Original post by Nicholas Ngomi, Research Officer at APHRC, can be found on the APHRC Blog.

The announcement that the the Global Entrepreneurship Summit (GES) 2015 was to be held in Kenya, the first time ever in sub-Saharan Africa, boosted Kenya’s credentials as a regional leader and investment destination. Of great significance was that the summit was to be officially opened by the most influential and powerful man in the world, the President of the United States of America (POTUS), H.E Barack Hussein Obama. GES 2015 and Obama’s visit brought a breath of fresh air to many. Months turned to days and finally activities in Kenya almost came to a standstill when the first ever Air force one landed on Kenyan soil.

In the lead up to this big day, there were many pre-conferences held and a lot of lobbying going around the continent and most important, Kenya, on what should be the priority on top of GES and Obama’s visit. The Government of Kenya, various ministries, donors, partners, non-governmental organizations, civil society groups and individuals all put their best foot forward in preparing a priority list for this very historic moment in Kenya. The overall impact of the summit and Obama’s visit cannot be underestimated and is indisputably huge in many ways.

President Kenyatta himself, youth and women (entrepreneurs or not), high end hotels & meeting venues and young entrepreneurs were big winners for both GES and Obama’s visit. Like every other day, there are losers and the summit and POTUS visit was not an isolation and saw some issues going unattended to.

Amidst the debates that took place at the UN Complex for the summit and the various speeches,  announcements and national addresses made during the visit by POTUS, I remained awake to look at what matters most to me; the health sector. As far as the health sector is concerned I was quick to note that the American government committed to increase funding for the Determined Resilient Empowered Aids free Mentorship Program (DREAM/ACT); a public-private partnership with the Bill & Melinda Gates Foundation and the Nike Foundation which seeks to reduce new HIV infections in adolescent girls and young women in up to 10 countries with high HIV prevalence. Kenya happens to be among the beneficiary countries from the largest share of funding for the US-led Presidents Emergency Plan for Aids Relief (PEPFAR) aimed at reducing HIV morbidity and mortality of infant, children and adolescents living with HIV in Kenya.

However, I was keen to note that little or no attention was given to Non-Communicable Diseases (NCDs). This happened in the backdrop of NCDs quickly rising as the single most cause of death in sub-Saharan Africa. According to World Health Organization figures, between 1990 and 2010, disease burden from many non-communicable causes increased, particularly stroke, depression, diabetes, and ischemic heart disease among upper-middle-income countries in the region.

As a researcher concerned with the rising double burden of disease (in addition to the traditional single burden of malnutrition and infectious disease, lifestyle diseases and obesity causing diabetes, heart disease, hypertension, stroke and hypercholesterolemia are in the rise) well aware that NCDs account for 27% of deaths equivalent to almost 100,000 people per year in Kenya and World Health Organization (WHO) projecting that  an estimated 28 million people in the Region will die from the same over the next 10 years, I was keen to evaluate the allocation for the fight against not only Neglected Tropical Diseases (NTDs) but also Non-Communicable Diseases (NCDs).

To my disappointment, the closest president Obama came to meeting my expectations was the urge to President Kenyatta to start running with H.E. the first lady and to keep fit. I can’t help but dare ask “did we just miss on a golden opportunity: shouldn’t we have lobbied for a share of the $1.2 trillion and support efforts by the government to halt/stabilize and reverse the rising burden!”

All is not lost: The silver lining is that NCDs remain a priority area for both the Division of NCDs at the Ministry of Health and APHRC as evidenced by a recent launch of the Kenya NCD Info[3] (a one-stop information hub on NCDs for public health practitioners, researchers, health care providers, policymakers and the general public). Health Challenges and Systems program at APHRC has gone beyond Kenyan borders to generate robust evidence on the extent to which and how Multi-Sectoral Approach is (or was) used in the formulation of policies for the implementation of the NCD “Best Buys” in different contexts through the Analysis of Non-communicable Diseases Prevention Policies in Africa (ANPPA) project.

In a world exposed to increasing environmental, political, economic and social uncertainty, the ability to withstand shocks and bounce back into a functional state has become critical. This skill, known as resilience, has been studied at length for decades in the context of complex economic, ecologic and social systems by researchers such as C.S. Holling and Carl Folke and, more recently, climate change specialists Neil Adger and Mark Pelling – to name only a few. As international development organizations adjust to the changing circumstances and paradigms of aid provision in the modern world, resilience has gained relevance in development practice.

Our understanding of resilience has evolved through time. Initially, we assumed systems were resilient if they were able to return to their original state after perturbations. Through extensive research, we’ve grown to understand that complex systems are dynamic rather than static, and that resilience often involves a shift towards a new system state, one which, in spite of following different processes, manages to preserve system functionality and structure. While there continue to be discrepancies as to how one defines resilience in practice, there is tremendous interest and international financing going towards “building resilience”, with millions spent annually in aid to build resilience in the developing world. As interest grows around resilience in the field of international development, so does the need to measure the impact and track the effects of resilience-building activities on the ground.

In a July 2015 publication for the Overseas Development Institute, authors Lindsey Jones and Thomas Tanner address the question: how should we measure a household’s resilience? Bringing this complex concept down to the household level enables researchers to suggest specific indicators and socioeconomic variables that can be analyzed to measure resilience in practice. Developing objective frameworks to measure resilience has resulted in extensive debates among academics due to the biases that inevitably arise when defining resilience. In their paper, Jones and Tanner argue for the use of subjective resilience measures at the household level as a complementary approach. Assuming that people understand the factors that contribute to their own ability to prepare for and adjust to external shocks, the subjective measurement of resilience calls into question the notion that outside experts are able to evaluate household resilience without including those who are effectively part of the household. Relying on household members’ cognitive ability to self-evaluate, subjective measurement takes a bottom up-approach to determine household resilience. Providing an overview for the study of resilience and the ways in which to measure it, the study makes a case for the ways in which subjective household resilience can be used to improve policymaking; promoting the need for bottom-up subjective methods to be integrated into international resilience measurement.

The subjective method was recently tested in east Africa by a consortium of international NGOs and research organizations operating under the Global Resilience Partnership. The consortium, teaming up with the East African movement and EASST partner, Twaweza, asked people in 1,300 households across Tanzania to evaluate their ability to adjust to future flood risk. Subjective measurement of resilience surveys tend to be much shorter than the more traditional, objective resilience surveys, making the data gathering process easier and cheaper. While final results are still under analysis, some initial results are featured in ODI’s recent Global Development blog post “The best way to measure a household resilience? Ask those who live there?” Subjective methodology is still a point of contention for researchers and is very much under development. However, the bottom-up perspective provides an opportunity to identify new indicators that could very well help us develop more robust ways in which to measure resilience and hold governments and households accountable.

Visit this link to read Lindsey Jones and Thomas Tanner’s working paper, “Measuring Subjective Resilience”.

Written by EASST Fellow, Fitsum Z. Mulugeta.

The World Bank’s Strategic Impact Evaluation Fund and the United Nations Children’s Fund (UNICEF) recently partnered to organize complementary workshops focusing on the use of rigorous methodologies and measurement tools to evaluate early childhood development programs. The workshops, held in Kigali, Rwanda were mostly delivered by EASST Fellows, Anthony Mveyange, John Bosco Asiimwe, Vedaste Ndahindwa, Samuel Oti, Amos Njuguna, Jeanine Condo and Fitsum Z. Mulugeta. Approximately 60 participants from 12 countries in Africa, Asia, Europe and South America were in attendance; including government officials, evaluation practitioners, local researchers and policymakers, and World Bank and UNICEF staff.

SIEF researchers and EASST Fellows prepared extensively to ensure they delivered the workshop effectively, conveying complex economic theory in an accessible manner. During the pre-workshop meeting, the team was able to strike a balance, addressing technical and mathematical concepts intuitively. As a workshop facilitator indicated: “I really understood methods like diff-in-diff when I tried to explain them without mathematical formulas”.

Joost de Laat, SIEF Program Manager introduced the training with a presentation on the importance of investing early, showing evidence from previous impact evaluation studies to illustrate his point. Conrad Barberton, also from the World Bank, followed with an introduction to costing early childhood intervention. An Introduction to Impact Evaluation lecture was delivered by EASST alumni Jeanine Condo, who promoted rigorous impact evaluation and explained the different methodologies to participants. Addressing the importance of theory of change, Jeanine invited participants to work on result chains for their respective country programs.

Joost’s session on measuring early childhood development outcomes, coupled with Samuel Oti’s data collection presentation, provided participants with the material needed to develop their projects. Samuel presented data collection guidelines and provided examples from his own personal experience for reference. Before Samuel ended his presentation with the strong phrase ‘garbage-in-garbage-out’, Jacobus Cilliers jumped in to share some of the lessons he’s learned through his own research. During an early study, Jacobus explained, his team did not gather identification information for respondents during baseline to ensure anonymity. In doing so, however, the endline data could not be linked to the corresponding baseline, compromising the impact evaluation. Personal experiences such as this provided important input, since silly errors like failing to gather identification information for respondents can compromise impact evaluation projects.

Country teams continued their work identifying indicators, determining data collection methods and frequency, and distributing responsibilities for the data collection process. Researchers were given an opportunity to learn about research project implementation directly from program implementers and policy makers. Given the experience practitioners have working across different communities, they provided valuable insights for researchers. The differences in perceptions between researchers and practitioners led to interesting discussions during the group sessions.

EASST Fellow, Amos Njuguna presented on Experimental Methods of Impact Evaluation and Jacobus followed with a session focusing on the implementation of Experimental Impact Evaluations. These presentations addressed both the theoretical aspects of experimental impact evaluation and the lessons learned while conducting program evaluations. Country teams then started exploring opportunities for running experimental impact evaluations in their respective projects.

On day three, Anthony Mveyange of EASST took the stage after a brief re-cap by Joost. Anthony came as a reverend with a word of hope for those who have already started their interventions and missed the opportunity to run an experimental impact evaluation. In some cases, the projects had already collected baseline data, in others, comparison groups were included as well, but without randomized assignment to the programs. Anthony’s introduction of diff-in-diff and regression discontinuity indeed gave hope for such groups. As a result, the presentation was filled with questions, debates and discussions.

The workshop concluded with country teams presenting their impact evaluation designs. General feedback was provided by the workshop facilitators and their peers, provoking interesting questions and discussions. After three days of presentations, discussions, team work and videos showing case studies, the training ended with an awards closing ceremony. Country teams all confirmed the tremendous value of the workshop for their work on early childhood development.