Evaluation of primary health care: approaches, comments and criticisms.

Abstract

A broad definition of evaluation is that it is a "process which attempts to determine as systematically as possible the relevance, effectiveness and impact of activities in the light of their objectives." Impact is the ultimate improvement that all primary health care (PHC) is aiming for but very good PHC must be implemented over several years before a measurable impact can be produced. The Narangwal Project in India has been one of the most successful examples of an evaluation of a PHC program. Another large PHC project that had a successful impact on improving health status was initiated in 1972 in West Azerbijan, Iran. The impact evaluation suggested a considerable effect in lowering infant mortality and neonatal tetanus. The 5 main components of PHC activities are: 1) peripheral or basic health services and village health worker (VHW) schemes; 2) intermediate level support to the basic health services and VHW schemes by regional and district services; 3) intersectional activities; 4) community and individual participation in all aspects of health care; and 5) cooperation and coordination with the traditional, private and nongovernment systems of health care. An evaluation of PHC must take into account how well the basic principles have been adhered to, and how well they are working. PHC activities are ususally implemented at the level of national government, intermediate administrations, and local governments. The debate about evaluation concerns who is involved. Should those who are managing PHC activities be involved, or outside experts? There are 2 sets of objectives which must be considered. The 1st are objectives of the PHC program itself; the 2nd, the objectives for evaluation. Methods used range from informal, unstructured conversations to large sample surveys. In depth local case studies can be valuable. The most useful indicators for evaluating PHC are enumerated.