Social Return on Investment (SROI) Kumar, Shubha R.; Banke-Thomas, Aduragbemi
African Journal of Reproductive Health,
09/2016, Letnik:
20, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Despite efforts, sub-Saharan Africa did not achieve many key Sexual and Reproductive Health (SRH) targets under the Millennium Development Goals. In the post 2015 era, the Sustainable Development ...Goals (SDGs) will frame decisions on donor priorities and resource allocations. Successfully addressing SRH challenges in sub-Saharan Africa have been blunted due to fragmentation of SRH interventions in planning and implementation, lack of coherence between policies and program implementation, resulting in poor program performance and lack of accountability. We suggest the Social Return on Investment (SROI) framework offers a strategic approach for sub-Saharan Africa in support of the implementation, monitoring and evaluation of SRH programs given its capacity to capture social and economic impacts, stakeholder participation, and sensitivity towards key human rights concerns relevant to SRH. SROI disrupts a "business as usual" approach for one that is systematic, participatory, and supportive of economic and human rights needs for success in the SDG era.
Malgré les efforts, l'Afrique subsaharienne n'a pas atteint beaucoup d'objectifs clés de santé sexuelle et de la reproduction (SSR) dans le cadre des objectifs du millénaire pour le développement. Dans l'ère post-2015, les objectifs de développement durable (ODD) encadreront les décisions sur les priorités des donateurs et les allocations de ressources. Aborder avec succès les défis de SSR en Afrique sub-saharienne a été émoussée en raison de la fragmentation des interventions SSR dans la planification et la mise en œuvre, le manque de cohérence entre les politiques et la mise en œuvre du programme, ce qui entraîne une mauvaise 'exécution du programme et un manque de responsabilité. Nous suggérons que le retour social sur le cadre de l'investissement (RSSI) offre une approche stratégique pour l'Afrique subsaharienne à l'appui de la mise en œuvre, le suivi et l'évaluation des programmes de SSR compte tenu de sa capacité à capter les impacts sociaux et économiques, la participation des parties prenantes, et la sensibilité envers les préoccupations clés des droits de l'homme relatives à la SSR. Le RSSI perturbe une approche de « la vie continue comme si de rien n'est» pour celui qui est systématique, participatif et solidaire par rapport aux besoins économiques et des droits de l'homme pour réussir dans l'ère des ODD.
recent efforts to bridge the evidence-policy gap in low-and middle-income countries have seen growing interest from key audiences such as government, civil society, international organizations, ...private sector players, academia, and media. One of such engagement was a two-day virtual participant-driven conference (the convening) in Nigeria. The aim of the convening was to develop strategies for improving evidence use in health policy. The convening witnessed a participant blend of health policymakers, researchers, political policymakers, philanthropists, global health practitioners, program officers, students, and the media.
in this study, we analyzed conversations at the convening with the aim to disseminate findings to key stakeholders in Nigeria. The recordings from the convening were transcribed and analyzed inductively to identify emerging themes, which were interpreted, and inferences are drawn.
a total of 630 people attended the convening. Participants joined from 13 countries. Participants identified poor collaboration between researchers and policymakers, poor community involvement in research and policy processes, poor funding for research, and inequalities as key factors inhibiting the use of evidence for policymaking in Nigeria. Strategies proposed to address these challenges include the use of participatory and embedded research methods, leveraging existing systems and networks, advocating for improved funding and ownership for research, and the use of context-sensitive knowledge translation strategies.
overall, better interaction among the various stakeholders will improve the evidence generation, translation, and use in Nigeria. A road map for the dissemination of findings from this conference has been developed for implementation across the strata of the health system.
Background: Globally, there has been increasing interest to demonstrate value-for-money of interventions using various approaches including social return on investment, which is a form of social ...cost-benefit analysis. This study pioneered its application in maternal and newborn health. Specifically, the methodology was used to assess the social impact and value-for-money of an emergency obstetric care training intervention for health care providers in Kenya.Methods: Qualitative methods and literature review were used to identify key stakeholders who were direct beneficiaries of the training; and map, evidence and financially value its outcomes. These qualitative findings were triangulated with quantitative evidence from existing literature and programmatic data, which helped to establish impact. Quantitative methods were also used to account for the financial investment (input) used to implement the intervention and output produced. Both qualitative and quantitative findings were incorporated into the impact map, to estimate the social return on investment ratio. Sensitivity analyses were done to test assumptions and the pay-back period estimated. Stakeholders who were not deemed direct beneficiaries were engaged to establish strengths, weaknesses, opportunities and threats of the intervention.Results: Multiple numbers of key stakeholders of the training were engaged via 28 focus group discussions, 18 interviews, and three paired interviews. Trained health care providers, women who received care from them and their newborns are training primary beneficiaries. From the thematic analysis, key emerging themes were that training led to positive outcomes including improved knowledge, skills and attitude with patients. However, there were concomitant negative outcomes including increased workload because of new patient expectation and frustration from inability to practise what was learnt. Women had positive opinions concerning the quality of care that they received. They expected positive outcomes including avoiding maternal and newborn morbidity and mortality. However, women affirmed that negative outcomes could occur, attributable to health care providers, themselves or simply due to chance. These outcomes experienced by both health care providers and women who received care from them have been mostly reported in the literature and evidenced from programme data. However, ‘increased workload’ is reported as increased care provision in the literature and ‘increased frustration due to inability to practise what had been learnt following training’ had not been directly linked to training previously.Based on programmatic data, total implementation costs was £1,079,383 for the 2,965 HCPs that were trained across 93 courses. The cost per trained HCP per day was £72.80. The total social impact for one year was valued at £13,747,173.78, with women benefitting the most from the intervention (73%). For beneficiaries, estimation of attribution, duration, and financial value of these outcomes by the beneficiaries was difficult and variable. Though beneficiaries provided insight for subsequent literature search for values. SROI ratio was calculated as £11.02: £1 and net SROI was £10.02: £1. The payback period for the investment was about one month. Based on the multiple one-way sensitivity analyses, the intervention guaranteed VfM in all scenarios except when all the trainers were paid consultancy fees and the least amount of outcomes occurred.
Background Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). ...Since 2009, the global guideline, referred to as the 'handbook', has been used to monitor availability, utilization, and quality of EmOC. Objective To assess application and explore experiences of researchers in LMICs in assessing EmOC. Design Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. Results Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the 'handbook' alone, whereas the others combined the 'handbook' with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. Conclusions There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision.
The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are ...preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O’Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual—level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility—level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system—level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility—level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.
In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, ...motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15–49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women’s socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90–41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55–3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.
Obstetric fistula has been eliminated in developed countries, but remains highly prevalent in sub-Saharan Africa. The End fistula campaign is the first concerted effort to eradicate the disease. The ...objective of this review is to retrieve and link available evidence to obstetric fistula prevention strategies in sub-Saharan Africa, since the campaign began. We searched databases for original research on obstetric fistula prevention. Fifteen articles meeting inclusion criteria were assessed for quality, and data extraction was performed. Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the most effective and cost-effective strategies for fistula prevention and utilise innovative tools to measure impact of strategies in order to ensure eradication of fistula.
Obstetric fistula has been eliminated in developed countries, but remains highly prevalent in sub-Saharan Africa. The End fistula campaign is the first concerted effort to eradicate the disease. The ...objective of this review is to retrieve and link available evidence to obstetric fistula prevention strategies in sub-Saharan Africa, since the campaign began. We searched databases for original research on obstetric fistula prevention. Fifteen articles meeting inclusion criteria were assessed for quality, and data extraction was performed. Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the most effective and cost-effective strategies for fistula prevention and utilise innovative tools to measure impact of strategies in order to ensure eradication of fistula. La fistule obstétricale a été éliminée dans les pays développés, mais reste très répandue en Afrique sub-saharienne. La Campagne pour mettre fin à la fistule est le premier effort concerté pour éradiquer la maladie. L'objectif de ce compte rendu est de récupérer et de lier l'évidence disponible aux stratégies de la prévention de la fistule obstétricale en Afrique sub-saharienne, depuis le commencement de la campagne. Nous avons cherché des bases de données pour la recherche originale sur la prévention de la fistule obstétricale. 15 articles ont satisfait aux critères d'inclusion et ont été évalués pour vérifier leur qualité et l'extraction des données et a été réalisée. La documentation grise a fourni un contexte. Les évidences tirées ont été liés à des stratégies de prévention extraites de la documentation grise. Les stratégies ont été classées à l'aide d'une méthode de cible axé innovante. Les lacunes dans la documentation montrent la nécessité pour la recherche sur la prévention de la fistule pour viser systématiquement la mesure de l'incidence et de la prévalence de la maladie, identifier les stratégies les plus efficaces et rentables pour la prévention de la fistule et d'utiliser des outils innovants pour mesurer l'impact des stratégies afin de garantir l'éradication de la fistule.
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