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Why evaluate health sector initiatives?

  • The evidence base around the effectiveness of different strategies and interventions in the health sector, while growing, is still weak in many areas. This poses challenges on a number of levels. Where thorough assessments are not available, decisions regarding how resources should be spent and what programmes should be supported may be made on the basis of incomplete information or findings from evaluations that are inappropriate for the specific contexts. In the worst cases, without proper evaluation programmes may also be doing more harm than good for survivors.
  • Evaluations provide a framework for identifying promising interventions, targeting specific aspects of those interventions that contribute to their success, and drawbacks and gaps with each strategy. Without this information, critical resources might be wasted on programmes that will not lead to desired outcomes or may even worsen the situation for women.
  • Ideally, a health programme should be able to measure progress toward its objectives and evaluate whether an intervention has been beneficial or has created additional risks. However, many health programmes carry out activities without clarifying what results they are trying to achieve or determining whether or not they did in fact achieve those results. (Guedes 2004, Bott, Guedes and Claramunt 2004)
  • Health programmes that address violence have a particularly great responsibility to invest in monitoring and evaluation given the possibility that a poorly-planned intervention can put women at additional risk or inflict unintended harm. For example, a training session may fail to change misperceptions and prejudices that can harm victims of violence, or may even reinforce them. Or a routine screening policy may be implemented in ways that actually increase women’s risk of violence or emotional harm.
  • Monitoring and evaluation offer invaluable information about the best way for health programmes to protect the health, rights and safety of women who experience violence.
  • Health services provide a unique window of opportunity to address the needs of abused women and are essential in the prevention and response to violence against women and girls, since most women come into contact with the health system at some point in their lives.  The health sector is frequently the first point of contact with any formal system for women experiencing abuse, whether they disclose or not. Every clinic visit presents an opportunity to ameliorate the effects of violence as well as help prevent future incidents.  Monitoring and evaluating these service in the health sector is crucial to the broader response to violence against women and girls. (Heise, Ellsberg and Gottomoeller, 1999)
  • Monitoring and evaluation should look at all elements of the system-wide approach to health, including the policies, protocols, infrastructure, supplies, staff capacity to deliver quality medical and psychosocial support, staff training and other professional development opportunities, case documentation and data systems, the functioning of referral networks, safety and danger assessments, among other items that are relevant to specific contexts and programmes.  (See Heise, Ellsberg and Gottomoeller, 1999, Velzeboer et al 2003, Bott, Guedes and Claramunt 2004)

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