Health Partners International (HPI) and Triple Line conducted the end of project evaluation (Feb – Oct 2016)for the DFID-funded Health Partnership Scheme (HPS) programme (July 2011 – June 2017), culminating in a presentation of the final report at the October 2016 THET Conference.
HPS supports partnerships between UK health organisations and their counterparts in 32 developing countries (mainly in Africa and Asia) to build capacity in the health workforce and health institutions in those countries and in the UK. HPS is managed by the Tropical Health and Education Trust (THET).
The purpose of the evaluation was to examine the health partnership model that has been implemented in the HPS programme.
The focus was on the effectiveness of the programme as a whole, plus learning about what works and what does not work in the current programme’s approach.
The evaluation will inform wider lesson learning about volunteering and building health worker capacity in developing countries, and reciprocal benefits of partnerships, and associated volunteering in the UK. It will also be used by THET to strengthen the current HPS programme in its final year and by the UK Government (DFID, Department of Health and the NHS) to develop future partnership programming.
The evaluation was a theory-based and utilisation-focused evaluation with a heavy emphasis on delivering evidence for the requirements of the key stakeholder community. A Theory of Change was developed by the evaluation team and was used to explore change prompted by the projects, and as the framework for analysis and reporting. The Theory of Change assumptions form the basis of the evaluation questions (and these questions also cover the DAC evaluation criteria).
The evaluation methodology was designed to assess contribution of the programme to the changes observed and picked up through the data collection methods. The team used thematic analysis through exploring the theory of change and the assumptions, identifying themes and patterns across the data sets, and by understanding what other initiatives might have contributed to change.
Data collection was conducted (i) in four countries in East, West, Southern Africa and Asia, covering 11 HPS projects; (ii) by Skype or phone with a further five projects; (iii) through three online surveys with volunteers, southern partners and UK partners; (iv) Skype interviews with UK and international stakeholders; and (v) a document review of key programme documents (including a sample portfolio analysis to aggregate effectiveness and impact findings from project documentation of 37 MNCH projects). The Country Case Study data collection included semi-structured in-depth interviews and participatory group discussions as well as facility observation.
The evaluation in figures
- 350 interviews
- 11 projects in four countries
- 5 remotely evaluated projects
- 3 online surveys
- 37 MNCH project reviews
- 122 Health workers interviewed
At the time of data collection for the evaluation, there have been 176 HPS projects (86 HPS and 90 HPS 1.5), 93 of which are still ongoing with 66 UK partner grant holders. Grants have been used by partnerships in 32 countries, the majority in sub-Saharan Africa. 1,700 volunteers (56% women and 44% men) have worked on these projects and have spent a total of 51,124 days overseas. Most of the UK partners and overseas partners have been health education institutions (39% of UK partners in ongoing projects), followed by professional associations (31% of UK partners in ongoing projects) and health delivery institutions (26% of UK partners in ongoing projects).
Evaluation findings overwhelmingly demonstrated the effectiveness of the partnership and volunteering approach in supporting health worker capacity strengthening. The Health Partnership Scheme has been successful in strengthening partnerships and project approaches so that there are more chances of sustainability and wide-scale change.
- HPS projects have contributed to health system strengthening by strengthening health worker capacity in terms of their skills, knowledge and confidence.
- Long-term volunteering and strategic short term volunteering are most effective.
- The volunteering and partnership approaches used by the HPS represent good value for money.
- HPS projects are highly relevant and aligned with local government commitments and priorities.
- The HPS and THET’s guidance have contributed to strengthening partnerships. THET’s input around networking and technical assistance has been well delivered.
- There are examples of women health worker empowerment but gender and social inclusion approaches and analysis are not strong enough.
- The HPS benefits both volunteers and the UK health systems.
- Monitoring, evaluation and learning have improved considerably, but more is needed.
What worked well
- Strong partnerships deliver strong projects. Long-term partnerships are effective at designing and implementing approaches that contribute to health system strengthening. Sustainability of project outputs are supported by the strength and longevity of the partnership.
- Volunteers overwhelmingly reported that their skills and confidence had increased as a result of working in challenging developing country situations.
What didn’t work so well
- There was very little collaboration between partnerships or with other aid programming in host countries.
- Health system constraints may have limited the chances for improving health worker capacity and health services.
- Partnerships that are able to link up, establish synergies and be more strategic are particularly effective, as are those which provide expertise for specialist technical areas.
- The best monitoring, evaluation and learning systems have been designed with and by the southern institution.
- Partnerships should be supported to have a more strategic approach to UK health worker professional development and health system strengthening in the UK