Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes
Date
2018Author
George, Asha S.
LeFevre, Amnesty E.
Schleiff, Meike
Mancuso, Arielle
Sacks, Emma
Sarriot, Eric
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Show full item recordAbstract
Community-based approaches are a critical foundation for
many health outcomes, including reproductive, maternal,
newborn and child health (RMNCH). Evidence is a vital part
of strengthening that foundation, but largely focuses on
the technical content of what must be done, rather than on
how disparate community actors continuously interpret,
implement and adapt interventions in dynamic and varied
community health systems. We argue that efforts to
strengthen evidence for community programmes must
guard against the hubris of relying on a single approach or
hierarchy of evidence for the range of research questions
that arise when sustaining community programmes
at scale. Moving forward we need a broader evidence
agenda that better addresses the implementation realities
influencing the scale and sustainability of community
programmes and the partnerships underpinning them
if future gains in community RMNCH are to be realised.
This will require humility in understanding communities
as social systems, the complexity of the interventions
they engage with and the heterogeneity of evidence
needs that address the implementation challenges
faced. It also entails building common ground across
epistemological word views to strengthen the robustness
of implementation research by improving the use of
conceptual frameworks, addressing uncertainty and
fostering collaboration. Given the complexity of scaling up
and sustaining community RMNCH, ensuring that evidence
translates into action will require the ongoing brokering of
relationships to support the human creativity, scepticism
and scaffolding that together build layers of evidence,
critical thinking and collaborative learning to effect change.