Realist evaluation in times of decolonising global health. (1st June 2022)

• Record Type: Journal Article
• Authors: Renmans, Dimitri; Sarkar, Nandini; Van Belle, Sara; Affun‐Adegbulu, Clara; Marchal, Bruno; Mukumbang, Ferdinand C.
• Other Names: Gautier Lara guestEditor.; Borgès Da Silva Roxane guestEditor.; Faye Adama guestEditor.; Ridde Valéry guestEditor.
• Is Part Of: International journal of health planning and management. Volume 37(2022)Supplement 1
• Page Start: 37
• Page End: 44
• Publication Date: 2022-06-01
• Subjects: decolonisation -- emancipation -- global health -- participatory action research -- power -- realist evaluation; Health planning -- Periodicals; Health services administration -- Periodicals; Santé publique -- Planification -- Périodiques; Santé, Services de -- Administration -- Périodiques; 362.1068
• DOI: 10.1002/hpm.3530
• Languages: English
• ISSNs: 0749-6753

Abstract

Abstract: Realist evaluation (RE) is a theory‐driven evaluation approach inspired by scientific realism. It has become increasingly popular in the field of global health where it is often applied in low‐ and middle‐income countries. This makes it timely to discuss RE's relationship to the emerging decolonisation of global health movement. In this short perspective, we argue that the principles and practices that underpin RE have great potential to contribute to the decolonisation endeavour. Both the focus on the inclusion of local stakeholders and the openness to the rival theories these stakeholders bring to the fore, are promising. However, in practice, we see that a lack of acknowledgement of power imbalances and different ontologies and an overreliance on Western‐based theories thwart this potential. We therefore suggest that realist evaluations performed by external researchers, especially in the field of global health, should actively engage with issues of (power) inequities. This is not only the just thing to do, but will also contribute to a better understanding of the intervention and may facilitate the emancipation of the disenfranchised. One way of doing this is through the adoption of participatory (action) research methods, currently underused in realist evaluations. We finally give a short example of an evaluation that combines emancipatory and participatory practice development with a realist approach. The Afya‐Tek project in Tanzania has an innovative bottom‐up approach throughout the full evaluation cycle and shows the possible strength of the proposed combination to create better interventions, more empowered stakeholders, and more illuminating programme theories. Highlights: Realist evaluation (RE) shows great potential to help decolonise global health But, its theory‐driven rationale creates obstacles for external researchers These can be partly overcome by an increased awareness of power imbalances Combining RE with participatory (action) research methods can be useful