R and E shapes health policy
The Primary Health Care Strategy is a major government priority and the Ministry of Health is managing a portfolio of evaluations as an integral part of the implementation.
The portfolio seeks to answer questions on three key areas: the implementation of the strategy, the impact this has on the services delivering it, and resulting changes in the health of the population.
The central part of the portfolio is a three-year Evaluation of the Implementation and Intermediate Outcomes of the Strategy, jointly funded by the Health Research Council (HRC), the Ministry of Health and ACC, and led by Victoria University's Health Services Research Centre (see "PHCS evaluation").
There are a number of other projects funded by the Ministry which look more closely at aspects of the strategy. They include evaluations of the first year from the perspective of the Public Health Organisations (PHOs) (completed); the Primary Health Care Nursing Innovations, the implementation of Care Plus; the Primary Mental Health Care Innovations and a number of initiatives to reduce inequalities, mainly in access. In addition, the Health Research Council is funding important projects including an economic analysis of the strategy and the role of primary care for older people.
Stephen Lungley, Senior Advisor (Research) with the Ministry of Health, says the evaluations each contribute information to different aspects of the strategy's implementation plan. "Most of these evaluations have strong formative components - that is, findings are reported throughout the implementation with a focus on how we can improve implementation and design features of the strategy as we go."
The effectiveness of evaluation in affecting policy depends on several factors. "Keys to the effectiveness of these projects have been the willingness on the part of the researchers and policy makers to discuss issues, the timeliness of the results, the style of presenting the results, and an understanding of the importance of implementation issues as well as outcomes," Stephen says.
He says researchers and policy makers have many common interests. "We all want the research to make a difference. We want it to inform policy development, help improve health services, and to tell us if the strategy has worked - and why and how."
But researchers and policy makers work under different constraints and this can lead to tensions. "A key issue for policy makers is often how to make the policy work. Evaluation is only one source of information. And they want reports to be accessible and timely. Analysts always need to know now!"
Researchers, on the other hand, need time to complete the evaluation and want to avoid rushed judgements. Constantly evolving policies make evaluation more difficult. And not least they need sufficient resources for their evaluation to meet expectations.
Stephen says the key to ensuring research is used in policy development is to have regular interaction among all parties. "We need to have regular feedback on issues as they arise. It is important for researchers to give presentations to all the key stakeholders about the research, and to ensure reports are accessible and set out the implications of the findings."
He says evaluation reports so far on the strategy have fed into policy papers. "For example around funding, the nature of community involvement, and the importance for providers to have a population health focus. The management review has resulted in an increase in the management fees for small PHOs, and the evaluation of Care Plus, which provides additional funding for people who use high levels of care, has been instrumental in developing the funding formula."
Stephen says there are many aspects of primary health care where significant questions about policy and implementation remain. "We need research and evaluation to resolve issues such as variation in the provision of services, the most appropriate ways to target resources, and what types of services work best in different circumstances. The strategy is a large investment for the government, so we need to ensure it is achieving its aims."
Victoria University's Dr Jackie Cumming, who is running the lead evaluation, says it is important to work closely with the Ministry of Health to ensure understanding of how the strategy is evolving, and that the focus is on key issues as well as new issues that emerge as implementation takes place. "I value the positive working relationship we have with the Ministry of Health. There are tensions at times - especially around what can be done for the funding that is available and around ensuring high quality analysis while also providing timely results - but these issues can be worked around."
For more information go to www.vuw.ac.nz/hsrc/reports/primary-index.aspx and the projects page at www.moh.govt.nz/primaryhealthcare.
A number of new reports will be published over the next months.
