Evaluation: Lessons Learned for the Uncontrolled World

The Global Health Initiative (GHI), President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative (PMI) and other global health programs are putting increasing emphasis on evaluation and learning to ensure that investments in global health are effective and achieve desired outcomes. At the same time, there is a growing debate in the evaluation literature on the most appropriate methods to assess the effectiveness, efficiency and impact of health interventions in real world situations. There are significant methodological, logistical, and political challenges to implementing evaluations of programs in practice that limit design options and mean that traditional experimental or quasi-experimental designs often are not feasible resulting in a need for alternative practical yet scientifically rigorous approaches.