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Table 4 Core components of the impact evaluation and operational research

From: Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership



Data source


Impact Evaluation

Impact and effective coverage

Oversampling DHS 2010 and 2015

Difference in differences in key population health indicators between 2010 and 2015, comparing the intervention area with rural comparison districts


Service utilization and coverage, facility and community health worker levels

Routine HMIS from hospital, health centers and community health worker program

Change in service utilization and coverage in intervention areas in comparison to other rural districts


Cause of death in children under five

Verbal autopsy through MOH program

Changes in the cause of death in children over the intervention period


Contextual factors

DHS, National Resource Database, environmental records

Analysis of impact of contextual factors on district-level differences, including environmental factors, epidemics, humanitarian crises, sanitation, equity measures, women's education, HIV prevalence, Government of Rwanda records of partner contributions and engagement

Economic and Costing Analysis


Costing data collected by project

Economic and costing assessment of the health system in the intervention area including the costs per capita of PHIT intervention; total costs per capita of the health systems in the two intervention districts; and financial contributions made by government, partners and patients to the local health systems

Component Evaluation

Health facility support

Health facility survey, HMIS, MESH data

Impact of intervention on strengthening across WHO building blocks, explore relationship with quality and volume of care delivered



External observation of care delivery, qualitative evaluation of district and health center staff

Effectiveness of MESH in improving quality of care focusing on children under-five, acceptability of and satisfaction with MESH


Strengthened CHW systems

Community HMIS data, household register

Analysis of change in CHW-delivered services in intervention area and comparison areas


Operational research

Project specific

Includes assessment of PHIT intervention on family-planning uptake, human resource retention, nutritional status in children