Qualitative data consisted of a combination of focus group discussions and key informant interviews with various project stakeholders and participants. These were analyzed using thematic coding to distill major themes arising by country, site, and perspective (provider, patient, etc.), and to draw comparisons with baseline findings and conditions in comparison areas, depending on the data available for each country. The qualitative findings help to contextualize the quantitative results and elucidate impacts of HealthRise programs that cannot be captured with quantitative data. By comparing the qualitative findings from intervention facilities at endline with those from intervention facilities at baseline, as well as with comparison facilities, it is possible to draw inferences about what some of the effects of the HealthRise programs may have been. Key themes arising from the intervention site qualitative data at endline are presented for each country, reflecting the perspectives of patients, providers, other facility staff, and policymakers, and comparisons are drawn to baseline and non-HealthRise sites, depending on the data available for each country. Quotes from interviews and focus group discussions are presented throughout to provide examples of key themes in participants’ own words. “What I learned from HR…the big aha moment…there is an absolute definite need to combine quantitative evaluation with qualitative evaluation...it’s one thing if you have numbers, it’s another thing what’s behind the numbers…I would argue so what, tell me how you did it, tell me how you got people engaged, to adhere to medication...what are the stories behind, what would the patients say...together they make a very strong story.” – Policymaker, US
Quantitative Overview
Patient exit interviews with biomarkers and facility surveys were implemented in India and in South Africa in intervention and comparison areas. All facility and patient survey questionnaires were designed by IHME and are available for download (Appendix A). Even though the design of the study had been completed, no endline data (quantitative or qualitative) were collected during the timeline of this evaluation in the India site of Udaipur because of challenges in procuring the necessary approvals. The sampling details and instruments are available to local partners who may be able to complete data collection in 2019. In the US and in Brazil, due to financial constraints, IHME did not collect quantitative data; rather, the analysis relies on data that were collected and collated by the grantees and shared with IHME. Brazil Data Collection
IHME did not collect quantitative data in Brazil for the endline analysis. Although community-level baseline data were collected in comparison municipalities in Brazil, the intervention in Brazil had the shortest implementation time, which, along with some of the barriers faced by the implementation teams, reduced the likelihood of seeing impacts of the interventions at the population level. Fortunately, both Brazilian sites had extensive monitoring datasets that tracked enrolled individuals over time and which permitted before and after analysis using the data regularly collected by in-country partners. Facility-level endline data collection in comparison municipalities was discouraged by local partners since electronic medical records are not available in those locations. 44
