Measuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations

Lancet. 2011 Jan 1;377(9759):85-95. doi: 10.1016/S0140-6736(10)60810-0. Epub 2010 Jul 9.


Evaluation of large-scale programmes and initiatives aimed at improvement of health in countries of low and middle income needs a new approach. Traditional designs, which compare areas with and without a given programme, are no longer relevant at a time when many programmes are being scaled up in virtually every district in the world. We propose an evolution in evaluation design, a national platform approach that: uses the district as the unit of design and analysis; is based on continuous monitoring of different levels of indicators; gathers additional data before, during, and after the period to be assessed by multiple methods; uses several analytical techniques to deal with various data gaps and biases; and includes interim and summative evaluation analyses. This new approach will promote country ownership, transparency, and donor coordination while providing a rigorous comparison of the cost-effectiveness of different scale-up approaches.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Delivery of Health Care / economics*
  • Developing Countries*
  • Humans
  • National Health Programs / economics*