Policy Wise

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The Scientist has a wonderful article on the need for proper monitoring and evaluation of public health pro grammes. While billions have been invested in recent years in public health, outcome measurement remains poor. ”The evaluation gap” leads to a situation where there is little accounting of the moneys spent or the benefit of the pro gramme. The article examines a few important reasons for that anomaly,

Why have even well-intentioned public health programs given the evaluation of outcomes short shrift? The reasons are complex and touch on every aspect of health program planning, from the economics of fund allocation to ingrained modes of thinking about large-scale public health interventions. Public health program administrators “really don’t like to talk about technical issues - whether the programs they’re designing are working or not,” says David Sack, a professor at Johns Hopkins Bloomberg School of Public Health. Sack says that administrators tend to place emphasis on the immediate amelioration of public health concerns and view tracking the impact of interventions as a secondary consideration. “If you call something ‘research,’ then it may seem irrelevant or an ivory tower type of thing,” says Sack, who is also the director of the Center for Health and Population Research in Bangladesh.

Then there’s the aspect of devoting already scarce funding to evaluation in global health programs. Johanna Daily, an infectious disease doctor and professor at Harvard Medical School, says that thorough evaluations may cost less than purchasing drugs, hiring health workers, and other implementation costs, they still cost something. “When people are criticized for not measuring, you have to understand that they are making that decision,” she says. “There’s a cost to measurement that has to be balanced with rational decisions.”

Daily says that public health funding is so hard to come by in the developing world, that money is spent on treatments and interventions that are known or suspected to work, while funding for evaluation of the impact is often ignored. “There’s so much work to be done and there’s so little money,” she says. Given the paucity of resources, says Daily, who also works on malaria projects with a Boston-based aid organization, Partners in Health, this disconnection is understandable. “If I had $100,000 I guess I would buy $100,000 worth of vaccines.”[link]

There are a couple of other important reasons: One, lack of trained evaluators in most developing countries. Evaluation is a specialist business and requires specific skills. Second, many such projects are mired in corruption and it is best for all concerned that there is no monitoring and evaluation. Also, many gigantic public health interventions are guilt assuaging trips for rich Western donors rather than well thought out public policy interventions. In such a scenario, evaluation does not occupy an important place in the entire equation.

The best approach to solve this problem is for donors to insist that monitoring and evaluation must be part of program planning with a separate budget allocated to it. It is heartening to note that USAID has taken this approach.

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