EVALUATION OF HEALTH SERVICES

• There has been a growing concern about the

functioning both in developing and developed
countries.
• People are concern about the quality, of medical
care , ultilization, coverage, benefit to the
community in term of morbidity and mortality
reduction and improvement in the health status of
the recipients of care.
• There is a need for evaluationto address these
issues.
 General steps of evaluation
• The following steps are involved:
• 1) Determine what to be evaluated
• 2) Establish standard and criteria
• 3) Plan the methodology to be applied.
• 4) Gather the information.
• 5) Analyse the information.
• 6) Take action.
• 7) Re-evaluation.
 1) Determine what is to be evaluated
• There are 3 types of evaluation.
• (a) Evaluation of structure-This is evaluation of
facilities ,equipment ,manpower , and organisation meet a
standard accepted by experts as good.
• (b) Evaluation of process: The process of medical care
includes the problem of recognition, diagnostic procedures,
treatment ,management , care and prevention.
• The way in which the process is carried out is evaluated by
comparing with the predetermined standard. An objective
and systematic way of evaluating a medical officer or a
nurse is called medical or nurse audit.
 3)Planning the methodology
• A format in keeping with the purpose of
evaluation must be prepare for gathering
information desired. Standard and the criteria
must be included at the planning stage.
• 4)Gathering information . It require collection
of information or data. The type of information
required may include : political, economic,
enviromental , cultural and administrative
factors that influence health situation.
 Re-evaluation
• Evaluation is an ongoing process aimed mainly
at rendering health services/activities more
relevant, more effective and more efficiently
 ELEMENT OF EVALUATION
• Evaluation is perhaps the most difficult task in
the whole area of health services.
• The components of the evaluation process are:
• A) Relevance: Relevance or requisiteness
relates to service appropriateness of the
service. Whether it is needed at all. If there is
no need , the service can be of no value.eg
vaccination against small pox is irrelevant
because small pox has been eradicated.
 b) Adequacy
It implies that sufficient attention has been paid
to certain previously determined course of an
action. For example , the staff allocated to a
certain programme may be describe as
inadequate if sufficient attention is not paid to
the quantum of work-load and the target to be
achieved
 c)Accessibility:
• Is the proportion of the population that is
expected to use the facility. The barrier may
be physical-distance , time, travel; economical-
travel cost fees charged; social $ cultural-taste
or language barrier.
• D) Acceptability-The service may be accessible
but not acceptable by people eg male
sterilisation , screening for rectal cancer.
 E) Efficiency:
• It is a measure of hoe resources-money manpower ,
materials and time are used to achieved a given
effectiveness.
• F) Effectiveness: It is the extent to which underlying
problem are prevented or alleviated.
• It measure the degree to which a pre-determined
objectives and target of the programme , service, or
institution expressed if possible , in term of health
benefit , problem reduction , or improvement in an
unsatisfactory health situation.
 g) Impact:
• It is an expression of the over all effect of the
programme , service or institution on health
status and socio-economic development.
• For example as a result of malaria control
programme , in addition to reduction in
malaria incidence , but all aspect of life-
agriculture , industrial and social showed an
improvement.
• Planning and evaluating must be viewed as a
continuous interactive process, leading to
continual modification both of objectives and
plans .
• Successful evaluation may also depend on
upon wether the means of evaluation were
built in to the design of the programme before
it was implemented.
 Management
• Administration: mean getting things done.
• Management: Purposeful and effective use of resources-
manpower, materials and finances for fulfilling a pre-
determined objective. Management consist of four basic
activities:
• 1) Planning-determine what to do
• 2)Organising:setting up the frame work or apparatus and
making it possible for people to work together.
• 3) Communicating-motivating people to do the work.
• 4)Monitorin(controlling) checking to make sure the work is
progressing satisifactorily.
Management method and Technics
• Method based on behavioural sciences:
• 1)Organizational design-Poor organization
result in waste of resources.
• Organisation must be suited to its current
situation and in the way it should serve.
• The organisation of health service should be
designed so as to meet the health need and
the demand of the people to serve.
• Organisation design should be review every
few years because of changing concept or
purpose ,changing problem and changing
technology.
• Efficient delivery of health service depend
upon the existence of an effective
organization/
 2) Personnel management
• This is skillful use of human resources.
• Proper method of selection , training, and
motivation, division of responsibility,
distribution of role; elimination of square pegs
in round hole (professional not suited to
administration either through training,
selection or natural inclination, should not be
entrusted with administrative burden).
• Incentive for better work, opportunities for
promotion and professional advancement ;
effective design of health team are all
fundamental techniques of personnel
management which could contribute to the
efficiency of health service delivery.
 Communication
• Better communication contributes to effective
functioning of an organization.
• Communication road block exist at various levels.
Between doctor and the patient; between doctor and
the nurse,between senior officer and junior; between
the directorate and the ministry; between health
ministry and other ministries and rest of the
government.
• Communication delay are responsible for delay in
regular reporting and notification; delay in compilation
of statistics; delay in the release of supplies and salaries;
• Delays in the institution of remedial
measures.
• One the task of health management is to
solve the communication problem by
establishing suitable vertical and horizontal
communication channels.
 4) Information system
• Information is needed for the day to day
management of health system.
• Information come from many sources-formal and
informal sources.
• The information must be tailored according to the
management need of individual health facility.
• The function of information system consist of:
collection, classification, transmission , storage ,
retrieval, transformation and display of information.
• A Good information system provide data for
monitoring health programme and give
requisite feed back to health administrator
and planner at all levels.
• Computer can play a role in improving the
health information system.
 MANAGEMENT BY OBJECTIVES
• Objectives are set for different Units and Subunits.
Each of the unit prepare their own action on a
short- term basis. This helps in achieving the result
more effectively and smoothly.
• QUANTITATIVE METHOD- Quantitative methods
are derived from field of economics , operation
research and budgeting. Some of these
techniques play a greater role in the management
of health services
 Cost benefit analysis.
The economic benefit of any programme is
compared with the cost of the programme.
The benefits are express in monetary terms to
determine wether a given programme is economically
sound and to select out of the alternative programme.
The main drawback of this technique is that benefit in
the health field can not be expressed in monetary
terms. Health benefit is generally expressed in term of
births or death prevented , or illness avoided or
overcome.
 Cost effective analysis
• It is similar to cost benefit analysis except that
the benefits instead of been expressed in
monetary term is expressed in terms of result
achieved , eg number of live saved or the
number of days free from disease.
 Cost Accounting
• It provides basic data on cost structure of any
programme.
• Financial records are kept in a manner permitting cost to
be associated with the purpose for which they are
incurred.
• It has three important purpose in health services:
• 1)cost control
• 2)planning and allocation of people and financial
resources.
• 3) Pricing of cost reimbursement.
 INPUT-OUTPUT ANALYSIS
• Input-output analysis is an economic
technique.
• In the health field , input refer to all health
services activities that consume
resources(manpower ,money , materials &
time).
• And output refer to such useful outcomes as
cases treated, live save or inoculations
performed.
 Model
• Model is a basic concept of management
science. It is an aid to understand how the
factors in a situation affect one another.
• It is an abstraction of the reality, not the
reality itself.
• The decision process includes the use of
model.
 6) System analysis
• The purpose of system analysis is to help the decision
maker to choose an appropriate course of action by
investigating his problem , searching out objectives,
finding out alternative solutions, evaluation of
alternatives in term of cost-effectiveness, evaluation of
the alternatives in term of cost effectiveness , re-
examination of the objectives if necessary and finding
the cost effectiveness alternative of all the available
alternatives. The system can be hospital supply system,
an information system, an out patient clinic or any other
system with problem of management.
 NETWORKANALYSIS
• A network is graphical plan of all events and activities to be
completed in order to reach an end objectives.
• It bring greater discipline in planning.
• The two common types of network technique are:( a) PERT
and( b) CPM
• PERT-(Programme Evaluation Review Technique:) is a
management technique which make detail planning possible
and more comprehensive supervision.
• The essence of PERT is to construct an arrow diagram
• The diagramme represent the logical sequence in which
events must take place.
• It is possible with such a diagramme to
calculate the time by which each activities
must be completed and to identify those
activities that are critical.
• This simple technique provides a basic
discipline by which all concerned in a project
can know what is expected of them and to
minimize any delays or crises in the
implementation of the plan.
• It aids in planning , schedule , monitoring the project.
• It allow better communication between various level
of management.
• It identify potential problem.
• It furnishes continuous and timely progress report.

• CRITICAL PATH METHOD (CPM)-CRITICAL The longest

part of the network. If any activities along the critical
path is delay, the entire project will be delayed.
 PLANNING –PROGRAMMING BUDGETTING
SYSTEM(PPBS)
• The planning-programming –budgeting system is
primarily a system to help decision makers to
allocate resources so that the available resources of
an organization are use in the most effective way to
achieve the objective.
• It calls for grouping of activities in to programme
related to each objectives.
• Zero budget Approach: All budget start at zero. And
no one get a budget that he can not specifically
justify on a year to year basis
 Work sampling
• It is systematic observation and recording
activities of one or more individuals carried
out at pre-determine or random interval.
• It provide quantitative measurement of the
various activities.
• The major parameter that are analysed are
the type of activities performed and the time
needed to do specified job.
• Work sampling studies have been done on
doctor , nurse , pharmacist and laboratory
technicians.
• It permit judgment to the appropriateness of
current staff, job description and training.
• It help in standardizing the method of
performing job and determine the man power
needs in any organization.
 Decision making
• Decision must be made with complete
information /data . It is better that decision
are made at appropriate level where the best
decisions can be made.
• In the health sector , decision should made
about development of resources , optimum
work load for doctor ,and Para- medical,
strategies for providing health care etc.
 QUESTIONS-PHS-303
• 1a What is planning in health system
management.
• 1b What is importance of planing fo health
programme/community intervention
• 2 What are the different level of planning in
health system management with examples.
• 3 What are the steps involve in planning a
health programme during a community
posting.
• 4 What are pre-planning condition that you
need to take in to consideration if you want
State Government to support your health
programme.
• 5 During your rural community posting and
you conducted situation analysis what are
those factors or variable you assessed to know
health problem of such community.
• 6) Write short note on the elements/variables use for
evaluation of health system. What are the reason why
health system are evaluated.
• 7) Explain the following with respect to health evaluation.
(a) Cost Benefit Analysis ( b) Cost Effective Analysis.
• 8) Explain NET-WORK ANALYSIS in health programme
management( PATH &CPM)
• 9) What are the resources needed for health programme
in a rural community. (b) what will determine your
community intervention during the posting i.e priority
setting.