Health Promotion Campaign in China - Assignment Example

Evaluation Forms and their Application 1. Introduction This assignment will discuss and analyse the health promotion campaign in China that started way back in 1986. In 2011, the Alliance for a Cavity-Free Future conducted a case study of “Love Teeth Day” or LTD which was launch to increase public awareness of oral health through different health promotion approaches. The selected evaluation forms are monitoring and impact. John Owen’s monitoring form is selected in order to enable performance monitoring and provide feedback from the ongoing health promotion programme. Similarly, the impact form was selected to measure the effectiveness or the extent of outcomes of the health promotion programme such as changes in attitudes and behaviour towards health (Owen, 2006). 2. Monitoring Evaluation (Form 1) Monitoring evaluation is generally about ensuring the programmes are being delivered in the agreed or planned manner. These include analysis of programme components, individual assessment, and overall programme implementation analysis. The purpose of this form is to help improve the programme by identifying flaws and shortcoming in the earliest possible time. For example, monitoring evaluation can check whether the programme is indeed reaching its intended beneficiaries or answer important questions such as; is the programme on track? What are the problems in delivery? How is the progress compared to previous month’s performance? and so on. According to the Alliance for a Cavity-Free Future or ACFF, the health promotion is reaching over 600 million people. These include providing actual oral health services, preventive and therapeutic services, health education materials, and promotion through mass media, and festivals. Every year, impact evaluation is being done by the national oral care committee to assess the programme’s effectiveness and overall oral health outcomes. However, the case study does not indicate any monitoring evaluation or assessment conducted since 1989 up to the present. Even during the programme expansion in 1995, there is no indication that the decision was encouraged by any programme monitoring result (ACFF, 2011). The monitoring form is therefore is very useful in this situation in the sense that such nationwide health programmes affecting millions of people involve significant resources that must use correctly. The components of the programme that may be measured by this evaluation form is the target population, compliance to specified implementation plan, effectiveness, the cost being incurred, and the balance between effectiveness and the cost of implementing the programme. For example, the 1995 expansion programme was intended to provide health education to additional 11 provinces (ACFF, 2011) but did it reach the target population. Similarly, the 1998 campaign was specifically to promote oral health care and awareness in rural communities (ACFF, 2011) but did it comply with the agreed implementation plan. Monitoring evaluation can help remove these uncertainties and provide clear picture of the progress and resources being use to implement the programme. It can identify the number of those being served on specific period and those that require further attention. Moreover, since the programme according to ACFF (2011) requires a lot of funding and assistance from professionals and community leaders, this evaluation form can monitor the turn of events such as the impact of increasing or decreasing participants, the possible sources of funds, and the number of health professionals required. 3. Impact Evaluation (Form 2) As mentioned early, the health promotion programme in China only experience impact evaluation once a year. The last impact evaluation revealed that from 14% in 1986 the use of fluoridated toothpaste increased by almost 42% in 1996 or over a 10 year period. Similarly, brushing also increased by 20% over the same period of time while mean dental caries decreased by 0.54 in 2005 (ACFF, 2011). Impact evaluation is therefore very useful in finding the outcome of a particular programme. However, this kind of impact evaluation is somewhat short of its supposed function particularly in determining resources used and compliance with the agreed plan. For example, although there has been an increased in brushing habit, is 20% good enough for 10 long years of implementation? Is the resources used during this period proportionate to this percentage? If the right impact evaluation is to be implemented, the report should contain solid evidence how the resources are allocated, a comparison between the target outcome and the present one, a list of unintended and intended outcome , the variation in the implementation and its impact on the current outcome, and so on. Impact evaluation can help identify flaws in programme components as well as best practices that must be maintained. For example, using an objective-based approach to impact evaluation may reveal issues involving stakeholders such as reasons for decreasing volunteers, funding, and so on. A need-based approach may yield some important information about specific needs of a group or community such the relevance of the programme to a particular population or services being delivered beyond a particular community needs. The claim that Love Teeth Day is an effective oral health promotion on a national scale (ACFF, 2011) is misleading since the impact evaluation is inadequate. Note that this programme never experience monitoring evaluation that can assist in the determination of the programmes real outcome or reasons why the programme only yield such small percentage despite funding, large-scale participation, and years of implementation. An impact evaluation if ever implemented in this programme in the following years should be based on realistic evaluation where the logic of the programme will be investigated, comparison will be made between the planned and current outcome, and identify which components are working and to what population it should be applied. More importantly, the impact evaluation should consider balancing the amount of resources used for a certain period against the programme outcome. 4. Analysis and Conclusion The primary issue that must be considered in this nationwide health promotion programme is the ability of a particular evaluator to cover and evaluate such large and ever expanding programme. For example, since this programme from its conception in 1980s to present day was never monitored, conducting a comprehensive impact evaluation will be an exercise in futility due to the scarcity of information to prove or justify the outcome. It lacks the evaluation process (monitoring) that can feed and signal issues that must be addressed by impact evaluation (United Nations, 2009). Moreover, previous impact evaluation results are not reliable. In fact, there is evidence to prove that the national oral care committee was not bothered by the low percentage of health outcomes. The mere fact that the programme is continuously being carried out despite obvious shortcomings is evidence of evaluators’ lack of adequate knowledge about the real purpose of impact evaluation. For example, given that the programme is indeed successful in changing the attitude and beliefs of the population, the time it takes and the resources used to influence these changes also matters. It is never enough to claim that changes had occurred or the percentage of those affected increased since they are more in evaluation than just measuring outcomes. According to Owen (2006), an impact evaluation should be realistic and its findings should come from a comprehensive inquiry such as knowing the context in which the programme is implemented, processes or mechanisms that enable delivery of services and achievement of a certain outcome. It should be methodological and objective in verifying and evaluating evidence, and measure the benefits against the cost (p.260-264). Another important issue is the complexity of the health promotion itself. Note that this health promotion aside from being nationwide and ambitious, it uses different forms of promotion such as health educational materials, TV and radio advertising, newspaper ad, special promotion in large-scale public events, and collaborative effort with schools, professionals, community leaders, government and non-government entities, and even shopping malls. The point is that with this complex health promotion an evaluator will never know which one of these promotional activities is working and actually affect the outcome of the programme. For example, it may be easy to measure the impact of promotions done in school with health educational materials since an evaluator can monitor and evaluate the impact in that particular school or class. In contrast, the only way an evaluator can measure the real impact of TV, radio, and newspaper advertising is to conduct a nationwide survey which is costly and time consuming. Note that the evaluator must separate those that are affected by TV from those who got the information from radio as well as determining the level of changes between them. Another associated issue are the funds coming from different sources. Identifying which fund goes to what services is a complex and difficult task considering that there are thousands of entities providing their support to the programme. To determine activities that should be allocated with the appropriate funds is another problem since each contributor has a particular interest. For example, a toothpaste company trying to promote its product through social responsibility programme may not be willing to allocate its funds to the construction of small health facility in one remote and thinly populated rural community. Moreover, if key performance indicators were not well defined and resources for collecting and recording information are limited, the task will be more difficult (Khandker et al 2010, p.13). 5. References ACFF, (2011), Health Promotion: Love Teeth Day, Alliance for a Cavity-Free Future, School of Stomatology, Fourth Military Medical University, Shaanxi, China Khandker S., Koowal G, & Samad H, (2010), Handbook on Impact Evaluation: Quantitative Methods and Practices, World Bank Publications, United States Owen J, (2006), Program Evaluation: Forms and Approaches, Allen & Unwin, United States United Nations, (2009), Planning Sustainable Cities: Global Report on Human Settlements, United Nation, Geneva Read More