Investing in Community Health- Finding the Evidence for Effectiveness (2003)

Fran Baum, Janice Duffy & Gwyn Jolley

This report is concerned with a thorough review of the various mechanisms for assessing the performance of community health services. This review was commissioned following discussion between the South Australian Community Health Research Unit (SACHRU) and the Directors of the four South Australian metropolitan community health services which led to the formulation of a SACHRU project to investigate systematically the various means by which community health evidence can be judged. The report discusses the use of economic techniques, routine data bases, systematic reviews and performance indicators. Each of these techniques has been assessed to determine the contribution they make to measuring effectiveness of community health services. This report also considers the types of evidence used in South Australian community health services and annotates the reports completed by SACHRU that have contributed to this evidence base. The final chapter draws general conclusions about the evidence for effectiveness of community health services and compares this evidence to that available for other sectors of the health system. It then considers three factors that contribute to the assessment of community health: the problem of attribution, the complexity of most community health interventions and the problems this poses for evaluators, and finally, the importance of ensuring that seductively simple evaluation methods to not drive the type and scale of community health interventions. The chapter concludes with a discussion of the way forward to a more systematic approach to assessing the performance of community health services. The systematic framework proposed assesses the quality of planning, program logic, evaluation and subsequent implementation of change in the community health sector, while taking into account the importance of the core values underpinning comprehensive primary health care, especially participation, equity and population-based approaches.

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