Toward a health project evaluation framework

To determine if primary health care is in fact working, this report presents a conceptual framework for evaluating such projects. First, the authors describe the problems related to current health project/program evaluations, including the assumed linear flow of impacts, attribution, feedback and indirect impacts, and time as an important variable in evaluation. Emphasizing the subtlety and long-term nature of the evaluation process, the authors then develop five concepts: (1) the use of the economic concepts of investment and consumption rather than such measures as morbidity and mortality to guage final project impact; (2) the importance of context and constraint analysis; (3) the growing claim of recurrent health program costs on national budgets; (4) equity considerations; and (5) the essential importance of a dynamic evaluation system which incorporates the above ideas. Finally, the authors discuss a series of practical issues which must be addressed before any evaluation strategy can be defined, namely, attribution of impact, timing of impact measurement, audience differences, data availability, and information costs. Attached are a 57-item bibliography, a list of generic questions for an economic evaluation of primary health care projects, and a proposed set of measures/indicators for health project evaluation.