of expected results:

Comments:

4 (very high):3 (high) :2 (medium) :1 (low) :0 (none)

Possible risks in the realization of the proposal

Comments:

4 (very high):3 (high) :2 (medium) :1 (low) :0 (none)

Final recommendations / comments: (including possibilities for funding outside PROFILE)

Date:

Evaluator:

 64

Imprint

As a federally owned enterprise, we support the German Government in achieving itsobjectives in the field of international cooperation for sustainable development.

Published byDeutsche Gesellschaft fürInternationale Zusammenarbeit (GIZ) GmbH

Registered offices Bonn und Eschborn

Friedrich-Ebert-Allee 4053113 BonnTelefon: +49 228 44 60-0Fax: +49 228 44 60-17 66

Dag-Hammarskjöld-Weg 1-565760 EschbornTelefon: +49 61 96 79-0Fax: +49 61 96 79-11 15

E-Mail: info@giz.deInternet: www.giz.de

AuthorsJasmin Dirinpur, Ekkehardt Lang and Stefan Weinmann

AcknowledgementsMany thanks to Franziska Schünemann for final editing.

Programme to Foster Innovation, Learning and Evidence in HIV and Health Programmes of German Development CooperationComponent Results Measurement and Operational Health Research

As atMarch 2013

Layout/DesignMartina Geisser, Kulturmarketing Berlin

 65

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Dag-Hammarskjöld-Weg 1-565760 EschbornT + 49 61 96 79-0F + 49 61 96 79-11 15E info@giz.deI www.giz.de