Evaluating Structural Interventions in Public Health: Challenges, Options and Global Best Practice

Abstract

Structural interventions in public health pose a host of challenges to evaluation. They operate through indirect pathways and are often complex and cross-sectoral. Programmes may require extended time horizons for health effects to be observed, and their delivery at the level of communities, institutions or populations carries major implications for sampling. Finally, issues of ethics, logistics and/or political feasibility may limit opportunities for random assignment and the use of experimental designs. However, high quality evaluation is vital. Too often, structural interventions are under-developed and under-researched because rigorous evaluation has seemed beyond the scope of established tools and methods. Mixed-methods approaches offer particular strengths in order both to assess impact and to document implementation to facilitate the design of effective policies and programmes