Evaluation, Participation and Community Health Care: Critique and LessonsPublisher: Internation Council for Adult Education (ICAE), Toronto, Canada
Year Published: 1979
Resource Type: Article
Cx Number: CX2102
Abstract: This paper offers a critique and lessons on evaluating health care services based on the authors' experiences in Canada and Africa. It was originally presented in November, 1979 at a meeting of the American Public Health Association.
The authors' ultimate criterion for the evaluation of health care services is good health for all. This paper focuses on the purposes of evaluation as related to the equitable distribution of health services and degrees of community involvement and self-reliance. Through a political classification of evaluation, the authors demonstrate how evaluators and evaluation methods are used to serve health service bureaucracies.
The alternative presented, participarty evaluation, identifies community members as the beneficiaries of health care services. "The key justificatory concept is ' the right to know and control'." "It challenged the model of input-output analysis - connects the individual to the larger economic and social context - and acknowledges the importance of justice in asserting the worth of a program."
The overall direction of the evaluation and the use of technique is dominated by the question of who benefits. The authors point out that the minimum that can be achieved through community participation is the stimulation of specific actions. The maximum level of participation occurs when poorer sections of the community become involved; this maximum level ensures that the poor's interests are served and their dependence on the powerful is weakened or broken. The authors suggest additional criteria that can be met by the evaluative approach. A detailed outline of the approach, using a specific example, is appended to the paper.