Applying Developmental Evaluation to Bring an Enhanced Equity Focus on Maternal Health Interventions

Session: The Role of Evaluations in Bridging Equities: Experiences from Latin America, Asia and Africa

Presenter: Arnab Dey, Sambodhi

Access to maternal health services and its outcomes have varied significantly depending on the determinants of socio-economic status of women in India. The gap in equity is more pronounced in Uttar Pradesh, where caste and religion forms a major aspect of the social structure and position in society. Uttar Pradesh hosts a number of equity-focused interventions, some of which are the endeavors of the Uttar Pradesh Technical Support Unit (UP-TSU). UP-TSU envisages to address the inequities in the reproductive, maternal, newborn and child health (RMNCH) outcomes by providing equitable health care opportunities to the heterogeneous population of the state. A number of its interventions at the community, health facility and system level work in concert to bridge the equity gap in the state. Evaluators are embedded within the program team (support team) to provide feedback on course correction on a near real-time basis. This paper describes an application of the developmental evaluation approach to explore, test and improve the equity focus of the intervention. Developmental evaluation is relevant given the complex dynamic realities of the health system interventions in UP and also the broader dynamic changes in the social, political and economic conditions in UP and the changes in the TSU over time. Maternal health interventions focusing on equity are often based on key assumptions of pathways of impacts. The developmental evaluation approach helps with interrogating crucial assumptions, such as coordination between health workers and uptake of data for decision-making. Most evaluations of health inequity initiatives have focused on how programmatic interventions have contributed to impacting equities. There has been far limited self-reflection on the pathways by which evaluations themselves can contribute to reducing inequities. The approach adopted by this evaluation goes beyond ‘use’ and explicates the notion of evaluation as an influence generating action to support equity.