Alternative accounting in maternal and infant global health

Abstract

Efforts to augment accountability through the use of metrics, and especially randomised controlled trial or other statistical methods place an increased burden on small nongovernmental organisations (NGOs) doing global health. In this paper, we explore how one small NGO works to generate forms of accountability and evidence that may not conform to new metrics trends but nevertheless deserve attention and scrutiny for being effective, practical and reliable in the area of maternal and infant health. Through an analysis of one NGO and, in particular, its organisational and ethical principles for creating a network of safety for maternal and child health, we argue that alternative forms of (ac)counting like these might provide useful evidence of another kind of successful global health work.

Armut und Gesundheit

“…As Adams, Craig and Samen (2015) point out, the obsession with the RCT is particularly unfortunate in shaping maternal mortality policy debates because it excludes evidence from smaller studies and observational data by NGO's working in the field that cannot mount expensive and logistically difficult RCTs. In short, many small NGOs are assumed to lack evidence for their programs simply because they cannot mount an RCT, when in fact they are doing exceptional and effective work using evidence-based interventions (Adams, Craig, and Samen 2015).…”

“…As Adams, Craig and Samen (2015) point out, the obsession with the RCT is particularly unfortunate in shaping maternal mortality policy debates because it excludes evidence from smaller studies and observational data by NGO's working in the field that cannot mount expensive and logistically difficult RCTs. In short, many small NGOs are assumed to lack evidence for their programs simply because they cannot mount an RCT, when in fact they are doing exceptional and effective work using evidence-based interventions (Adams, Craig, and Samen 2015). When the IHME produced its first, radical set of global and national maternal mortality estimates (Hogan et al 2010), it specifically excluded any intervention-based studies and hospital-based studies that lacked sufficient statistical power or were assumed not to reflect the general population.…”

It Takes More than a Village: Building a Network of Safety in Nepal’s Mountain Communities

“…Many of the regions where OHW works are at once geographically remote and socioeconomically disadvantaged. As we describe above and in other work [2,3] such regions are often marked by a lack of paved roads, little to no transport for emergencies, and minimal functioning government supported health care resources, including lack of essential drugs. Some communities where OHW works practice agro-pastoralism, such that members of households, including pregnant women, are 'on the move' for trading or in high altitude pastures during the summer months.…”

NGOs, partnerships, and public-private discontent in Nepal’s health care sector

“…Here, we take up the call by other anthropologists to ethnographically examine the local, cultural politics of smaller forms of public-privatization (Brada 2011;Kenworthy 2016;Storeng and Béhague 2016). This approach is important because smaller NGOs play increasingly bigger roles in partnering with governments and generating the success stories of global health agendas, including demonstrating their 'impact' through quantitative metrics and performance indicators (see for example Adams et al 2015;Biehl and Petryna 2013;Storeng and Béhague 2014b), which may or may not be accountable to the communities where they work.…”

“…Firstly, PPPs in Nepal such as Possible drive the kind of 'audit culture' (Strathern 2000) that Gimbel and colleagues discuss (this issue), yet globally there still lacks comprehensive, mutually agreed-upon metrics for evaluating the fit, acceptability, and effectiveness of these forms of partnerships (Miley 2014 (Adams et al 2015;Adams 2016;Rottenberg et al 2015). Performance-based frameworks are typically built around output-based indicators (such as counting the number of patients on antiretroviral therapy, or the number of such drugs dispensed), as opposed to summary or quality measures that might describe the workings of a system of longitudinal care or set of interventions (such as the percentage of people living with HIV enrolled in a community health follow-up program whose CD4 count has increased from baseline).…”