Midline qualitative evaluation of an integrated health, livelihood, agriculture, and conservation program: Application of the RE-AIM framework.

The population, health, environment and development (PHED) approach has been recognized for providing a more holistic and synergetic approach to program implementation than the single-sector approach. However, evidence is still needed to support the theory that multi-sectoral integration is more effective than a siloed approach. In this study, we applied the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework for midline evaluation of an integrated health, livelihood, agriculture and conservation program in Southwest Oromia, Ethiopia that specifically targeted women and youth. The data were collected through key informant interviews (KIIs), focus group discussions (FGDs) and most significant change (MSC). The findings show that the project successfully reached target beneficiaries with livelihood interventions, such as through village saving and loan associations, which were seen as important hubs for linkages to other sectors and services. Regular communication, coordination and alignment of goals with local government stakeholders supported successful program implementation, adoption and sustainability of the multi-sectoral approach. The findings highlighted the need for strategies to enhance women's and youth's participation, and to increase government ownership to ensure sustainability. Additionally, we found the RE-AIM framework to be flexible and adaptable for application in a qualitative PHED program evaluation.