The Results4TB research project includes a policy formulation process and further adopts a controlled trial design, integrating cost-effectiveness and realist evaluation components, for estimation of impact and value for money. This allows evaluating policy effectiveness in terms of adherence and treatment success rates and estimation of policy cost per desired outcomes.
In order to understand a complex policy process and assess policy effectiveness the project combines the realist research approach with a trial design. The Realist research approach applies participatory and interactive techniques to elicit the programme theory.
The programme theory (PT) is the set of assumptions of programme designers (or other actors involved) that explain how they expect the intervention to reach its objective(s).
In May 16-17 the first workshop was conducted in order to undergo a concept mapping exercise with TB stakeholders to formulate the programme theory. The 2-day workshop was held in Kakheti region, where participated diverse range of key TB stakeholders. The workshop participants represented policy-makers, TB program managers, health care facility managers, service providers (TB doctors and nurses) and researchers.
The workshop has 3 main goals:
- Identifying the key elements of the problem, the long-term outcome and the policy options
- Thinking about the pathway of change or the causal pathway behind the policy option(s)
- Synthesis – a structured (set of) pathways that summarize the programme theory of the participants
Participants were divided into three groups and were asked to identify any type of bottlenecks across the TB treatment cascade from demand and supply sides that impede TB care in Georgia; the next step was to identify possible solutions. In the final stage of the workshop, findings were summed up and presented to the participants.
As a result of the 1st PT workshop the participative situation and solution analysis led to formulating the initial programme theory. The detailed hypothesis informed the formulation of the policy and the design of the pilot intervention, and the design of the eventual policy via a cluster randomized trial, realist evaluation and cost-effectiveness studies.