The transition from efficacy of interventions to effectiveness of delivery strategies is where we so often lose our way. If efficacy is “proven” by techniques such as the randomized controlled trial that screen out the noise of confounding variables, then, ultimately, the techniques to assess effectiveness of delivery strategies and to decide priorities for health sector policy must do just the opposite. They must take into account, they must even grow out of, precisely the messy, contradictory, dissonant noises of real life. In this sense “delivery strategy” is a misleading term,.
