From implementation to learning: a process-oriented framework to evaluate innovative global health capacity building in fragile and conflict-affected settings.

Abstract

Background: Global Health Capacity Building (GHCB) initiatives are central to strengthening health systems and workforce readiness in Fragile and Conflict-Affected Settings (FCAS). While many evaluation frameworks exist, most were developed for stable contexts and offer limited guidance on how to adapt evaluation processes to environments rife with political instability, limited infrastructure, population mobility, and rapidly shifting conditions. As innovative learning modalities, such as online and blended learning modalities expand in FCAS, there is a critical need for evaluation approaches that are context-responsive, process-oriented, and tailored to fragile settings.

Method: This paper presents the Evaluation of Capacity Building (eCAP) framework, an evidence-informed framework for evaluating GHCB in FCAS. The eCAP framework was developed through a 5-year iterative process by the Global Health Institute at the American University of Beirut, as informed by 3 sequential phases: (1) 3 systematic reviews exploring evaluation methods for GHCB in low- and middle-income countries and in the MENA region; (2) evaluation of 5 case studies implemented in the region; and (3) a synthesis of outcomes and process-related results between 2019 and 2024.

Results: The eCAP framework conceptualizes the evaluation lifecycle in FCAS as a dynamic and adaptive process across three interconnected phases: (1) understanding the program (modality, population, context, level of evaluation, and program logic); (2) implementation (logistics, recruitment, engagement, tool selection, and timing of data collection), and (3) analysis, feedback, and learning. Without prescribing standardized indicators, the framework emphasizes decision-making principles for evaluation that enable adaptation to contextual constraints and other field-based realities. The framework is useful for diverse FCAS, and it has demonstrated feasibility and utility in capturing short-to-medium term outcomes while preserving methodological rigor under challenging and unstable conditions.

Conclusion: The eCAP framework addresses a key gap in the evaluation of GHCB initiatives in FCAS by offering a structured yet adaptable approach grounded in ample field-based evidence. The framework provides practical guidance for researchers, implementers, and funders seeking to design and evaluate capacity building initiatives in complex humanitarian environments. Ultimately, this framework has implications for strengthening evaluation practices, improving programmatic learnings, and guiding policy and funding decisions related to capacity building in FCAS.