Transparency for Development: Intervention Design and Evaluation Approach

Abstract

This discussion paper outlines a recently started mixed method research program to assess whether, why, and in what contexts transparency and accountability (T/A) interventions improve health outcomes. The project is intended to advance the state of knowledge about the impact of T/A interventions on service delivery in several ways. First, we will develop a new T/A intervention, based on an initial theory about how T/A affects service delivery in different contexts as well as the range of existing work in this field, that is designed to be flexible enough to work across multiple contexts. Development of this intervention will leverage the local knowledge of embedded and capable local partners through an intensive co-design process. Second, we will conduct mixed-methods evaluations of this intervention in multiple sites: our research plan combines an initial phase in which we will evaluate its impact in two carefully selected sites, Tanzania and Indonesia, with both a randomized controlled trial and an integrated and extensive qualitative evaluation to understand mechanisms and the role of context; a cost-effectiveness analysis; and a second phase, which explores the generalizability of both our first phase results and the theoretical implications of them for mechanisms and the role of context. Third, these findings will provide the basis for development of a more nuanced and empirically grounded theory of the impact of T/A— both the different mechanisms through which T/A interventions seek to affect development outcomes, such as collaborative problem solving or community pressure, and the conditions under which these mechanisms should be expected to improve service delivery. All of these elements will be used to produce a range of new tools for practitioners of T/A as well as sectoral health experts assessing whether to add T/A interventions instead of or alongside more traditional health interventions.