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Evaluating Wellcome Foundation’s Drug Resistant Infections Projects

We are developing a methodology to evaluate Wellcome’s Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance and Promoting Access and Responsible use of Antibiotics in Children projects.


Itad has been asked to develop a methodology to answer a series of evaluation questions for two Wellcome Foundation programmes, within the context of Wellcome’s DRI programme of activities.

The two programmes are:

  1. Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance (SPIDAAR)
  2. Promoting Access and Responsible use of Antibiotics in Children (PARAC)

We are proposing a theory-based, utilisation focused evaluation building on our experience evaluating other components of Wellcome’s DRI work.

Combating Antimicrobial Resistance

Antimicrobial agents are essential to combat diseases in humans, animals, plants and crops. However, the misuse and overuse of Antimicrobial agents is escalating the spread of Antimicrobial Resistance (AMR) and has the potential to reverse a century of progress in public health.

Fighting drug resistance, especially resistance to antibiotics, requires the application of science to policy, public engagement and behaviour change, and substantial efforts at the global, regional, national and local levels.

About Wellcome Trust’s AMR initatives

The Wellcome Trust is continually working to reduce the rise of AMR through several key initiatives, including:

  1. Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance (SPIDAAR)

Wellcome has partnered with Pfizer Inc. on this public-private initiative to strengthen the generation and access to AMR data and create sustainable surveillance activities in Kenya, Uganda, Malawi and Ghana. The latter part of the project is a collaboration with Duke University’s Innovation team.

  1. Promoting Access and Responsible use of Antibiotics in Children (PARAC)

PARAC is exploring access to and responsible use of antibiotics in children in South Africa, Tanzania, China and Vietnam. This is an innovative and new partnership with UNICEF undertaking implementation research to ensure better implementation of research methods and approaches. Working in this way helps to ensure that implementation plans are suitable to the context in which they are being made and are acceptable to those who are going to be implementing the policy, services.

Our role

For SPIDAAR we are:

  1. Providing a robust evidence base to assess the relevance, efficiency, impact and sustainability of SPIDAAR;
  2. Producing relevant and timely insights to enable SPIDAAR programme adaptation of activities and processes;
  3. Capturing learning from SPIDAAR to inform SPIDAAR and future Wellcome initiatives;
  4. Embracing a workplan focused on informing Wellcome’s understanding of the effectiveness of the approach for working with Ministries of Health and health facilities as well as inform thinking about replication of the SPIDAAR programme in the future.

For PARAC, we split the work into 2 workstreams: a process review (UNICEF relationship) and topic review (Implementation research) grouping the Evaluation Questions (EQs) accordingly.

The evaluation is sequenced into three phases:

1) Inception: to refine the theoretical framework for our work

2) Review: process review and topic review

3) Recommendations: Reporting will be delivered at each stage as illustrated in the work plan.

Our methods and approaches

We are committed to making our evaluation as useful as possible to Wellcome. Itad shares a commitment with the SPIDAAR and PARAC teams to ensure that evaluation findings are used within adaptive management of SPIDAAR and PARAC and are also of use to others outside the programme.

To this end, the evaluation draws on the principles of utilisation-focused evaluation and co-creation of recommendations by the evaluation team.

As learning partners to SPIDAAR and PARAC, we are identifying key learning points (beyond formal reporting) to share formative learning and insight in ways suited to the audience, such as slide sets at management meetings, Board summaries or webinars for practitioners and experts.

We see considerable potential for ‘ongoing learning’ to be identified and shared and believe that Itad should support this as an “honest broker” – helping Wellcome and SPIDAAR to capture and share lessons that have immediate value to adaptive management. We also hope to create a replicable model that would be of interest to partners and external audiences as global public goods.

Outcomes and impact


We will answer questions on the outcomes, impact and sustainability of SPIDAAR. We are using contribution analysis, plus necessary and sufficiency analysis to describe the plausible contribution of SPIDAAR activities over time under the Theory of Change.

Our initial analysis is providing a framework to explore impact pathways, the relative importance of outputs to reaching goals, as well as key assumptions and risks in the SPIDAAR strategy. This evidence story will then be built upon through the evaluation to support adaptive management, combined with findings on operational effectiveness we will be able to inform learning questions regarding the added value of SPIDAAR, its replicability and use in other settings.


Following the final evaluation data collection and analysis, the Itad and Wellcome teams will co-create a set of clear, actionable recommendations for future improvement. We will deliver reporting to Wellcome at inception and as a final report.

We aim to leave the Wellcome team with the resources they need to continue working with UNICEF and to undertake/fund implementation research.