Evidence Aid: The humanitarian relief evidence problems and what can be done? Oxford, Sept. 26, 2011 Hey CERN, 186,282 miles per second, it’s not just the law, it’s a good idea!
Evidence Aid: The humanitarian relief evidence problems and what
can be done? Oxford, Sept. 26, 2011
Hey CERN, 186,282 miles per second, it’s not just the law, it’s a good idea!
Outline
• World is changing
• We have a minority lens
• Politics not ideal
But we can make headway via:
Donors
Self and peer expectations
Pushing logical next steps like defining “proven”
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Global
Nigerian Civil War: Problem, who was malnourished?
http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science/journal/01406736
QUAC Stick Developed
•
doi:10.1016/S0140-6736(72)91323-2 | How to Cite or Link Using DOI Copyright © 1972 Published by Elsevier Science Ltd.
Permissions & Reprints
Volume 300, Issue 7769, 22 July 1972, Pages 143-146
PATTERN OF PROTEIN-CALORIE MALNUTRITION IN YOUNG
CHILDREN ATTENDING AN OUTPATIENT CLINIC IN
BAGHDAD
Adnan Shakirb, c, a, M. Demarchib, c, a and N. El-Millib, c, a a Department of Pædiatrics and Child Health, Baghdad
University Medical College;, United Kingdom b National Nutrition Institute,, Baghdad;, Iraq c and School Health Service,, Baghdad, Iraq
Available online 26 September 2003.
http://dx.doi.org/10.1016/S0140-6736(72)91323-2http://dx.doi.org/10.1016/S0140-6736(72)91323-2http://dx.doi.org/10.1016/S0140-6736(72)91323-2http://dx.doi.org/10.1016/S0140-6736(72)91323-2http://dx.doi.org/10.1016/S0140-6736(72)91323-2http://www.sciencedirect.com/science?_ob=HelpURL&_file=doi.htm&_acct=C000002018&_version=1&_urlVersion=0&_userid=18704&md5=6d9c02baeb49680a4c32f9e84708b47chttp://www.sciencedirect.com/science?_ob=HelpURL&_file=doi.htm&_acct=C000002018&_version=1&_urlVersion=0&_userid=18704&md5=6d9c02baeb49680a4c32f9e84708b47chttp://www.sciencedirect.com/science?_ob=RedirectURL&_method=outwardLink&_partnerName=936&_udi=B6T1B-49MF3KY-520&_pii=S0140673672913232&_origin=article&_zone=art_page&_targetURL=https://s100.copyright.com/AppDispatchServlet?publisherName=ELS&contentID=S0140673672913232&orderBeanReset=true&_acct=C000002018&_version=1&_userid=18704&md5=1bcb1f53310f45c1f5df1db13c8dc73fhttp://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science/journal/01406736http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=http://www.sciencedirect.com/science/journal/01406736
# wars by Type, 1946-2003. Source: R Garfield & GBD Initiative
Trends in Child Mortality Relative to MDG4
Sub-Saharan Africa
South Asia
Latin America
East Asia
Under-
Five
Mortality
Rate
244
188
171
62
206
129
92
42.6
122
54 31
17.8
123
58
36
19.1
1970 1990 2004 2015
} MDG4 Goals Source: The State of the World’s Children, 2006
Changing patterns of world's population exposed to conflict, on a conflict
intensity scale of 1-10 (1=lowest intensity, 10=highest intensity)
0
50000000
100000000
150000000
200000000
250000000
300000000
350000000
400000000
450000000
1951
1953
1955
1957
1959
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
1 2 3 4 5 6 7Source: Richard Garfield
Baseline measured or comparison group available
Yes No
Impact cannot be shown
Level of project evaluation the same as or logical with the level of implementation
No
Yes
3 essential criteria of causation met, ideally with at least one other
No
Valid indicator used with valid data collection methodology
No
Impact = difference between baseline or comparison rate and measured rate
Place&time Task
Serbia 8/02-7/03 Improve nutritional quality, HH income
Serbia, Kosovo, 7/02-6/03 Help 10,000 IDP’s return, psycho-social, winterize
Macedonia 5/02-12/02 Provide health care to refugees & returnees
Balkans 6/02-6/03 Reduce dependence on aid of chronic EVI’s
Bosnia, Croatia 5/02-4/03 Induce stable incomes, independence for EVI’s
DRC 1/02-5/03 Primary Health Care (PHC) for 15,000 refugees
Tanzania 1/01-12/01 PHC for refugees
Kenya 1/02-12/02 PHC for refugees
Uganda 1/02-12/02 Achieve food self-sufficiency
Eritrea 9/01-9/02 “increase life-saving PHC activities”
Rwanda 7-9/02 Provide PHC, Water and San. to returnees
Sierra Leone 2/02-4/03 Provide medical care via at least 13 clinics
Guinea 1/02-12/02 Provide mental health services to refugees
Guinea 2002 Induce econ. self-sufficiency, reduce SGBV
Guinea 2002 Provide PHC to 60,000
Place&time
Serbia, Kosovo, 7/02-6/03
Macedonia 5/02-12/02
Balkans 6/02-6/03
Bosnia, Croatia 5/02-4/03
Guinea 2002
Serbia 8/02-7/03
Guinea 2002
Sierra Leone 2/02-4/03
Uganda 1/02-12/02
Eritrea 9/01-9/02
Kenya 1–12/02
Rwanda 7-9/02
Guinea 1/02-12/02
Tanzania 1/01-12/01
Serbia 8/02-7/03
Baseline N/A
No Baseline
Baseline measured
Place&time
Serbia, Kosovo, 7/02-6/03
Macedonia 5/02-12/02
Balkans 6/02-6/03
Bosnia, Croatia 5/02-4/03
Guinea 2002
Serbia 8/02-7/03
Guinea 2002
Uganda 1 – 12/02
Sierra Leone 2/02-4/03
Eritrea 9/01-9/02
Rwanda 7-9/02
Kenya 1-12/02
Guinea 1/02-12/02
Tanzania 1/01-12/01
Serbia 8/02-7/03
No Benefits Likely
Benefits document
Likely did good things,
not documented
Created 10X multiplier effect for psych-soc.
“Durable solutions” for EVI’s met with durable
Inputs such as school books, home repairs.
“Food self-sufficiency” & “Self-reliance”
Delivered 2885 MT of general rations.
Fig. 3: Incidence of Dysentery, Mtendeli Camp, Tanzania,
cases/1000/mo.
0
1
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5
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J'9
8 F M A M J J A S O N D
J'9
9 F M A M J J A S O N D
J'0
0 F M A M J J A S O N D
J'0
1 F M A M J J
Photo by Teun Voeten
Rape in San Francisco, 1970's
36.7
1.70.6
5
1.7
0
5
10
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25
30
35
40
Russell 1978 FBI SF FBI Nat. NCS SF NCS Nat.
Rate
per
1000 w
om
en
per
year
From D. Russell and R. Bolen.
Bolton Box
Good Bad
Expected Unexpected
Unique role of us to create robust metrics to go here
To look broadly and at long enough periods to really know what goes here
Bolton Box – Measles Vac.
Good Bad
Expected Unexpected
Less measles in those vaccinated
Child cries, very small # adverse reactions, not doing other things.
People gain trust in health system, staff morale goes up…
People prefer use of used syringes, staff will not do other things without extra pay…
Bolton Box – Micro Fin. for HIV+
Good Bad
Expected Unexpected
HIV+ moms have employment
With assets, women Become more Vulnerable to crime.
People gain self esteem, role model for their kids…
Women got HIV intentionally to get $200 loan.
Bolton Box
Good Bad
Expected Unexpected
Is it ethical to run a humanitarian program that cannot show a benefit?
Bolton Box
Good Bad
Expected Unexpected What goes here for
Democracy building child protection, child soldier reint. poverty reduction, rape counseling, community sens. safe spaces Surveys, research, teaching
From BBC, Oct 13, 2009. http://news.bbc.co.uk/2/hi/africa/8304721.stm
Summary
1. The “medical” & “cost effective “ model is not the majority view.
2. Political, rights-based, contextual issues stacked against evidence centered relief.
3. Financial accountability forces always on side of cost benefit / cost-effectiveness approach.
4. Ethics in the broadest sense require knowing what affects we produce.
Possible ways forward
1. Create donor incentives to learn & doc.
2. Establish consensus criteria on what it means to be “proven” and start getting donors to fund differently between types
3. Establish function audit mechanism among biggest donors.
4. Start developing a “professional ethos” like pilots and nurses.
Questions? Thank you!
“Count what is countable, Measure what is measurable. What is not measurable, make measurable.” Galileo From: Kaydos, 1998
Births 2500 grams, Mtendeli Camp, Tanzania
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J'98 M M
J S NJ'99 M M
J S NJ'00 M M
J S NJ'01 M M
J
2500g
Inc. of Fever/Malaria, Mtendeli Camp Tanzania, cases/1000/mo.:
Source IRC
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J'98 M M
J S NJ'99 M M
J S NJ'00 M M
J S NJ'01 M M
J
Births 2500 grams, Mtendeli Camp, Tanzania
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100
150
200
250
300
J'98 M M
J S NJ'99 M M
J S NJ'00 M M
J S NJ'01 M M
J
2500g
Suppl. Feeding of
Pregn. Women.
3% delivering women syph.+