Performance measurement

Evaluation - "a systematic way of learning from experience and using lessons learned to improve current activities and promote better planning by careful selection of alternatives for future action", WHO 1994 - provides an objective basis for assessing the performance of health projects, agency performance, global programmes, and health policies and changes.

Process evaluation shows how a programme or change is implemented as planned; outcome evaluation aims to find out the effects (and, longer term, impact) of an intervention. Careful planning, clear identification of questions to be asked, data (or proxy data) required, and identifying who will conduct the evaluation (internal, external, collaborative) are pre-requisites of all evaluations.

Monitoring measures the continuous process of activity over time (against a standard); with the introduction of sector-wide approaches (SWAps), the need to monitor poverty reduction strategy plans (PRSPs), and the new global programmes, sector monitoring is increasingly important.

Development partners are attempting to standardise evaluation methodologies - assessing interventions, country programmes, and developing sector and thematic reviews. These will inform future health policy and interventions. In 2000, the WHO World Health Report attempted, for the first time, to evaluate and compare 191 health systems world-wide. The methodology used requires refinement, but the results will yield valuable data.