Evaluation of Health Services

Question 1

Define evaluation.

Answer 1

Evaluation is a process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives.

Question 2

Describe the planning cycle.

Answer 2

Needs assessment -> planning -> implementation -> evaluation -> cycle repeats

Question 3

What are the types of evaluation methods?

Answer 3

Qualitative- Consult stakeholder (Observation, interviews, focus groups, review of documents)
Quantitative- Routinely collected data, review of records, surveys, other special studies

Question 4

Describe the evaluation framework.

Answer 4

(MR DAF)
Define what the service is
Aim/objectives of the service
Framework: Structure, process, outcome
Methodology to be used
Results, conclusions, recommendations

Question 5

Describe the framework of health services evaluation.

Answer 5

1. Structure (what amenities/facilities/logs present)
   Buildings, staff, equipment
2. Process
   What is done
3. Output (combined with process usually)
4. Outcome
5. Classification
   - Mortality, morbidity, quality of life, patient satisfaction PROMs (patient reported outcome measures)
   - Different from output, this is more focused on long term impact

Eg 1
S: Staff to patient ratio
P: Length of patient waiting time
O: Patient Satisfaction

Eg 2
S: Locations of basins and alcohol gel
P: Ensure if staff wash their hands
O: Number of cases of hospital acquired infections

Eg 3
S: Number of surgeons per 1000 population
P: Number of surgeries in a day
O: Mortality and Morbidity

Question 6

What are the problems with health outcomes?

Answer 6

Link between health service and health outcome may be difficult to establish
Time lag between service provided and outcome may be long
Large sample sizes may be needed to obtain statistically significant effects
Data may not be available
Data quality and accuracy

Question 7

Explain Maxwell’s dimensions of quality.

Answer 7

1. Effectiveness
   Does the intervention / service produce the desired effect?
2. Efficiency
   Is the output maximised for a given input (or is the input minimised for a given level of output)?
3. Equity
   Are patients being treated fairly?
4. Acceptability
   How acceptable is the service offered to the people needing it?
5. Accessibility
   Is the service provided? Geographical access; Costs for patients; Information available; Waiting times
6. Appropriateness
   Is the right treatment being given to the right people at the right time? [Overuse? Underuse? Misuse?]