This mixed methods study investigates why fewer than one in five impact evaluations integrates a value-for-money analysis of the development intervention being evaluated. This study distills four main insights from combined analysis of 33 semi-structured and unstructured interviews, surveys of 497 policy makers and 16 journal editors, and portfolio analyses of World Bank and worldwide impact evaluations. The study finds that low levels of training in cost data collection and analysis methods, together with a lack of standardization of the value-for-money assumptions (e.g., time horizons, discount rates, and economic or financial cost accounting) limit value-for-money integration into impact evaluations. Further eroding researchers' incentives, demand for cost evidence from the journals that publish impact evaluations is mixed. Ill-defined standards of rigor undermine editors' capacity to evaluate the quality of value-for-money analysis when it is integrated with impact evaluation evidence. Institutional funders of impact evaluations do not consistently demand that cost analysis be integrated into their funded evaluations. This study finds no evidence in support of the myth that policymakers do not demand cost evidence. Rather, it finds that researchers have few ways of knowing what kind of analysis policymakers need and when they need it. Improving the stock of impact evaluators who are cross trained in value-for-money methods, establishing standards in what constitutes rigor in costing, resolving methodological issues, and improving linkages between policymakers and researchers would lead to greater integration of value-for-money methods in impact evaluations.

Objective

To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces.

Design

Geospatial Impact Evaluation using a difference-in-differences approach.

Setting

Democratic Republic of the Congo.

Participants

52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys.

Interventions

The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality.

Results

We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median.

Conclusion

The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns.