Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?

Since the beginning of the 1990s, health care reform projects have taken pl ace in many of the former Communist countries, but these projects are rarel y evaluated systematically. Evaluation, however, is an important tool for i ncreasing their rationality and continuity. The aim of this paper is to ide ntify the difficulties in the efforts towards systematic evaluation and dra w lessons for the future. For this aim, the requirements for a more rigorou s, controlled evaluation are compared with our experiences of evaluating a health care reform project in the Slovak republic. From this comparison a n umber of discrepancies arise: it was difficult to set clear and realistic g oals at the start of the project; the outcomes of the project could not alw ays be measured, nor could 'the process' always be distinguished from the o utcomes. Systematic evaluation was further hampered by an insufficient degr ee of structuration of the project, in advance and during the implementatio n, and by the absence of a tradition and infrastructure for data collection . On the basis of the experiences and relevant literature, recommendations for future evaluations are formulated. The main lesson is that, given the c ontext, often it will not be possible to use an ambitious evaluation design , and concessions need to be made. At the same time, continuous efforts tow ards more systematic evaluation procedures should be made, but it is wise a nd more sustainable to do this in an incremental way. (C) 2000 Elsevier Sci ence Ireland Ltd. All rights reserved.