Impact Evaluation and Accountability
Accountability in government health programs refers to the obligation and ability to provide answers to questions concerning the actions that were taken and decisions made on such programs (Gyllstrom, Gearin, Frauendienst, Myhre, Larson, & Riley, 2015). Provision of adequate information and justification are necessary for answering these questions. Accountability can be categorized into three major areas including political, financial, and performance accountability. In political accountability, politics, election and policy-making processes are the paths through which accountability is sought. Equity is the main concern here, where the government has an essential role to play in providing remedies to the failures in health care by creating regulations and allocating adequate resources. Being accountable financially involves ensuring that financial resources can be tracked and the reports on their allocation, disbursement, and utilization are available and unquestionable. Accountability in performance entails determining whether the set performance targets have been obtained by focusing on the interventions, results, and outputs. The application of the classifications above assists in developing a clear picture of issues of accountability in the delivery of health services through government programs (Gyllstrom et al., 2015)
Thus, there are three roles of accountability in health care programs initiated by the government. Firstly, the prevention of misuse and abuse of public authority or resources in these programs is a basic control that is directly related to financial accountability. Secondly, the reassurance that appropriate professional standards, societal values, and legal procedures are applied in using resources and exercising authority is important. Thirdly, the government has to use feedback and learning to support improvements and manage the delivery of services with the aim of meeting specific performance standards (Institute of Medicine, 2011).
However, the programs are often faced with difficulties in maintaining accountability while running these programs. The challenges in the achievement of the purposes of accountability include the lack of expertise and high imbalances of information that is accessible to health services providers, users and bodies offering oversight. Secondly, the efforts to enhance accountability in these programs are hindered by the discrepancy of provided incentives and the public and private interests. Thirdly, the gaps in terms of the capacity of institutions undermine the efforts to boost accountability in all these categories. Program evaluation is significant since health programs and heath care institution need to be held accountable to the communities that they have been designed to serve. A wide range of stakeholders also have an interest in finding out accountability of a government program. They include the funds providers, policy makers, and agencies implementing the program both local and state, community leaders and independent citizen groups such as civil society. Accountability of these programs is demonstrated through the program evaluation tool (McLees, Nawaz, Thomas, & Young, 2015).
Program evaluation is a step-by-step process through which government’s health-related programs are improved and made to account for their actions by applying appropriate, ethical, feasible and accurate procedures. This implies attention is paid to documentation, the process of implementation of the program and its success in the achievement of the expected outcomes are measured. Information obtained is then used to make sure that those responsible for the programs are held accountable to major stakeholders (Program Evaluation, 2013). An evaluation of a program is carried out in four ways including implementation or process evaluation, evaluation of outcome, evaluation of impact and cost-effectiveness and benefits analysis. Evaluation of the implementation is for assessing what level has the program attained in its intended operations. It looks at the design, activities of a program and its compliance with professional standards, statutory and regulatory authorities. Outcome evaluation is for assessing the extent to which objectives that are outcome oriented have been achieved by the program. This evaluation looks into the outcomes and outputs of a program including the unplanned for effects. Evaluation of impact finds out what are the program’s net effects by comparing outcomes of a program with the estimated effects that would be obtained in the absence of a program. Finally, the evaluation of the effectiveness of costs examines the outputs or a program and compares them with the costs used to obtain them. It is a cost-benefits analysis that helps in identifying the best alternatives in terms of costs by finds out the costs and benefits of a program (Frieden, 2014).
Program evaluation is conducted through an established framework, which is a practical tool intended for summarizing and organizing the important elements of an evaluation. Program evaluation frameworks consist of certain steps and standards that are essential in the practice of evaluation. The steps that need to be adhered to are engagement of stakeholders, description of the program, determining the design of evaluation, the collection of reliable evidence, justification of conclusion, sharing, and application of learned lessons. Feasibility, accuracy, and propriety are the four groups of standard applied in evaluation activities (Wholey, Hatry, & Newcomer, 2010).
Engaging stakeholders is essential because such programs involve working in partnerships and it is important to understand and consider the perspectives of all stakeholders. The stakeholders are mainly, those directly or indirectly affected by the program by either receiving the services or benefiting from provision of better assets in the community. Others are those involved in operations of the programs and the users of the evaluation. The second step is the description of the program whereby the needs, expected effects, activities, resources, stage of development, context, and logic model are described in detail. This step helps in providing a clear understanding of the goals and strategies of a program. The third step considers the evaluation design that looks into the purpose, users, questions, methods and agreements of the evaluation. The methods mainly used are the experimental, quasi-experimental and observational designs. In the fourth step, credible evidence is gathered and here, the aspects of trustworthy evidence such as sources, quality, indicators, quantity, and logistics affect the perceptions of evidence credibility. In justification of conclusions step, processes such as interpretation, standards, analysis, judgment, synthesis, and recommendations are used to justify provided evidence. The last step involves, ensuring lessons learned are used and shared. Here, there are key elements that are considered in the evaluation including, preparation, follow-up, design, feedback, and dissemination (Wholey, 2010).
The accountability of those responsible for managing the health programs can be easily determined by the results obtained in an evaluation practice. The findings of an evaluation are meant to show that a program has contributed to reduction or mortality and morbidity or pertinent risk factors. It also helps is assuring the programs financial accountability such that money is spent in an effective and appropriate manner. Moreover, it helps in showing when it is necessary to have more funding, support, and initiate policy changes in order to have better results and improvements in the program (Gyllstrom, 2015).
Therefore, the achievement of certain success factors of a program or its intended outcomes shows whether the program management team is accountable. Firstly, the sustainability of the program both financially and politically is significant. This implies that the team is accountable if the programs have continued receiving funding and support in terms of policies from the necessary stakeholders. Secondly, accountability of a team ensures interventions of the programs are stable thereby help in consistently solving the problems for which they the program was intended. Thirdly, a high number of people that the interventions have been able to reach exist as compared to the number of people the program had planned to serve. Moreover, the level of exposure the program gives to the clients targeted indicates the level of accountability. This is because limited client contract interventions are likely to have outcomes that are less measurable as compared to the more in-depth interventions. Another way of determining accountability through the evaluation findings is the examination of the financial records of the program as well as the laid down policies used in the implementation of the program. Cross-examination trough auditing procedures of financial records such as budgets, cash flows, and income and expenditure statements will help in determining the accountability of the team. Review of the policies laid out in the implementation of the program help in identifying whether the program officials are fair and equitable in providing health services through the program (Program Evaluation, 2013). Therefore, the findings of an evaluation program help in determining the accountability of the team responsible for managing a government’s health-related program.
Frieden, T. R. (2014). Six components necessary for effective public health program implementation. American journal of public health, 104(1), 17-22.
Gyllstrom, E., Gearin, K., Frauendienst, R., Myhre, J., Larson, M., & Riley, W. (2015). Local Health Department Factors Associated With Performance in the Successful Implementation of Community-Based Strategies: A Mixed-Methods Approach. American journal of public health, 105(S2), S311-S317.
Institute of Medicine. (2011). For the Public’s Health: The Role of Measurement in Action and Accountability. National Academies Press.
McLees, A. W., Nawaz, S., Thomas, C., & Young, A. (2015). Defining and Assessing Quality Improvement Outcomes: A Framework for Public Health.American journal of public health, 105(S2), S167-S173.
Program Evaluation: Strategies to Facilitate Agencies’ Use of Evaluation in Program Management and Policy Making. (2013).GAO Reports, 1-38.
Wholey, J. S., Hatry, H. P., & Newcomer, K. E. (2010). Handbook of practical program evaluation (Vol. 19). John Wiley & Sons.