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|Title: ||Proof of impact and pipeline planning: directions and challenges for social audit in the health sector|
|Authors: ||Andersson, Neil|
HEALTH INFORMATION SYSTEMS
|Issue Date: ||2011|
|Citation: ||Andersson, N. (2011). Proof of impact and pipeline planning: directions and challenges for social audit in the health sector. BMC Health
Services Research, 11(Suppl 2):S16. doi:10.1186/1472-6963-11-S2-S16|
|Abstract: ||Social audits are typically observational studies, combining qualitative and quantitative uptake of evidence with
consultative interpretation of results. This often falters on issues of causality because their cross-sectional design
limits interpretation of time relations and separation out of other indirect associations.
Social audits drawing on methods of randomised controlled cluster trials (RCCT) allow more certainty about
causality. Randomisation means that exposure occurs independently of all events that precede it – it converts
potential confounders and other covariates into random differences. In 2008, CIET social audits introduced
randomisation of the knowledge translation component with subsequent measurement of impact in the changes
introduced. This “proof of impact” generates an additional layer of evidence in a cost-effective way, providing
implementation-ready solutions for planners.
Pipeline planning is a social audit that incorporates stepped wedge RCCTs. From a listing of districts/communities
as a sampling frame, individual entities (communities, towns, districts) are randomly assigned to waves of
intervention. Measurement of the impact takes advantage of the delay occasioned by the reality that there are
insufficient resources to implement everywhere at the same time. The impact in the first wave contrasts with the
second wave, which in turn contrasts with a third wave, and so on until all have received the intervention.
Provided care is taken to achieve reasonable balance in the random allocation of communities, towns or districts
to the waves, the resulting analysis can be straightforward.
Where there is sufficient management interest in and commitment to evidence, pipeline planning can be
integrated in the roll-out of programmes where real time information can improve the pipeline. Not all
interventions can be randomly allocated, however, and random differences can still distort measurement. Other
issues include contamination of the subsequent waves, ambiguity of indicators, “participant effects” that result from
lack of blinding and lack of placebos, ethics and, not least important, the skills to do pipeline planning correctly.|
|Project Number: ||104613|
|Project Title: ||Nigeria Evidence-based Health System Initiative (NEHSI) : Implementation|
|Appears in Collections:||Nigeria Evidence-based Health System Initiative (NEHSI) / Initiative Données probantes et systèmes de santé au Nigeria (NEHSI)|
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