Lessons Learned From Implementing Prospective, Multicountry Mixed-Methods Evaluations for Gavi and the Global Fund

Lessons learned from implementing evaluations for Gavi, the Vaccine Alliance and the Global Fund for AIDS, Tuberculosis, and Malaria can help inform the design and implementation of ongoing or future evaluations of complex interventions. We share 5 lessons distilled from over 7 years of experience implementing evaluations in 7 countries. Key Findings We present 5 key lessons distilled from 7 years of experience implementing evaluations in 7 countries, which include the importance of: Including an inception phase to engage stakeholders and inform a relevant, useful evaluation design Aligning on the degree to which the evaluation is embedded in the program implementation Monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly Hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods Contextualizing recommendations and clearly communicating their underlying strength of evidence Key Implications Global health initiatives, particularly those funding or implementing complex interventions, should consider embedding evaluations to understand how and why the programs are working to adapt as necessary and maximize impact. Evaluators of complex interventions should continue to share lessons learned related to balancing stakeholder priorities, aligning on “breadth” versus “depth” of the evaluation scope and ensuring use of the evaluation findings. ABSTRACT Introduction: As global health programs have become increasingly complex, corresponding evaluations must be designed to assess the full complexity of these programs. Gavi and the Global Fund have commissioned 2 such evaluations to assess the full spectrum of their investments using a prospective mixed-methods approach. We aim to describe lessons learned from implementing these evaluations. Methods: This article presents a synthesis of lessons learned based on the Gavi and Global Fund prospective mixed-methods evaluations, with each evaluation considered a case study. The lessons are based on the evaluation team’s experience from over 7 years (2013–2020) implementing these evaluations. The Centers for Disease Control and Prevention Framework for Evaluation in Public Health was used to ground the identification of lessons learned. Results: We identified 5 lessons learned that build on existing evaluation best practices and include a mix of practical and conceptual considerations. The lessons cover the importance of (1) including an inception phase to engage stakeholders and inform a relevant, useful evaluation design; (2) aligning on the degree to which the evaluation is embedded in the program implementation; (3) monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly; (4) hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods; and (5) contextualizing recommendations and clearly communicating their underlying strength of evidence. Conclusion: Global health initiatives, particularly those leveraging complex interventions, should consider embedding evaluations to understand how and why the programs are working. These initiatives can learn from the lessons presented here to inform the design and implementation of such evaluations.