Effectiveness Review

The Development Effectiveness Review 2008 Report is the second annual corporate performance report of the Asian Development Bank (ADB). It assesses progress in implementing ADB's long-term strategic framework 2008-2020 (Strategy 2020) using specific performance indicators, baselines, and targets presented in ADB's results framework. The review measures ADB's contribution to development in Asia and the Pacific and performance as an organization. It pinpoints areas where ADB has been successful, where challenges remain, and where corrective action is required.

The Development Effectiveness Review Report is the annual corporate performance report of the Asian Development Bank (ADB). It assesses progress in implementing ADB's long-term strategic framework 2008-2020 (Strategy 2020) using specific performance indicators, baselines, and targets presented in ADB's results framework. The review measures ADB's contribution to development in Asia and the Pacific and performance as an organization. It pinpoints areas where ADB has been successful, where challenges remain, and where corrective action is required.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

The Agency for Healthcare Research and Quality (AHRQ) commissioned the RTI International–University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) to explore how systematic review groups have dealt with clinical heterogeneity and to seek out best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). Such best practices, to the extent they exist, may enable AHRQ's EPCs to address critiques from patients, clinicians, policymakers, and other proponents of health care about the extent to which “average” estimates of the benefits and harms of health care interventions apply to individual patients or to small groups of patients sharing similar characteristics. Such users of reviews often assert that EPC reviews typically focus on broad populations and, as a result, often lack information relevant to patient subgroups that are of particular concern to them. More important, even when EPCs evaluate literature on homogeneous groups, there may be varying individual treatment for no apparent reason, indicating that average treatment effect does not point to the best treatment for any given individual. Thus, the health care community is looking for better ways to develop information that may foster better medical care at a “personal” or “individual” level. To address our charge for this methods project, the EPC set out to answer six key questions (KQ). Key questions for methods report on clinical heterogeneity include: 1. What is clinical heterogeneity? a. How has it been defined by various groups? b. How is it distinct from statistical heterogeneity? c. How does it fit with other issues that have been addressed by the AHRQ Methods Manual for CERs? 2. How have systematic reviews dealt with clinical heterogeneity in the key questions? a. What questions have been asked? b. How have they pre-identified population subgroups with common clinical characteristics that modify their intervention-outcome association? c. What are best practices in key questions and how these subgroups have been identified? 3. How have systematic reviews dealt with clinical heterogeneity in the review process? a. What do guidance documents of various systematic review groups recommend? b. How have EPCs handled clinical heterogeneity in their reviews? c. What are best practices in searching for and interpreting results for particular subgroups with common clinical characteristics that may modify their intervention-outcome association? 4. What are critiques in how systematic reviews handle clinical heterogeneity? a. What are critiques from specific reviews (peer and public) on how EPCs handled clinical heterogeneity? b. What general critiques (in the literature) have been made against how systematic reviews handle clinical heterogeneity? 5. What evidence is there to support how to best address clinical heterogeneity in a systematic review? 6. What questions should an EPC work group on clinical heterogeneity address? Heterogeneity (of any type) in EPC reviews is important because its appearance suggests that included studies differed on one or more dimensions such as patient demographics, study designs, coexisting conditions, or other factors. EPCs then need to clarify for clinical and other audiences, collectively referred to as stakeholders, what are the potential causes of the heterogeneity in their results. This will allow the stakeholders to understand whether and to what degree they can apply this information to their own patients or constituents. Of greatest importance for this project was clinical heterogeneity, which we define as the variation in study population characteristics, coexisting conditions, cointerventions, and outcomes evaluated across studies included in an SR or CER that may influence or modify the magnitude of the intervention measure of effect (e.g., odds ratio, risk ratio, risk difference).

The Canadian International Development Agency (CIDA) allocates vast sums of money each year, providing vital assistance to countless individuals across the developing world. Yet many observers and insiders have sharply criticized CIDA for its lack of concrete results. Presenting a range of work by scholars and practitioners, this collection offers the most comprehensive examination of CIDA's efforts in over a decade. Contributors explore recent trends in Canadian foreign aid, including topics such as its place in Canadian politics, gender and security concerns, advocacy and public engagement, the complexity of CIDA policies, and CIDA's relationship with non-governmental organizations. The perspectives assembled in Struggling for Effectiveness bring clarity to the issue of foreign aid while judiciously gauging Canada's record and offering concrete suggestions for strengthening CIDA's efforts to help people living in poverty. Extensively researched and comprehensive in scope, Struggling for Effectiveness will be indispensable to anyone interested in Canadian assistance abroad and Canada's place in a rapidly changing world. Contributors include Stephen Baranyi (University of Ottawa), David Black (Dalhousie University), Elizabeth Blackwood (Simon Fraser University), Stephen Brown (University of Ottawa), Dominique Caouette (Université de Montréal), Adam Chapnick (Canadian Forces College), Denis Côté (Canadian Council for International Cooperation), Molly den Heyer (Dalhousie University), Nilima Gulrajani (Oxford University), Hunter McGill (University of Ottawa), Anca Paducel (Graduate Institute of International and Development Studies, Geneva), Rosalind Raddatz (University of Ottawa), Ian Smillie (independent scholar and consultant), Veronika Stewart (Simon Fraser University), and Liam Swiss (Memorial University of Newfoundland).

This is the fifth annual review which explores long-term development effectiveness trends and analyses the choice of lending and non-lending instruments and activities to achieve World Bank development objectives. The 2001 review confirms a significant improvement in the outcomes of the Banks lending performance. It finds that selecting the right combination and sequence of activities for a particular objective can make the difference between success and failure, whether at individual project level, for country assistance programmes or for global, sectoral and thematic priorities. At each level, there is unexploited potential to maximise strategic selectivity, and this is especially important in countries with a poor policy framework or acute institutional development needs.

ARDE 2003 examines the effectiveness of Bank support for developing country policy reform,. It finds that Bank support has contributed to reform in a number of cases. But there are also cases where the Bank's support has not been associated with improvements in the policy environment.