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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

ACT PROCESS: evaluating the process, context, and impact of interventions to enhance health facilities in Tororo, Uganda.

LSHTM investigators:
Clare Chandler, Sarah Staedke & Deborah DiLiberto
External collaborators:
Moses Kamya, Susan Nayiga, Lilian Taaka, Christine Nabirye, Miriam Kayendeke (Infectious Diseases Research Collaboration, Uganda).
Funding body:
The Bill & Melinda Gates Foundation through the ACT Consortium.

The ACT PROCESS Study is a mixed methods evaluation that is running alongside a cluster randomised trial (ACT PRIME) that aims to assess the effect of a health facility intervention on population health indicators.

The ACT PROCESS study aims to provide an in-depth understanding of the way this intervention was delivered, its mechanisms of effect, and how context shapes the outcomes observed. The project objectives are:

1. To develop a comprehensive logic model of the health facility intervention with intervention components mapped through to their intended effects and outcomes.

2. To evaluate the process of the health facility intervention implementation including health worker training, health centre management tools, supply of AL and RDTs for malaria, and interactions with local and district stakeholders.

3. To develop a rich contextual record of factors that may have affected the health facility intervention outcomes such as other interventions or programmes implemented in the area, changes to malaria case management guidelines, and other environmental, economic, political or individual factors.

4. To carry out a limited assessment of the wider expected and unexpected impacts of the HFI at the household, community, private sector, and public health system levels.

Methods for collecting data for the ACT PROCESS study include tape-recorded health worker communication assessments, patient exit interviews, self-filled questionnaires, in-depth interviews, focus group discussions, and a structured contextual record. Data collection started in early April 2011 and is on-going until July 2012.