Monitoring vested health partnerships.

SETTING: This article is based on the experience of the Public Health Agency of Canada Innovation Strategy (PHAC-IS) federal funding program in building Canadian population health partnerships. INTERVENTION: The PHAC-IS addressed complex public health issues by funding evidence-based population health interventions in communities across Canada. These interventions were multifaceted and required the development of diverse "vested" partners to sustain systemic impact. This article explores the key elements of a vested partnership that affect systems change, and how to monitor the effects and achievements of vested partnerships as greater than what individual partners can achieve on their own. OUTCOMES: Vested health partnerships have diverse partners that fit the system they are trying to change, a clear, public sectoral agenda, partner alignment, and pooling of both human and financial assets. A vested health partnership assumes strength in the diversity and governance of the partnership as well as in how it demonstrates collaborative systems change. It is important to monitor and measure both the partners and the synergy and collective impact of the partnership. IMPLICATIONS: Short-term reach may need to be compromised for the brokering required to establish broad vested partners. Alignment, vestedness, and outcome measurement seem linked since strong partners that grow and adapt together change the way each sees and monitors the solution. Sophisticated partnerships, like a murmuration of starlings, act in concert to push learning and change practices, policies and societal norms. Capturing the movement of the flock is as important as counting the birds.

RéSUMé: MISE EN SITUATION: Le présent article se fonde sur l'expérience du programme de financement fédéral de la Stratégie d'innovation de l'Agence de la santé publique du Canada (SI de l'ASPC) en matière d'établissement de partenariats canadiens en santé de la population. INTERVENTION: La SI de l'ASPC s'attaque à des problèmes de santé publique complexes en finançant des interventions en santé de la population fondées sur des données probantes qui sont mises en œuvre dans les collectivités canadiennes. Ces interventions à multiples facettes ont demandé l'établissement de divers partenariats « acquis ¼ pour assurer une incidence systémique. Le présent article aborde les éléments clés d'un partenariat acquis favorisant les changements systémiques et explique comment évaluer les effets et les réalisations des partenariats acquis, qui sont supérieurs à ce que peut réaliser de façon individuelle un partenaire. RéSULTATS: Les partenariats de santé acquis réunissent divers partenaires qui font partie du système qu'ils s'emploient à changer et demandent l'établissement d'un programme sectoriel public clair, l'harmonisation des partenaires et la mise en commun des ressources humaines et financières. Un partenariat de santé acquis tire profit de sa diversité et sa structure de gouvernance ainsi que de la façon dont il peut favoriser un changement systémique collaboratif. Il est important de surveiller et de mesurer autant les partenaires que la synergie et l'incidence générale du partenariat. INCIDENCE: Une portée immédiate peut devoir être compromise pour négocier l'établissement de vastes partenariats acquis. L'harmonisation l'engagement et la mesure des résultats semblent être liés puisque de solides partenaires qui grandissent et s'adaptent ensemble changent la façon dont chacun perçoit la solution et la surveille. Les partenariats sophistiqués, comme une nuée d'étourneaux en vol, font un mouvement commun favorisant l'apprentissage et la modification des pratiques, des politiques et des normes sociales. Comprendre le mouvement collectif est tout aussi important que le dénombrement des oiseaux.

Financial education for HIV-vulnerable youth, orphans, and vulnerable children: A systematic review of outcome evidence.

Problem: According to Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide. Global commitments to reverse the HIV epidemic will only be achieved if strategies prioritize children and youth. Relevant evidence reviews found mixed evidence that HIV prevention may be addressed through economic strengthening activities such as financial education for youth. There was some evidence related to the potential for plural interventions that include both financial and sexual, reproductive health education. However, there is limited quality evidence that focused on HIV vulnerable youth in low- and middle-income countries (LMICs). Aims: This systematic review assessed the scope and strength of evidence for financial education and plural interventions aimed at reducing HIV vulnerability for youth, orphans and vulnerable children (OVC) in LMICs. Methods: Standard methodological procedures expected of systematic reviews were used. Six scientific and 24 grey literature sites were searched for relevant studies in English, French, Spanish and Arabic published between 1990 and 2016. Experimental and quasi-experimental research methods were considered where data was gathered at baseline and at least 6 months after the end of the intervention. Mixed-methods studies were considered provided they demonstrated validity in terms of randomization, appropriate sampling and controls, and minimization of bias errors and attrition. Evidence was then analysed and mapped to show types of financial and plural interventions by outcome type, direction and strength of evidence through qualitative assessments by the team. In addition, meta-analysis of odds ratios was conducted to validate the strength of evidence. This analysis illustrated the relative effect or weight of interventions on HIV-related outcomes based on confidence levels and sample sizes. Results: Of 5,216 records, 16 moderate to higher quality studies representing 10 interventions were identified, mostly focusing on HIV-vulnerable girls in Sub-Saharan Africa. More than half of the interventions were plural and included access to finance and counselling or supports to improve confidence, negotiating ability and social conditions. Most studies used an experimental design. Only 11 of the 16 studies had comparable enough measures to be validated with meta-analysis of odds ratios. Findings: The strongest evidence showed plural education interventions with self-efficacy supports, with and without savings to have positive effects on HIV-related outcomes. These outcomes included improved knowledge, attitudes and reduced sexual risk-taking behaviour. Evidence also showed improved self-efficacy from plural interventions, the changes in confidence, negotiating ability and social conditions that enable people to act on knowledge. Self-efficacy seems important as both a set of conditions to support reduced vulnerabilities and a way to measure them in terms of outcomes. While positive effects were also observed related to increased savings and improved attitudes toward saving, generally interventions showed mixed effects on financial and economic outcomes. Conclusions: This systematic review supports emerging evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMIC. Even so, as a body of evidence, it is not clear which components are effective at producing favourable outcomes. Therefore, asset theories linking financial education and asset building with favourable outcomes for vulnerable youth are not as clear as may be commonly assumed. Quality evidence is needed in more settings separating out economic, health and self-efficacy components to better understand pathways and effects on outcomes. Segmentation in quantitative studies will enhance our understanding of asset, capability and self-efficacy theories for greater impact. Mixed methods and qualitative studies will be important complements to enhance our understanding of contextual conditions and how to build assets and self-efficacy in HIV vulnerable youth and OVC.