A DIFFERENT APPROACH TO EVALUATING PHC PROJECTS IN DEVELOPING-COUNTRIES - HOW ACCEPTABLE IS IT TO AID AGENCIES

A growing number of criticisms of health impact evaluations have emerg ed during the last decade, within the context of the health sector in developing countries. These criticisms are presented, and an alternati ve approach which focuses on 'intermediate' or 'proximate' determinant s of health is described. If alternative approaches to evaluation are to be adopted, then they must be accepted by the policy makers who dec ide about funding. This paper reports on interviews held with key memb ers of two major European bilateral aid agencies which fund numerous e valuations of primary health care projects (PHC) in developing countri es. Differences in views between headquarters and field staff are repo rted. It seems likely that expensive, ill-designed and inappropriate h ealth impact evaluations will continue to be implemented due to politi cal pressures, which ignore the conceptual and methodological problems associated with such evaluations. It is suggested that this situation is an example of policy leading science, as opposed to science leadin g policy.