Qualitative learning on RBF 29 March 2014 RBF Workshop, Buenos Aires, Argentina

Kent Ranson | Senior Economist (Health), HRITF Shun Mabuchi| Health Specialist, Africa Region

H E A LT H R E S U LT S I N N O VAT I O N T R U S T F U N D

Learning objectives

•  Why do qualitative research? •  What is qualitative research? •  How can qualitative research be used in

designing and implementing RBF? •  What are some of the challenges of

using qualitative research?

Structure of session

•  Presentation (20 mins) •  Role play (25 mins) •  RBF challenge in Nigeria

o Presentation (5 mins) o Small group discussion (30 mins) o Synthesis and large group discussion (20 mins) o What was actually done (10 mins)

Challenge of diverse target audience!

Why do qualitative research?

Why do qualitative research?

•  Studying processes: the aim is to explain (e.g. an intervention’s apparent success, or otherwise) rather than merely describe

•  “Behind every quantity there is a quality” (Sobo 2009)

•  Studying meaning: what is important to people and why? o  Influences social interactions and

ultimately health outcomes

What is qualitative research?

What is qualitative research?

•  Explores and understands (interprets) the social world through participants’ and their own perspectives

•  Focusses on actors, understanding their varying perspectives, relationships and decisions

•  Is attentive to social and political context

What is qualitative research? (cont’d)

•  Emphasizes the ‘software’ of health systems: ideas and interests, norms and values, relationships and power

•  Follows distinct criteria for rigour o Reflexivity: A continuous process of reflection on

research and activities undertaken to collect and interpret data

Qualitative research in designing and implementing RBF

Systems function lens

5

WHO - 2007"

Social construction / complexity lens

•  Policy and systems shaped by politics, culture, discourse

•  Decisions diffused through system •  Problems (and solutions) are related to

understanding complexity •  Human ‘software’ critical to health

systems performance Kabir Sheikh et al - 2011"

Stages to which qualitative research can contribute

Intervention stage Qualitative research contribution Formative research -  Understand the target problem and context of the

intervention -  Choose and refine intervention design -  Baseline data to compare with data collected later

Process evaluation -  Ongoing as the trial / intervention is implemented -  Is it going as planned? -  May look at quality, intervention delivery, intervention

receipt, reach (barriers to participation), context -  Can contribute to changes during the trial as well as to

an understanding of effect

Outcome evaluation -  Changes in health worker and community perception and behaviour, acceptability of intervention components

-  Intended and unintended consequences

Challenges and working to overcome them

Challenges to overcome

•  Timelines vs. rigour / exertion •  Problems of capacity •  Quality control •  Ethical issues •  Biomedical science dominance: among

researchers, editors, others o Fighting the perception that findings are biased,

common sense, or offer little value relative to cost

Building HRITF qualitative research portfolio

Intervention stage Qualitative research contribution Formative research -  e.g. research feeding into intervention design in the

Gambia

Process evaluation -  e.g. case studies ongoing in: -  Cameroon -  Central African Republic -  Nigeria -  Zimbabwe

Outcome evaluation -  e.g. In Kenya, explaining differential performance across outcome indicators

-  in Nigeria, explaining differential performance across health centres (exercise)

Thank You

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