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Good Morning. Programme Evaluation in Health Care. Contents. Introduction Focus of evaluation Types of evaluation Elements of evaluation Design of evaluation Constraints on using results of evaluation Evaluation of dental health programme Economic evaluation Summary and conclusion

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  1. Good Morning

  2. Programme Evaluation in Health Care

  3. Contents • Introduction • Focus of evaluation • Types of evaluation • Elements of evaluation • Design of evaluation • Constraints on using results of evaluation • Evaluation of dental health programme • Economic evaluation • Summary and conclusion • References

  4. Introduction • Evaluation has been defined as a systematic, rigorous, and meticulous application of scientific methods to assess the design, implementation, improvement or outcomes of a program. • It is the comparison of actual impacts against strategic plans.

  5. Evaluation is mostly concerned with the final outcome and with factors associated with it. • While monitoring is confined to day to day or on-going operations.

  6. The purpose of evaluation Evaluation allows us to • Measure the progress of each activity • Measure the effectiveness of each activity • Identify problems in carrying out the activities • Plan revision and modification and • Justify the costs of administering the programme

  7. In the words of WHO expert committee on National Health planning in developing countries, evaluation measures; • The degree to which objectives and targets are fulfilled and the quality of the results obtained. • The productivity of available resources in achieving clearly defined objectives. • How much output or cost effectiveness is achieved.

  8. Focus of evaluation • Evaluation studies ultimately focus on the goals, objectives, or intent of the program or activity being studied.

  9. Donabedianrightly sees structure, pro­cess, and outcomes as inextricably linked.

  10. Types of Evaluation Scriven ; two types. • Formative Evaluationand • Summative Evaluation

  11. Formative evaluation • Refers to the internal evaluation of a program. • It is an examina­tion of the processes or activities of a pro­gram as they are taking place. • It is usually carried out to aid in the development of a program in its early phases.

  12. Example; a fluo­ride rinse program • Para-professionals are trained to administer three types of fluoride rinses under a strict sequence of procedures. • After 3 days of operation observed to determine the extent of adherence to a strict sequence of procedures. If the sequence is incorrect, formative eval­uation allows the program to make reme­dial changes at that point.

  13. Summative evaluation • Summative evaluation, by contrast, judges the merit or worth of a program after it has been in operation. • It is an attempt to deter­mine whether a fully operational program is meeting the goals for which it was devel­oped.

  14. Elements of Evaluation • Relevance • Adequacy • Accessibility • Acceptability • Effectiveness • Efficiency • Impact

  15. 1. Relevance • Relevance or requisiteness relates to the appropriateness of the service, whether it is needed at all. • If there is no need, the service can hardly be of any value. • For example, vaccination against smallpox is now irrelevant because the disease no longer exists.

  16. 2. Adequacy: • It implies that sufficient attention has been paid to certain previously determined courses of action. • For example, the staff allocated to a certain programme may be described as inadequate if sufficient attention was not paid to the quantum of work-load and targets to be achieved.

  17. 3. Accessibility • It is the proportion of the given population that can be expected to use a specified facility, service, etc. • The barriers to accessibility may be physical (e.g., distance, travel, time); economic (e.g., travel cost, fee charged); or social and cultural (e.g., caste or language barrier).

  18. 4. Acceptability: • The service provided may be accessible, but not acceptable to all, e.g., male sterilization, screening for rectal cancer.

  19. 5. Effectiveness: • Effectiveness has been defined as ‘the ratio between the achievement of the programme activity and the desired level of achievement proposed by planners. • It is the extent to which the underlying problem is prevented or alleviated.

  20. Resources are evaluated by dividing the actual expenditure of resources by the planned expenditure. • Activities are evaluated by dividing actual performance by planned performance. • Objectives are evaluated by dividing actual attainment by planned attainment.

  21. 6. Efficiency • Efficiency has been defined as the ratio between the result that might be achieved through expenditure of a specific amount of resources and the result that might be achieved through a minimum of expenditure (WHO 1974). • It is a measure of how well resources (money, men, material and time) are utilized to achieve a given effectiveness.

  22. 7. Impact • It is an expression of the overall effect of a programme, services or institution on health status and socio-economic development. • For example, as a result of malaria control in India, not only the incidence of malaria dropped down, but all aspects of life-agricultural, industrial and social-showed an improvement.

  23. If the target of 100 per cent immunization has been reached, it must also lead to reduction in the incidence or elimination of vaccine preventable diseases. • If the target of village water supply has been reached, it must also lead to a reduction in the incidence of diarrhoeal diseases.

  24. General steps of Evaluation

  25. 1. Determine what is to be evaluated Generally speaking there are 3 types of evaluation based on what is to be evaluated a. Evaluation of structure- Whether facilities, equipment, manpower and organisation meet a standard accepted by experts as good.

  26. b. Evaluation of process • Including problems of recognition, diagnostic procedures, treatment and clinical management, care and prevention. • The way in which the various activities of the programme are carried out is evaluated by comparing with a predetermined standard.

  27. c. Evaluation of outcome • Concerned with end results that is whether person using health services experience measurable benefits such as improved survival or reduced disability. • The traditional outcome components are the 5 Ds of ill-health viz. disease, discomfort, dissatisfaction, disability and death.

  28. 2. Establish standards and criteria • Standards and criteria must be developed in accordance with the focus of evaluation.

  29. Structural criteria : • Process criteria: • Outcome criteria:

  30. 3. Plan the methodology to be applied • A format in keeping with the purpose of evaluation must be prepared for gathering information desired. • Standards and criteria must be included at the planning stage.

  31. 4. Gather information • Evaluation requires collection of data or information. • The type of information required may include political, cultural, economic, environmental and administrative factors influencing the health situation

  32. Data collection methods • Self administered survey • Telephone surveys • Face to face structured • Archival trend data • Observation • Record review • Focus groups • Unstructured interview/narratives • Open ended questions on a written survey • Participant observation • Archival research

  33. 5. Analyse the results • The analysis and interpretation of data and feedback to all individuals concerned should take place within the shortest time feasible, once information has been gathered. • In addition, opportunities should be provided for discussing the evaluation results.

  34. 6. Take action • For evaluation to be truly productive, emphasis should be placed on actions - actions designed to support, strengthen or otherwise modify the services involved.

  35. 7. Re-evaluate • Evaluation is an on-going process aimed mainly at rendering health activities more relevant, more efficient and more effective.

  36. References • Community oral health. Cynthia M. Pine. 1st edition. • Preventive and Social Medicine. K. Park. 20th edition • Jong’s Community Dental Health. George Gluck, Warren Mrganstein. 5th edition. • Dental public health. Geoffrey Slack, Brian Burt. 2nd edition • Concepts in dental public health. Jill Mason. • Framework for Program Evaluation in Public Health – CDC. Weekly REPORT. September 17, 1999 / Vol. 48 / No. RR-11

  37. Poul Erik Petersen and Stella Kwan. Evaluation of community-based oral health promotion and oral disease prevention - WHO recommendations for improved evidence in public health practice. Community Dental Health (2004) 21 (Supplement), 319-329 • Health programme evaluation. Guiding principles for its application in the managerial process for national health development. World Health Organisation, Geneva 1981

  38. Thank You

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