Last night my husband and I watched as Olympic speed skater Shani Davis won the gold. Unfortunately for us, we didn’t experience the thrill of surprise in his victory because NBC airs the program hours after it happens and we had read the news earlier in the day. My husband informed me that many frustrated viewers wrote to NBC requesting live coverage of the Olympic games. “Did it work?” I asked and was told no. I suppose we’ll watch Shaun White compete for gold too (even though we already know he wins).
Did it work? This question is integral to our lives. Did my Toyota come to a stop when I pressed the brakes? Did my headache go away after I took Tylenol? We don’t always realize it but we are constantly conducting evaluations. These questions and answers contribute to our understanding of what works and what doesn’t work so that we avoid repeating the failures. The concept is pretty simple, so shouldn’t it also apply to the health programs we support?
It appears that the importance of evaluation in health programs is gaining attention. Perhaps this is in response to Moyo’s argument that $1 trillion in international aid has actually increased poverty and the shocking lack of evidence to the contrary. Last fall, I attended a lecture by Richard Horton, Editor of the Lancet, at which he urged the global health community of Seattle to use their expertise to support critical evaluation of global health data. President Obama’s recently announced Global Health Initiative highlights the need for robust monitoring and evaluation efforts in order to accelerate best practices and impact. Furthermore, donor communities are increasingly demanding evidence of impact from the organizations they support. With increasing attention on the importance of evaluation, the global health community is turning their efforts to the improvement of metrics, data, and evidence.
Barriers to the evaluation of global health programs are not insignificant. Evaluations are expensive, time consuming and highly political. For one thing, donors typically want their contributions to go to strengthening a health program rather than to a study of it. Furthermore, many government and non-government organizations fear finding evidence that their programs are not successful and potentially lose funding. Despite the difficulty, expense, and potential for undesirable results, conducting rigorous evaluations of our programs is one of the most valuable things we can do. Only with evidence can we attempt to answer the question of “does it work?”