Process evaluation in a Colombian primary health care programme

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Abstract
In a comprehensive primary health care (PHC) project, evaluation was carried out for decision-making purposes during a five-year period. All information gathered by different methods was afterwards analysed and ordered, using a systems approach: the system of the project, with its inputs, process, output and outcome was defined and data arranged and analysed accordingly. Criteria for the analysis were reliability and validity, relevance, costs of obtaining the data, and use of the data. For decision-making purposes the information on the process - the interaction between project activities and the community - with all its different components was the most relevant. It was obtained by the use of adapted World Health Organization (WHO) protocols, by external evaluations, and from participatory evaluation. Output data (mainly on coverage) were quite easily obtained, but only when combined with information on the process could it be known whether such data gave an indication of effective coverage. Methods used for process evaluation are described and it is suggested that process evaluation should always be built into PHC projects and programmes. WHO protocols, adapted to local situations, and used in a participatory manner, are good instruments for evaluation of the processes at service and community level.

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