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Instructions
LARGE SCALE EFFECTIVENESS EVALUATIONS OF HEALTH PROGRAMS
Short Answer Questions
These short answer questions ask you to demonstrate your knowledge and understanding of the concepts presented in course lectures and readings. You are encouraged to reference the concepts from specific readings and lectures, but should rephrase the concepts in your own words, rather than directly quoting from a text. Please adhere to the word limit for your response to each question—we are looking for clear and concise responses that demonstrate a strong grasp of the material. For most questions, students should be able to provide a strong answer to the question in well under the word limit.
Short answer questions
1. Please explain the concept of the “counterfactual,” and how evaluators include this concept in their evaluation designs. (Limit of 150 words)
2. Using the categories presented by Habicht et al. in the course reading and in lecture (adequacy, plausibility, and probability), please answer the following: What type of impact inference can be made from a) one cross-sectional survey of the recipient population following a program?; b) one cross-sectional survey of the recipient population and a control population following a program? Please discuss why these evaluation designs allow for different levels of inference. (Limit of 150 words)
3. Please explain the difference between the “Stepwise Approach” and a “Stepped-Wedge” design. When would you recommend that evaluators use a step-wise approach and when would you recommend that they use a stepped- wedge design? (Limit of 150 words)
4. Consider a diarrhea program in an African country where families frequently seek care for sick children at private drug shops. To improve coverage of oral rehydration solution with zinc, the program trains drug shop owners to provide ORS with zinc and also uses community-based health educators to increase demand for ORS. Please explain two concepts that you would include at each level of the pathway to impact in an impact model for this program, with a very brief explanation as to why. (Limit of 150 words)
5. You have been asked to critique an evaluation of a maternal health program in Bangladesh that aims to increase the proportion of pregnant women who deliver at a health facility (only 37.4% in 2014 as measured by the Demographic and Health Survey). To achieve this goal, the program is working with the Ministry of Health to upgrade all lower level health centers (~1 per 30,0000 population) to provide 24/7 delivery, greatly increasing access to skilled delivery care beyond the current services at health complexes and hospitals (~1 per 270,000 population). The evaluation team plans to evaluate the program’s success by tracking the proportion of deliveries that take place at a facility. They don’t plan to look at mortality measures or track program activities (inputs, process, and outputs). What reasons would you give the evaluation team for why they should: a) track inputs, process, and outputs; and b) use mortality measures to evaluate the impact of their program? (Limit of 150 words)

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