Evaluating healthcare interventions: Answering the HOW question

Health programme evaluation is still coming of age in India. In general, seeking

an evidence-base for decision-making within public services is still a missing feature in our policymaking process. In any case, it is not because there is scientific evidence that something becomes (or should become) a policy anyway. This presumptuousness has (rightly) frustrated many a researcher-scientist. Policymaking is very much a political process where researchers seek opportunities to introduce evidence from science (or an application of scientific tools). Programme evaluation is one such. In Australia for example and UK, commissioning of evaluation studies that apply rigorous and verifiable scientific designs to answer questions of policy-relevance is a common practice. Similarly, we see a surge in methods in the 60s & 70s in the US (in parallel with the commissioning of large publicly funded programmes by the Kennedy and Johnson administrations, see Great Society programmes).

Public health programme evaluation in India was the subject of a recent article I wrote. The abstract is below.

Healthcare interventions are complex and often do not lend themselves easily to classical experimental study designs. We examined published evaluation studies of public health programmes in India and discuss the scope for using realist evaluation, a type of theory-driven inquiry that attempts to understand what works, for whom and under what conditions. In spite of considerable methodological challenges, framing evaluation questions such that they address the questions of how and why healthcare interventions work (or not) is of key importance to policymakers and decision-makers in health. The recent calls in literature for health systems research offers a new opportunity for collaboration between social scientists and public health researchers in filling up the gaps in evaluation research in India.

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The article appears in the June 2013 issue of the journal Indian Anthropologist, in a special issue co-edited by Arima Mishra of the Azim Premji University. Article co-written with Bart Criel & Bruno Marchal.

Also see:

1. A special portal on theory-driven evaluation for health systems research maintained mainly by Bruno Marchal
2. A Mendeley reading list and group on Critical Realism and Realist Evaluation with useful papers on this approach maintained by me.