Impact Evaluation and Accountability Essay

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Health Care -- Impact Evaluation and Accountability

Accountability to stakeholders should be an integral aspect of any health-related government program. This is achieved by systematic and objective assessment of how a program's effectiveness, evaluation normally involves measuring and documenting a program's effectiveness; calculating a program's outcomes; documenting a program's execution and cost effectiveness; strengthening a program's impact. In the case of health-related government programs, the stakeholders to whom accountability is owed typically are those served by the program, those conducting the program, and those who will use evaluation findings to make decisions about the program. The importance of evaluations for accountability is underscored by the resources provided by state and federal governments for ongoing evaluations to ensure ongoing accountability to all stakeholders. Evaluation for the purpose of accountability can assist stakeholders and specifically those in charge of the programs in a number of ways, all of which in program continuation, refinement and impact.

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Accountability in the Context of Health-Related Government Programs and Evaluating such Programs

Accountability to stakeholders is ideally an ongoing aspect of any program. Program accountability invariably involves evaluation. Evaluation is a "systematic, objective assessment of how well a program is working -- addressing both program quality and results" (Shipman, 2005). Research indicating that this evaluation entails: measuring and documenting a program's effectiveness; calculating a program's outcomes; documenting a program's execution and cost effectiveness; strengthening a program's impact (MacDonald, et al., 2001, p. 1). Whatever evaluation method is used, the collected data must be effectively synthesized to deliver "reliable, unbiased, and meaningful information on the strength of evidence behind each program" (Chatterji, 2008). In addition, in the case of healthy-related government programs, the stakeholders consist of 3 groups: the people to be served by the program; the people operating the program; the people who will use the evaluation findings (MacDonald, et al., 2001, p. 15). Here, the people served by the program are external stakeholders who may include patients, advocacy groups, members of the community and/or state and local officials (MacDonald, et al., 2001, pp. 2, 15). The people operating the program are internal and external stakeholders who may include: program management, program staff, program partners, agencies involved in funding the program, and members of related coalitions (MacDonald, et al., 2001, pp. 2, 15). The people who will use the evaluation findings are internal and external stakeholders who are or will be able to make decisions about the program and may include: the public, taxpayers, program partners, agencies that fund the program (MacDonald, et al., 2001, pp. 2, 15). As research indicates, individuals and groups may be stakeholders in several respects through overlapping categories; for example, public officials may be stakeholders as people/groups being served by a health-related government program and may also be stakeholders as individuals/groups who will use evaluation findings and be in a position to make decisions about that health-related program. In sum, accountability in the context of health-related government programs involves assessments and documentation regarding the program's effectiveness, outcomes, execution, cost effectiveness and impact for the benefit of patients, advocacy groups, members of the community and/or state and local officials, program management, program staff, program partners, agencies involved in funding the program, members of related coalitions, the general public and taxpayers.

The importance of accountability is underscored by federal and state dedicated resources and organizations designed to provide ongoing evaluation. These resources/organizations are dedicated to independently ensuring and enhancing the accountability of government programs. One example of these dedicated organizations is the state of Maine's Office of Program Evaluation and Government Accountability (OPEGA), which independently and objectively audits Maine's programs and activities to ensure that the programs are effective, efficient, meet their objectives, adhere to program policies and procedures, and comply with federal and state laws/regulations (Main State Legislature, 2009). Another example of dedicated resources/organizations to ensure and enhance accountability is provided on the federal level by the National Center for Chronic Disease Prevention and Health Promotion through a website providing links, manuals and contacts for establishment and ongoing evaluation of health-related government programs (National Center for Chronic Disease Prevention and Health Promotion, 2011).

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Clearly, on both the federal and state levels, government officials and program coordinators understand the importance of intelligent, ongoing evaluation of health-related government programs for effective accountability to all program stakeholders.

How Evaluation Can Assist in Determining Accountability by Those in Charge of a Health or Social Program

Evaluation of a health-related government program can assist in determining accountability by pursuing one of two objectives, either process or outcome. Process objectives focus on a program's activities, showing effective actions and implementation (MacDonald, et al., 2001, p. 26). Outcome objectives, on the other hand, focus on program goals, whether short-term or long-term (MacDonald, et al., 2001, p. 26). As mentioned above, program accountability typically involves: measuring and documenting a program's effectiveness; calculating a program's outcomes; documenting a program's execution and cost effectiveness; and strengthening a program's impact (MacDonald, et al., 2001, p. 1). It is in carrying out these measurements, calculations, assessments and documentation that evaluation can assist in determining accountability. The specific ways in which these methods assist in determining accountability depend on the method used, though the results of several methods may overlap.

Measuring and documenting a health-related government program's effectiveness is typically used in the case of a "mature" program -- one which is already implemented and in effect for a significant amount of time -- because there is enough meaningful data to collect, examine and document (MacDonald, et al., 2001, p. 44). This method involves collection, review, assessment and documentation of data to determine whether the program is progressing toward its stated goals. Depending on the findings, stakeholders can decide whether to: continue or terminate the program; refine the program or keep the program as is; expand, contract or keep the program at its current parameters (MacDonald, et al., 2001, p. 45).

Calculating a health-related government program's outcomes involves extensive preparation. In order to effectively calculate outcomes, researchers must: specifying outcomes -- whether long-term or short-term that are to be measured, selecting indicators, reviewing existing data sources, determining which resources can be used for data collection, collecting data, reviewing assessing and documenting data, determining findings based on the data review (MacDonald, et al., 2001, pp. 59-60). Though evaluation work is extensive and time-consuming, the rewards can also be extensive. Evaluation can provide considerable assistance by: promoting the program, enhancing its image, and focusing greater attention on program issues; identify training and technical needs for staff and provide further direction for program staff;

showing stakeholders that resources are being used well and cost-effectively; assisting stakeholders in justifying the use of resources for the program, forming effective program budgets, comparing outcomes from the current evaluation against previous outcomes, comparing desired outcomes against data-supported outcomes, formulating realistic future outcomes, formulating yearly and long-range plans; determining possible program partners and collaborators (MacDonald, et al., 2001, pp. 74-5). All these benefits ultimately assist in a health-related government program's continuation, refinement and impact.

Conclusion

Accountability to stakeholders should be an integral aspect of any health-related government program. Using a systematic and objective assessment of how a program's effectiveness, evaluation normally involves measuring and documenting a program's effectiveness; calculating a program's outcomes; documenting a program's execution and cost effectiveness; strengthening a program's impact. In the case of health-related government programs, the stakeholders to whom accountability is owed typically are those served by the program, those conducting the program, and those who will use evaluation findings to make decisions about the program. Obviously, the list of these stakeholders may be extensive, including but not limited to: patients, activists, program management, program staff, the public, taxpayers, and agencies that fund the program. The importance of evaluations for accountability is underscored by the resources provided by state and federal governments for ongoing evaluations to ensure ongoing….....

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