It is unrealistic to assume that we can predict the impacts of a health policy with certainty. Many – if not most – health system arrangements and implementation strategies have not been rigorously evaluated. But regardless of the availability (or paucity) of the evidence to inform decisions, policymakers must still make such choices.
Some degree of monitoring and evaluation is therefore almost always warranted (See Box 6.1), and data should be collected that can be used to:
Box 6.1 Monitoring and evaluation1 |
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Policymakers and other stakeholders will often need to know whether a new policy or programme has been implemented according to their expectations. Is the programme rollout, for example, progressing as planned? Are the objectives being achieved, and are the allocated funds being spent appropriately? Monitoring is the term commonly used to describe the process of systematically collecting data to provide answers to such questions. The term performance monitoring is often used when the main focus of an evaluation is to compare how well a project, programme, or policy is being implemented, with the results that were expected. Indicators are frequently used as part of the monitoring process. An indicator has been defined as a quantitative or qualitative factor or variable that provides a simple and reliable means to measure achievement, to reflect the changes connected to an intervention, or to help assess the performance. An indicator may simply be the number of events, such as the number of vaccinations conducted within a set period of time. Or it may be a construct based on various sources of data, for example, the proportion of all children fully immunised before their first birthday. The term evaluation is sometimes used interchangeably with monitoring, but the former usually suggests a stronger focus on the achievement of results. These terms are not used consistently and may mean different things to different people. The term impact evaluation is frequently used when an attempt is made to evaluate whether observed changes in outcomes (or impacts) can be attributed to a particular policy or programme. |