Browsing by Person "Brikci, Nouria"

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A theory-based evaluation of the Leadership for Universal Health Coverage Programme: insights for multisectoral leadership development in global health.
(2022-09-29) Witter, Sophie; Brikci, Nouria; Scherer, David
Leadership to manage the complex political and technical challenges of moving towards universal health coverage (UHC) is widely recognized as critical, but there are few studies which evaluate how to expand capacities in this area. This article aims to fill some of this gap by presenting the methods and findings of an evaluation of the Leadership for UHC (L4UHC) programme in 2019-2020. Given the complexity of the intervention and environment, we adopted a theory-driven evaluation approach that allowed us to understand the role of the programme, amongst other factors. Data from a range of sources and tools were compared with a programme theory of change, with analysis structured using an evaluation matrix organized according to the Organisation for Economic Co-operation and Development-Development Assistance Committee (OECD-DAC) criteria. Data sources included key informant (KI) interviews (89 in total); surveys of the 80 workshop participants; a range of secondary data sources; case studies in two countries; and observation of activities and modules by the evaluator. Participants and KIs at the global and country levels reported high relevance of the programme and a lack of alternatives aiming at similar goals. In relation to effectiveness, at the individual level, there was an increase in some competencies, particularly for those with less experience at the baseline. Less change was observed in commitment to UHC as that started at a relatively high level. Understanding of UHC complexity grew, particularly for those coming from a non-health background. Connections across institutional divides for team members in-country increased, although variably across the countries, but the programme has not as yet had a major impact on national coalitions for UHC. Impacts on health policy and practice outcomes were evident in two out of seven countries. We examined factors favouring success and explanatory factors. We identified positive but no negative unintended effects. While noting methodological constraints, the theory-based evaluation approach is found suitable for assessing and learning lessons from complex global programmes. We conclude that L4UHC is an important addition to the global and national health ecosystem, addressing a relevant need with some strong results, and also highlight challenges which can inform other programmes with similar objectives. [Abstract copyright: © 2022. The Author(s).]
The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010-2015
(Wiley, 2018-01-12) Witter, Sophie; Brikci, Nouria; Harris, Tim; Williams, Richard; Keen, Sarah; Mujica, Ana; Jones, Alex; Murray-Zmijewski, Alex; Bale, Barbara; Leigh, Bailah; Renner, Ade
This article presents the findings of a theory-based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time-series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost-effectiveness is high-in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even-or perhaps especially-in a weak health system, a reform-like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.
The Sierra Leone Free Health Care Initiative (FHCI): process and effectiveness review
(HEART (Health & Education Advice & Resource Team), 2016-04) Witter, Sophie; Brikci, Nouria; Harris, Tim; Williams, Richard; Keen, Sarah; Mujica, Ana; Jones, Alex; Murray-Zmijewski, Alex; Bale, Barbara; Leigh, Bailah; Renner, Ade
What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies
(BioMed Central, 2019-01-21) Witter, Sophie; Anderson, Ian; Annear, Peter; Awosusi, Abiodun; Bhandari, Nitin N.; Brikci, Nouria; Binachon, Blandine; Chanturidze, Tata; Gilbert, Katherine; Jensen, Charity; Lievens, Tomas; McPake, Barbara; Raichowdhury, Snehashish; Jones, Alex
Background - All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems.