COVID-19 vaccination willingness in peri-urban Tanzanian communities: Towards contextualising and moving beyond the individual perspective.

With only 5.1% of the population fully vaccinated against COVID-19, Tanzania has one of the lowest vaccination rates in the world and after two years of changing policies regarding the disease, the country struggles to get its vaccination campaign on the rails. In this study, we identify the determinants of COVID-19 vaccination willingness in two villages of the Mvomero district in Eastern Tanzania. Based on survey data, we performed univariate analyses to assess differences in vaccination intention for various social groups, and built a four-dimensional multivariate ordered logistic regression model that comprises respondents' personal and socioeconomic characteristics, the channels through which they get their information, their attitudes and perceptions towards COVID-19, and their social network embeddedness. Only 37.0% of the respondents indicated that they would be willing to get vaccinated against COVID-19. Vaccination willingness differed significantly according to gender, age, educational attainment and religion; with men, the elderly, people with post-secondary education and Catholics and Muslims more likely to accept a vaccine. Predictors of vaccination willingness were gender, age, social media and informal contacts as information sources, perceived effectiveness of the vaccine and of alternative medicine, fear of side effects, a general dislike of vaccines, and the proportion of vaccinated people and the highest value of trust in international organisations in one's network. Although people's attitudes and perceptions have the largest share of the explanatory value, our model shows that all four of our model's building blocks were imperative in explaining vaccination willingness. Therefore, our paper presents a compelling case for the inclusion of respondents' social embeddedness as a common dimension for exploratory models of vaccination willingness.

Theory-based evaluation of the impact of Master's programmes in development studies: Insights from a mixed-methods and multicultural alumni action research project.

To understand the impact of the international Master's programmes offered at the Institute of Development Policy (University of Antwerp), a theory-based evaluation was undertaken. In the first phase, a Theory of Change (ToC) was elaborated, distinguishing between three levels of impact (individual, organisational and societal), four learning dimensions (knowledge, skills, attitudes and networks) and five implicit pathways (change agent, social network, widening access, academic diversity, international understanding). Given the multifaceted and vague nature of the 'impact' concept under study, we selected an international, gender-balanced, multi-sectoral team of alumni researchers who fostered inclusiveness of different perspectives, at the same time capitalising on their depth of understanding, having gone through the study experience themselves. A mixed-methods approach was adopted to validate the ToC, combining a Most Significant Change approach, categorisation and text analysis of 101 alumni impact stories. Our findings demonstrate the importance of the three levels of impact and four learning dimensions in capturing graduate impact. While the impact stories confirmed the dominant 'change agent' pathway, they also hinted at the importance of hybrid complementary configurations of pathways to fully grasp how impact materialises.

Interventions for improving male involvement in maternal and child healthcare in Uganda: A realist synthesis.

This study aimed at understanding how, when, and under what circumstances interventions succeed (or fail) to improve male involvement in maternal and child healthcare in Uganda. A realist synthesis approach was used to unpack the complexity of these health interventions to explain their theories and applications in specific circumstances. Our review of 19 studies revealed that men were specifically approached as clients, partners or agents for behavioural change. Broadly, mechanisms of education, training, restriction, environmental restructuring, modeling, enablement, persuasion, incentivization and coercion were used to involve men in maternal and child healthcare. Education, training, modeling, enablement and environmental restructuring mechanisms were more effective in 'cultivating' a sustained will of men to get involved as couples. However, unintended outcomes were inevitable in circumstances where mechanisms did not match specific contexts. Using coercion, restriction or incentivization is more likely to result in short-term and negative outcomes because of context heterogeneities.

Adolescent Dating Violence Among Nicaraguan Youth.

This study examines the rates of victimization and perpetration of physical, sexual, and psychological dating violence among a sample of 193 ever-partnered Nicaraguan adolescents. Findings reveal high levels of partner violence, with 20% of students experiencing physical violence, 27% experiencing sexual violence, and 45-83% experiencing different types of psychological violence. For both victimization and perpetration, physical and sexual abuse were found to be positively correlated with psychological abuse, most notably for girl victims. We analyze the gender dynamics of the findings, contextualize them in a sociocultural analysis, and provide directions for prevention and future research.

To evaluate or not: Evaluability study of 40 interventions of Belgian development cooperation.

Due to an increasing importance of evaluations within development cooperation, it has become all the more important to analyse if initial conditions for quality and relevant evaluations are met. This article presents the findings from an evaluability study of 40 interventions of Belgian development cooperation. A study framework was developed focusing on three key dimensions (i.e. theoretical evaluability, practical evaluability and the evaluation context) and subdivided over the different OECD/DAC criteria. Drawing upon a combination of desk and field research, the study framework was subsequently applied on a set of 40 interventions in Benin, DRC, Rwanda and Belgium. Findings highlight that the context dimension scores remarkably better than the theoretical and practical evaluability in particular. The large majority of the interventions have the conditions in place to satisfactorily evaluate effectiveness and efficiency while the opposite holds for sustainability and impact in particular. These findings caution against commissioning of evaluations that ritually focus on all OECD/DAC criteria regardless of their readiness. It underscores the usefulness of a flexible 'portfolio' approach towards evaluations, in which a more systematic use of evaluability assessment from the start of interventions could play a role.

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the 'Black Box' of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda.

Increased attention on "complexity" in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: "success to the successful", "growth and underinvestment", and "supervision conundrum". The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.

Performance-based financing: the same is different.

Although it is increasingly acknowledged within the Performance-Based Financing (PBF) research community that PBF is more than just payments based on outputs verified for quality, this narrow definition of PBF is still very present in many studies and evaluations. This leads to missed opportunities, misunderstandings and an unhelpful debate. Therefore, we reinforce the claim that PBF should be viewed as a reform package focused on targeted services with many different aspects that go beyond the health worker level. Failing to acknowledge the importance of the different elements of PBF negatively influences the task of practitioners, researchers and policymakers alike. After making the case for this wider definition, we propose three research pathways (describing, understanding and framing PBF) and give a short and tentative starting point for future research, leaving the floor open for more in-depth discussions. From these three vantage points it appears that when it comes to PBF 'the same is different'. Notwithstanding the increased complexity due to the use of the wider definition, progress on these three different research pathways will strongly improve our knowledge, lead to better adapted PBF programs and create a more nuanced debate on PBF.

Look Who's Talking. Explaining Water-Related Information Sharing and Demand for Action Among Ugandan Villagers.

Many national water policies propagate community-based participatory approaches to overcome weaknesses in supply-driven rural water provision, operation, and maintenance. Citizen involvement is thought to stimulate bottom-up accountability and broaden the information base, which may enrich design and implementation processes and foster improved water accessibility and sustainability. Practices on the ground, however, are embedded in socio-political realities which mediate possible beneficial effects of participatory approaches. This paper builds on full social network data collected in a Ugandan village to study the social and political reality of two distinct levels of participation, i.e. local information sharing among citizens and a more active appeal to fellow citizens to improve water services. We use Logistic Regression Quadratic Assignment Procedure to explore what type of actor and network traits influence information sharing and whether the same factors are in play in the demand for action to remedy water-related problems. Whereas social aspects (social support relations) and homophily (using the same water source, the same gender) play an important role in information sharing, it is the educational level, in particular, of the villager who is called upon that is important when villagers demand action. Our findings also demonstrate that those most in need of safe water do not mobilize their information sharing ties to demand for action. This indicates that building local water policies and practice exclusively on locally existing demand for action may fail to capture the needs of the most deprived citizens.

Opening the 'black box' of performance-based financing in low- and lower middle-income countries: a review of the literature.

Although performance-based financing (PBF) receives increasing attention in the literature, a lot remains unknown about the exact mechanisms triggered by PBF arrangements. This article aims to summarize current knowledge on how PBF works, set out what still needs to be investigated and formulate recommendations for researchers and policymakers from donor and recipient countries alike. Drawing on an extensive systematic literature review of peer-reviewed journals, we analysed 35 relevant articles. To guide us through this variety of studies, point out relevant issues and structure findings, we use a comprehensive analytical framework based on eight dimensions. The review inter alia indicates that PBF is generally welcomed by the main actors (patients, health workers and health managers), yet what PBF actually entails is less straightforward. More research is needed on the exact mechanisms through which not only incentives but also ancillary components operate. This knowledge is essential if we really want to appreciate the effectiveness, desirability and appropriate format of PBF as one of the possible answers to the challenges in the health sector of low-and lower middle-income countries. A clear definition of the research constructs is a primordial starting point for such research.

Taking stock of monitoring and evaluation systems in the health sector: findings from Rwanda and Uganda.

In the context of sector-wide approaches and the considerable funding being put into the health sectors of low-income countries, the need to invest in well-functioning national health sector monitoring and evaluation (M&E) systems is widely acknowledged. Regardless of the approach adopted, an important first step in any strategy for capacity development is to diagnose the quality of existing systems or arrangements, taking into account both the supply and demand sides of M&E. As no standardized M&E diagnostic instrument currently exists, we first invested in the development of an assessment tool for sector M&E systems. To counter the criticism that M&E is often narrowed down to a focus on technicalities, our diagnostic tool assesses the quality of M&E systems according to six dimensions: (i) policy; (ii) quality of indicators and data (collection) and methodology; (iii) organization (further divided into iiia: structure and iiib: linkages); (iv) capacity; (v) participation of non-government actors and (vi) M&E outputs: quality and use. We subsequently applied the assessment tool to the health sector M&E systems of Rwanda and Uganda, and this article provides a comparative overview of the main research findings. Our research may have important implications for policy, as both countries receive health sector (budget) support in relation to which M&E system diagnosis and improvement are expected to be high on the agenda. The findings of our assessments indicate that, thus far, the health sector M&E systems in Rwanda and Uganda can at best be diagnosed as 'fragmentary', with some stronger and weaker elements.

Building national M&E systems in the context of changing aid modalities: the underexplored potential of national evaluation societies.

Changes in the aid architecture have provided a renewed impetus for monitoring and evaluation (M&E), while simultaneously imposing a major reform agenda on the key players involved. More specifically, since 1999, aid-dependent countries have been facing pressure to strengthen their national M&E systems, while donors have been asked to refrain from using their own parallel systems and to rely instead on country systems. Surprisingly, attempts to strengthen national M&E frameworks have thus far largely overlooked the potential of national evaluation societies (NES). Similarly, NES have also remained off the academic radar. Our study aims to fill this gap by mapping key features of NES, as well as their perceived contributions to country-led M&E. In this effort, we rely upon evidence from our survey of 23 NES in Sub-Saharan African countries with Poverty Reduction Strategy Papers (PSRP). Our findings show that there is quite some diversity among NES. Overall, NES are active organisations, whose unique membership features a wide variety of national M&E stakeholders who potentially play key roles in country-led and localised M&E development. Major obstacles faced by NES include the lack of financial resources, donor support and political influence. Survey findings also demonstrate that the increasing interest of donors and governments in NES has yet to materialise into strategic support.