The science of programme evaluation has grown over the years, particularly in response to the complexity of many programmes implemented within health systems, in which multiple actors, services, interventions and levels of care may be involved. We recently reported on a formative evaluation that used multiple and mixed methods to assess such a programme that focused on using lay or community health workers to support people in South Africa receiving treatment for TB and HIV/AIDS. To inform the field of programme evaluation, we reflect in this paper on each of the methods used in relation to the evaluation objectives, and offer suggestions on ways of optimising the use of multiple, mixed-methods within formative evaluations of complex health system interventions.

Some of the issues we discuss include viewing programme evaluation as a creative and innovative process, in which thoughtful selection of methods may result in a more textured understanding of the programme; the relevance and application of the concept of triangulation; and balancing the range and mixing of methods with the resources and experience available in the evaluation team. As programme evaluations ultimately aim to improve programme implementation and strengthen health systems, it is important that evaluators be mindful of how their methods and findings will inform the policies and practices of the programmes they evaluate. The full paper is available here and we welcome comments and other evaluation experiences from members of the forum:


Arrie Odendaal

Health Systems Research Unit

South African Medical Research Council

Tel: +27 21 9380454 | Cell: 072 8665 173

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