Evaluation priorities

Just as each goal and each objective of a programme will be allocated a priority, evaluations should also be ranked. Thus, with limited resources, certain choices have to be made. Some evaluations may be useful, but not essential. Others may not be possible with the resources available. Others may be important, but there may be a lack of technical expertise to carry them out. The rule of thumb should be that, as with objectives, only those evaluations that are feasible and worth the effort should be undertaken.

Objectives for the health worker

One way to decide which evaluations should be carried out is to review what types of effect the key elements of the programme are having. For example, the primary health care worker who is, perhaps, the main resource of the programme should attempt to assess his or her role in the overall development of the programme. Specifically, it might be worth preparing personal objectives to assess achievements over a particular period. This will allow the individual to monitor his or her own progress in meeting realistic objectives.

For example, for some PHC workers a major objective will be to persuade community leaders from various sectors to become involved in the programme to reduce alcohol and drug problems. This might mean developing an intermediate objective to meet three leaders from health, police, religious, civic, educational, or nongovernmental organizations within the first three months, with a further objective of persuading at least two people from each sector to join the community action team. Or the intermediate objective might be for specific levels of new resources to be contributed to the community action team for its use.

Defining one's own contribution to the overall community programme in this way may be especially helpful in cases where overall progress is hard to achieve, and harder yet to measure. Because alcohol- and drug-related problems are often intractable, and improvements are sometimes difficult to see, the PHC worker should know that he or she is on the right track and is accomplishing specific tasks that will contribute to the long-term reduction of problems. The primary health care worker should not be discouraged if after a year's work there are still alcohol and drug problems in the community, or even if the problems seem to get larger. This may happen as people become aware of the problems in general, and the stigma and the denial are reduced. A preventive programme will sometimes lead many people to seek treatment, as they or their families recognize for the first time that they have a drinking or drug problem. In this case, monitoring of the problem may show that it is growing, whereas in fact it is merely becoming visible for the first time. The primary health care worker should, therefore, not become discouraged, but should develop some personal objectives for periodic assessment to show that progress is being made, no matter how things may look from other perspectives.

Objectives for the community

Another measure of success is the degree of involvement of different sectors within the community in helping to reduce the problems. Ideally, all sectors of the community will come to recognize the problems of alcohol and drug abuse and will want to contribute to programmes to reduce such problems. Thus, in an evaluation of the process, involvement of community organizations can be a very useful measure, even if apparent alcohol and drug problems are not yet being reduced.

A long-term commitment to solutions involving all sectors of society is essential. This commitment should cover the availability of things like staff, equipment, and facilities, as well as funds. While it may be very helpful to get a commitment of financial resources from a local business, it would be equally valuable to be assured of the dedication of a part-time staff member from another business who could help carry out some of the tasks necessary for a preventive programme, or the use of an office or meeting place.

Likewise, members of a local organization may be willing to contribute their time, but they should be trained and monitored to ensure that the quality of service they provide is good. Evaluation of such free services might appear ungrateful, and some people may not wish to be monitored in this way. Yet, if the job is important, it is important to do it correctly. Well-meaning individuals can sometimes harm a programme, despite their best intentions. For example, many people believe that "scare messages" delivered to school-age children, emphasizing the horrible effects of drug use, are effective in discouraging children from trying drugs. But careful research indicates that this is not the case. A well-meaning teacher who delivers scare messages to children is, at best, wasting time and energy, and, at worst, may increase the children's curiosity about drugs.

Outside the community

Communities can learn from one another, and can benefit from one another's successes and mistakes. One community may decide that its highest priority in a preventive programme is education of schoolchildren about the harm caused by use of a particular drug. However, even with a highly sophisticated evaluation, it may be difficult to determine whether the programme has had any effect in terms of diminished drug use (outcome evaluation). In this case, it would probably be more useful to evaluate the activity, the input, the process, or the outputs. Assuming that the programme managers were able to demonstrate the feasibility of such a programme, a neighbouring community might be encouraged by this success to adapt the programme for its own use. This is an unexpected outcome which should be included in an evaluation report.