Systematic Health Program Evaluation - Essay Example

Systematic Health Program Evaluation A health program is "an organized response to reduce or eliminate one or more problems by achieving one or moreobjectives, with the ultimate goal of improving the health of society." (Shortell & Richardson, 1978 as cited by Grembowski, 2001, p.3). Program evaluation, representing the techniques and concepts of social science, is the use of social research methods to systematically investigate the effectiveness of social intervention programs and is "intended to be useful for improving programs and informing social action aimed at ameliorating social problems." (Rossi, Lipsey & Freeman, 2003, p.28). The escalating costs and scarce resources for health programs prompted healthcare providers to abandon traditional "fee-for-service" medical service and to contract with a variety of "managed care" organizations, which has contributed to the rapid growth of health program evaluation during the past three decades. (Grembowski, 2001, p.5). Thus, the purpose of evaluation is to produce information about the performance of a program in achieving its objectives and the judgment of worth of any activity reached by 'weighing information against some explicit or implicit yardstick' that result in decision making. Development of evaluation research "Evaluation research can be defined as a type of study that uses standard social research methods for evaluative purposes, as a specific research methodology, and as an assessment process that employs special techniques unique to the evaluation of social programs" (Powell, 2006). Ever since the concept of value for money in health care was introduced there has been concerted effort to develop techniques that assist decision makers to bring a balance between benefits and costs associated with each option available before them and "the early application of cost-benefit analysis were undertaken in the United States during the 1930s in connection with flood control programs." (Robinson, 1993). Policy analysis and evaluation research received fillip at the federal government level in the year 1965 with the introduction of 'the War on Poverty-Great Society initiative and the Executive Order establishing the Planning-Programming-Budgeting system in the U.S. Both programs initiated scholars to examine the "efficiency with which public measures allocate resources, their impacts on individual behavior, their effectiveness in attaining the objectives for which they were designed, and their effects" in bridging the socio-economic divide. (Rossi, Lipsey & Freeman, 2003, p. 14). Program evaluation is defined as the use of social research methods to systematically investigate the effectiveness of social intervention programs in ways that are adapted to their political and organizational environments that are designed to inform social action in ways that improve social condition. The evaluation sponsors are the person, group, or organization that requests or requires the evaluation and provides the resources to conduct it. Stakeholders include individuals, groups, or organizations having a significant interest in how well a program functions, for instance, those with decision-making authority over the program, funders and sponsors, administrators and personnel, and clients or intended beneficiaries. The findings of an evaluation may be used by decision makers and other stake holders in their day-to-day management level or at broader funding or policy levels. The health promotion cycle consists of four stages, beginning with needs assessment, leading to program planning, implementation and then to evaluation. According to Hawe, Degeling, and Hall (1990) for health promotion, evaluation involves measurement and observation and comparison with some criterion or standard. An evaluation tries to answer the differences made with the introduction of a particular health promotion program and the changes in health status it has produced. Hence, an evaluation involves observing, documenting and measuring of the actual results of the programs in relation to the expected outcome. Purpose of health care evaluation: Evaluation research in health care is a rapidly developing area, because proposals for establishing or altering health care services are increasingly expected to include a framework for evaluating their delivery and effectiveness. Although there are three different levels of evaluation, such as process evaluation, impact evaluation, and outcome evaluation, for evaluating health promotion program 'the short term effects of the program must be assessed before any long term benefits can be measured'. Understanding how to use the methodology effectively for making a case for the establishment, continuation, or expansion of a health service and improving existing ones is crucial. Research methods are applied to answer whether the program is working as intended and the relevance of a particular case, so that the 'accuracy and objectivity of judgment about the program's success in reaching its objectives' are increased. 'The evaluation process fulfils this purpose by defining clear and explicit criteria for success, collection representative evidence of program performance, and comparing it to the criteria established at the outset' (Grembowski, p. 3-4). An evaluation assists program managers, planners, policy makers, as well as health officials to assess program performance and make informed judgment about a program's worth from the insight generated by evaluation findings, which makes evaluation an essential 'decision-making tool'. When an evaluation findings rate a program ineffective or unsuccessful, even due to some methodological flaws, fund providers or other decision makers may change program implementation, replace personnel, or even terminate the program and allocate funds elsewhere. Thus, the fundamental question in all evaluations should be 'How much is this program worth' rather than 'How much does this save' because answering this fundamental question can have far-reaching consequences for large numbers of people.( Grembowski, p. 5) Evaluation methods There are several evaluation methods, such as: input measurement, output/performance measurement, impact/outcomes assessment, service quality assessment, process evaluation, benchmarking, standards, quantitative methods, qualitative methods, cost analysis, etc. However, planning is the important step in evaluation process and it involves gathering and analyzing a wide range of information relevant to the program under evaluation. Planning covers a broad field with different approaches, such as strategic planning, program planning, and operational planning. A planning model has six key steps involved in planning process, and they are: (1) pre-planning and project management; (2) Situational assessment; (3) identifying goals, populations of interest, and objectives; (4) identifying strategies, activities and resources; (5) developing indicators; and (6) reviewing the program plan. For achieving best results from any planning participation by stakeholder groups is critical, because a lack of participation may lead to decisions being overruled, delayed, challenged, or questioned by either internal or external stake holders. Adhering to time schedule is also crucial as missed deadlines can result in lost opportunities, decreased impact of the project, and greater stress in partner relationships. Another important aspect is having informed decision and able management of budget and other resources. Proof for program evaluation efficacy Recently HIV/AIDS epidemic is the major challenge before health care providers and in the United States there are many multi-agency collaboration programs aimed at preventing the HIV/AIDS epidemic, sponsored by Department of Health and Human Services (DHHS). Evaluations of these programs are essential to understand their cost effectiveness and viability for further continuation, and example for the benefit of program evaluation can be extracted from the experience of Kerr et al who have evaluated supervised injecting facilities (SIF) initiative in the United States. Injected drug use (IDU) is linked with high rates of HIV infection and recently supervised injecting facilities (SIF) have been proposed as a potential solution for reducing infections from non-sterile injection. North America's first medically supervised injection facility was launched in September 2003 despite high controversy surrounding this intervention about similar facilities in Europe and Australia. It is viewed that "dearth of formal evaluation has led to fears that such facilities may encourage drug use, increasing rates of relapse among former injecting drug users, and by facilitating drug use, discourage current users from seeking treatment." (Kerr et al, 2006). An evaluation of Vancouver facility by Kerr et al (2006) have shown that "its opening has been associated with reductions in public drug use and publicly discarded syringes and reductions in syringe sharing among local injecting drug users." This finding establishes that program evaluation is crucial to eliminate public apprehensions as well as measuring program outcome by healthcare providers. . Reference Grembowski, David. (2001). The Practice of Health Program Evaluation. London: Sage. Retrieved July 24, 2008, from http://books.google.com/booksid=-5OOi5VCHY8C&pg=PA297&dq=Evaluation+research+of+health+programs&sig=ACfU3U10mXTPP_iyJx1h4Y6pa5Z7XBuE7g&vq=%22Evaluation+Fundamentals%22&source=gbs_book_citations_r&cad=1_0#PPA3,M1 Rossi, Peter. Henry., Lipsey, Mark. W., & Freeman, Howard. E. (2003). Evaluation: A systematic approach (7th edn.). Sage. Retrieved July 24, 2008, from http://books.google.co.in/booksid=8K3Ax5s7x5oC&pg=PA14&lpg=PA14&dq=efficiency+with+which+public+measures+allocate+resources,+their+impacts+on+individual+behavior,+their+effectiveness+in+attaining+the+objectives+for+which+they+were+designed,+and+their+effects&source=web&ots=Ll4VuwQitK&sig=UR0legX_xLKN2otls-FmAAIP08k&hl=en&sa=X&oi=book_result&resnum=4&ct=result Robinson, Ray. (1993, September 11). Economic evaluation and health care: Origins. BMJ, 307, 670. Retrieved July 24, 2008, from http://www.pubmedcentral.nih.gov/picrender.fcgiartid=1678982&blobtype=pdf Hawe, P., Degeling, D., & Hall, J. (1990) Evaluating Health Promotion: A Health Worker's Guide. Sydney: MacLennan & Petty. Kerr, Thomas et al. (2006, January 26). Impact of a medically supervised safer injection facility on community drug use patterns: A before and after study. BMJ.com, 332. Retrieved July 24, 2008, from http://harm.live.radicaldesigns.org/downloads/Kerr_SIS_BMJ.pdf Powell, Roland L. (2006). Evaluation research: An overview. Library Trends, High Beam Research. Retrieved July 24, 2008, from http://www.highbeam.com/doc/1G1-151440807.html Read More