Chi Chunhuei, Tuepker Anaïs, Schoon Rebecca, Núñez Mondaca Alicia
Center for Global Health, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.
Division of General Internal Medicine and Geriatrics, Oregon Health and Science University/ Portland Veterans Affairs Health Care System, Portland, Oregon, USA.
Int J Health Plann Manage. 2018 Apr;33(2):511-523. doi: 10.1002/hpm.2483. Epub 2018 Jan 5.
Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research.
近几十年来，国际卫生项目在资金投入和实施方面发生的显著变化引发了关于社区在决定实施哪些卫生项目中所起作用的讨论。在这场讨论中，一个重要却被忽视的方面是需要改变项目评估的规范，以便对社区所有权的分析（超越各种程度的“参与”）被视为强有力评估实践的核心。本文对主流评估实践提出挑战，并提出了一个批判性评估框架，该框架有三个层面：上游评估，评估项目决策的“主体”和“方式”；中游评估，关注选择项目目标的“主体”和“方式”；下游评估，即当前主流评估的重点，评估项目是否实现了既定目标。我们框架的一个重要原则是，社区有权决定其健康发展的道路。无论技术成果如何，成功的一个先决条件是项目必须解决社区高度关注的问题。当前的参与式方法仍然很少践行社区对项目选择的所有权，因为它们容易受到资助机构预先确定的优先事项的影响。除了批判评估实践并提出替代框架外，我们还认识到可能面临的挑战，并为未来研究提出了方向。
