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Evaluating Delivery Systems: Complex Evaluations and Plausibility Inference

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  • 1 Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London; Ghana Health Service, Volta Regional Health Directorate, Ho, Volta Region, Ghana; Ghana Health Service, Eastern Regional Health Directorate, Koforidua Eastern Region, Ghana; Health Policy Unit London School of Hygiene and Tropical Medicine, Keppel Street, London
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Delivery system evaluation is poorly defined and therefore a barrier to achieving increased coverage of interventions. We use a pre- and post-implementation cross-sectional observational study with assessment of the intermediate processes to evaluate a new delivery system for insecticide-treated nets (ITNs) in two regions of Ghana. In Volta Region, ownership of at least one net rose from 38.3% to 45.4% (P = 0.06), and 6.5% of respondents used a voucher in the purchase. In Eastern Region, ownership of a net rose from 13.7% to 26.0% (P < 0.001) and 0.5% of households used a voucher to purchase a net. Just 40.7% and 21.1% of eligible antenatal clinic (ANC) attendees were offered a voucher in Volta and Eastern Regions, respectively, and 36.0% and 30.7% used their voucher in the purchase of an ITN. Without attributing nets to the specific delivery system, in Eastern Region the success of the new system would be overestimated.

Author Notes

*Address correspondence to Jayne Webster, Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. E-mail: Jayne.webster@lshtm.ac.uk

Authors' addresses: Jayne Webster, Jane Bruce, Jo Lines, and Daniel Chandramohan, Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, E-mail: Jayne.webster@lshtm.ac.uk. Margaret Kweku and McDamien Dedzo, Ghana Health Service, Volta Regional Health Directorate, Ho, Volta Region, Ghana. Kojo Tinkorang, Ghana Health Service, Eastern Regional Health Directorate, Koforidua Eastern Region, Ghana. Kara Hanson, Health Policy Unit London School of Hygiene and Tropical Medicine, Keppel Street, London.

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