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We don’t know enough about what’s worked because scaled-up programs are rarely evaluated systematically. For Millions Saved, the What Works Working Group tapped only a small set of public health successes. In large part, this was because solid evidence of the health impact of many international health programs simply does not exist. In general, while very small programs (particularly pilot programs) may be evaluated, little research is done to estimate the health impacts of at-scale efforts.
Even for well-known interventions that have received large amounts of donor support over many years, the base of evidence about what has worked (or not worked) in scaled-up programs - in terms of health outcomes, rather than process measures - is quite slim.
The gap in evaluation inhibits the documentation of success and prevents policymakers from being able to tell the difference between a well-told story and a hard fact as they make decisions about which programs to support. The lack of evaluation also reduces the chances for success in the first place. In many of these cases, high-quality evaluations that clearly established the causal link between programs and impact spurred greater investments, broader application, and ultimately, more success. Efforts to assess whether programs were yielding the hoped-for-benefits have been instrumental in securing continued funding.
Employing rigorous evaluation methods that link inputs and impact in large-scale programs is far from simple, and often requires financial and technical resources that are otherwise absorbed simply in operating a program. But without such evaluation, policy decisions are based on scanty information from small-scale experiences combined with a large dose of opinions and politics.