HOW DO HEALTH-SERVICE MANAGERS RESPOND TO QUALITATIVE RESEARCH

During 1992 a qualitative evaluation of a government health service-ru n community health worker (CHW) project in South Africa found that pro ject workers were doing good work despite serious structural shortcomi ngs related to lack of community participation and inadequate integrat ion of the project in the health district system. Recommendations were made to develop the project in order to enhance community involvement , to build closer integration between the project and the services off ered at the health centre, and to collaborate with non-government CHW projects in neighbouring areas. The evaluation study was followed up o ne year later by interviews with health managers to determine their re sponse to the evaluation. The managers reported that they had found th e qualitative data valuable for understanding how clients perceived th e health service, and for planning a more community-responsive service . Despite this, the recommendations from the evaluation were not imple mented and political developments in the district resulted in the CHW project being closed down. It is concluded that qualitative evaluators need to carefully explore the political context of primary health car e interventions in order that their research provides useful data for decision-making.