evidence champions

thoughts from #evalcon on evidence uptake, capacity building

i attended a great panel today, hosted by the think take initiative and idrc and featuring representatives from three of tti’s cohort of think tanks. this is part of the broader global evaluation week (#evalcon) happening in kathmandu and focused on building bridges: use of evaluation for decision making and policy influence. the notes on evidence-uptake largely come from the session while the notes on capacity building are my own musings inspired by the event.

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one point early-on was to contrast evidence-informed decision-making with opinion-informed decision-making. i’ve usually heard the contrast painted as faith-based decision-making and think the opinion framing was useful. it also comes in handy for one of the key takeaways from the session, which is that maybe the point (and feasible goal) isn’t to do away with opinion-based decision-making but rather to make sure that opinions are increasingly shaped by rigorous evaluative evidence. or to be more bayesian about it, we want decision-makers to continuously update their priors about different issues, drawing on evidence.

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this leads to a second point. in focusing on policy influence, we may become too focused on influencing very specific decision-makers for very specific decisions. this may lead us to lose sight of the broader goal of (re-)shaping the opinions of a wide variety of stakeholders and decision-makers, even if not linked to the immediate policy or program under evaluation. so, again, the frame of shaping opinions and aiming for decision-maker/power-center rather than policy-specific influence may lead to altered approaches, goals, and benchmarks.

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a third point that echoed throughout the panel is that policy influence takes time. new ideas need time to sink in and percolate before opinions are re-shaped. secretary suman prasad sharma of nepal noted that from a decision-maker point of view, evaluations are better and more digestible when they aim to build bit by bit. participants invoked a building blocks metaphor several times and contrasted it with “big bang” results. a related and familiar point about the time and timing required for evaluation to change opinions and shape decisions is that planning for the next phase of the program cycle generally begins midway through current programming. if evaluation is to inform this next stage of planning, it requires the communication of interim results — or a more thoughtful shift of the program planning cycle relative to monitoring and evaluation funding cycles in general.

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a general point that came up repeatedly was what constitutes a good versus a bad evaluation. this leads to a key capacity-building point: we need more “capacity-building” to help decision-makers recognize credible, rigorous evidence and to mediate between conflicting findings. way too often, in my view, capacity-building ends up being about how particular methods are carried out, rather than on the central task of identifying credible methodologies and weighting the findings accordingly (or on broader principles of causal inference). that is, capacity-building among decision-makers needs to (a) understand how they currently assess credibility (on a radical premise that capacity-building exercises might generate capacity on both sides) and (b) help them become better consumers, not producers, of evidence.

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a point that surfaced continuously about how decision-makers assess evidence was about objectivity and neutrality. ‘bad evaluations’ are biased and opinionated; ‘good evaluations’ are objective. there is probably a much larger conversation to be had about parsing objectivity from independence and engagement as well as further assessment of how decision-makers assess neutrality and how evaluators might establish and signal their objectivity. as a musing: a particular method doesn’t guarantee neutrality, which can also be violated in shaping the questions, selecting the site and sample, and so on.

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other characteristics of ‘good evaluation’ that came out included those that don’t confuse being critical with only being negative. findings about what is working are also appreciated. ‘bad evaluation’ assigns blame and accountability to particular stakeholders without looking through a nuanced view of the context and events (internal and external) during the evaluation. ‘good evaluation’ involves setting eval objectives up front. ‘good evaluation’ also places the findings in the context of other evidence on the same topic; this literature/evidence review work, especially when it does not focus on a single methodology or discipline (and, yes, i am particularly alluding to RCT authors that tend to only cite other RCTs, at the expense of sectoral evidence and simply other methodologies), is very helpful to a decision-making audience, as is helping to make sense of conflicting findings.

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a final set of issues related to timing and transaction costs. a clear refrain throughout the panel is the importance of the timing of sharing the findings. this means paying attention to the budget-making cycle and sharing results at just the right moment. it means seeing windows of receptivity to evidence on particular topics, reframing the evidence accordingly, and sharing it with decision-makers and the media. it probably means learning a lot more from effective lobbyists. staying in tune with policy and media cycles in a given evaluation context is hugely time consuming. a point was made and is well-taken that the transaction costs of this kind of staying-in-tune for policy influence is quite high for researchers. perhaps goals for influence by the immediate researchers and evaluators should be more modest, at least when shaping a specific decision was not the explicit purpose of the evaluation.

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one is to communicate the findings clearly to and to do necessary capacity-building with naturally sympathetic decision-makers (say, parliamentarians or bureaucrats with an expressed interest in x issue) to become champions to keep the discussion going within decision-making bodies. to reiterate, my view is that a priority for capacity-building efforts should focus on helping decision-makers become evidence champions and good communicators of specific evaluation and research findings. this is an indirect road to influence but an important one, leveraging the credibility of decision-makers with one another. two, also indirect, is to communicate the findings clearly to and to do necessary capacity-building with the types of (advocacy? think tank?) organizations whose job is to focus on the timing of budget meetings and shifting political priorities and local events to which the evidence can be brought to bear.

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the happy closing point was that a little bit of passion in evaluation, even while trying to remain neutral and objective, does not hurt.

Thinking About Stakeholder Risk and Accountability in Pilot Experiments

This post is also cross-posted here in slightly modified form.

Since I keep circling around issues related to my dissertation in this blog, I decided it was time to start writing about some of that work. As anyone who has stood or sat near to me for more than 5 minutes over the past 4.25 years will know, in my thesis I examine the political-economy of adopting and implementing a large global health program (the affordable medicines facility – malaria or “AMFm”). This program was designed at the global level (meaning largely in D.C. and Geneva with tweaking workshops in assorted African capitals). Global actors invited select Sub-Saharan African countries to apply to pilot the AMFm for two years before any decision was made to continue, modify, scale-up, or terminate. It should also be noted from the outset that it was not fully clear what role the evidence would play in the board’s decision and how the evidence would be interpreted. As I highlight below, this lack of clarity helped to foster feelings of risk as well as a resistance among some of the national-level stakeholders about participating in the pilot. . . as  . .

To push the semantics a bit, several critics have (e.g.) noted that scale and scope and requisite new systems and relationships involved in the AMFm disqualify it from being considered a ‘pilot,’ though i use that term for continuity with most other AMFm-related writing. . .

In my research, my focus is on the national and sub-national processes of deciding to participate in the initial pilot (‘phase I’) stage, focusing specifically on Ghana. Besides the project scale and resources mobilized, one thing that stood out about this project is that there was a reasonable amount of resistance to piloting this program among stakeholders in several of the invited countries. I have been very fortunate that my wonderful committee and outside supporters like Owen Barder have continued to push me over the years (and years) to try to explain this resistance to an ostensibly ‘good’ program. Moreover, I have been lucky and grateful that a set of key informants in Ghana that have been willing to converse openly with me over several years as I have tried to untangle the reasons behind the support and resistance and to try to get the story ‘right’. . .

The set-up of the global health pilot experiment, from the global perspective, the set-up was a paragon of planning for evidence-informed decision-making: pilot first, develop benchmarks for success and commission an independent evaluation (a well-monitored before and after comparison) — and make decisions later. . .

In my work, through a grounded qualitative analysis, I distil the variety of reasons for supporting and resisting Ghana’s participation in the AMFm pilot to three main types: those related to direct policy goals (in this case, increasing access to malaria medication and lowering malaria mortality), indirect policy goals (indirect insofar as they are not the explicit goals of the policy in question, such as employment and economic growth), and finally those related to risk and reputation (individual, organizational, and national). I take the latter as my main focus for the rest of this post. . . . .

A key question on which I have been pushed is the extent to which resistance to participation (which meant resisting an unprecedented volume of highly subsidized, high-quality anti-malarial treatments entering both the public and the private sector) emerges from the idea of the AMFm versus the idea of piloting the AMFm with uncertain follow-up plans. . ..

Some issues, such as threats to both direct and indirect policy goals often related to the AMFm mechanism itself, including the focus on malaria prevention rather than treatment as well as broader goals related to national pride and the support of local businesses. The idea of the AMFm itself, as well as it a harbinger of approaches (such as market-based approaches) to global health, provoked both support and resistance. . . .

But some sources of resistance stemmed more directly from the piloting process itself. By evidence-informed design, the global fund gave “no assurance to continue [AMFm] in the long-term,” so that the evaluation of the pilot would shape their decision. This presented limited risks to them. At the national level, this uncertainty proved troubling, as many local stakeholders felt it posed national, organizational, and personal risks for policy goals and reputations. Words like ‘vilification‘ and ‘chastisement‘ and ‘bitter‘ came up during key informant interviews. in a point of opposing objectives (if not a full catch-22, a phrase stricken from my thesis), some stakeholders may have supported the pilot if they knew the program would not be terminated (even if modified), whereas global actors wanted the pilot to see if the evidence suggested the program should (not) be terminated. Pilot-specific concerns related to uncertainties around the sunk investments of time in setting up the needed systems and relationships, which have an uncertain life expectancy. also, for a stakeholder trying to decide whether to support or resist a pilot, it doesn’t help when the reputation and other pay-offs from supporting are uncertain and may only materialize should the pilot prove successful and be carried to the next stage. . . .

A final but absolutely key set of concerns for anyone considering working with policy champions is what, precisely, the decision to continue would hinge upon. Would failure to meet benchmarks be taken as a failure of the mechanism and concept? A failure of national implementation capacity and managerial efforts in Ghana (in the face of a key donor)? A failure of individual efforts and initiatives in Ghana? .

Without clarity on these questions about how accountability and blame would be distributed, national stakeholders were understandably nervous and sometimes resistant (passively of actively) to Ghana’s applying to be a phase I pilot country. To paraphrase one key informant’s articulation of a common view, phase I of the AMFm should have been an experiment on how to continue, not whether to continue, the initiative. . . .

How does this fit in with our ideas of ideal evidence-informed decision-making about programs and policies? The experience recorded here raises some important questions when we talk about wanting policy champions and wanting to generate rigorous evidence about those policies. Assuming that the policies and programs under study adhere to one of the definitions of equipoise, the results from a rigorous evaluation could go either way.

What risks does the local champion(s) of a policy face in visibly supporting a policy?

Is clear accountability established for evaluation outcomes?

Are there built-in buffers for the personal and political reputation of champions and supporters in the evaluation design?

The more we talk about early stakeholder buy-in to evaluation and the desire for research uptake on the basis of evaluation results, the more we need to think about the political economy of pilots and those those stepping up to support policies and the (impact) evaluation of them. Do they exist in a learning environment where glitches and null results are considered part of the process? Can evaluations help to elucidate design and implementation failures in a way that has clear lines of accountability among the ‘ideas’ people, the champions, the managers, and the implementer’s? These questions need to be taken seriously if we expect government officials to engage in pilot research to help decide the best way to move a program or policy forward (including not moving it forward at all).