Applying Theory Driven Evaluation to Policy Redesign to Impact Maternal Health Inequities: Lessons from Chile

Session: The Role of Evaluations in Bridging Equities: Experiences from Latin America, Asia and Africa

Presenter: Orielle Solar, FLASCO

This paper summarizes some experiences from Chile in reorienting public health programs to integrate health equity into the policy design, guided by theory-driven evaluation orientations. During 2008-2010, the Ministry of Health of Chile adapted the work of the Priority Public Health Conditions Knowledge Network (PPHC) of the Commission on Social Determinants of Health combined with evaluation theory using the results chain. As part of their national strategy for health equity, six health programs were chosen for re-design and review so that they would better address socially determined health inequities. The redesign of public health programs involves the review of its theory of change, rationale, objectives, interventions, achievements, targets and indicators. While every program is based on theory, the underlying theory is often not explicitly understood, especially if it has not been explicitly described. The theory needs to be surfaced through a reflection process involving stakeholders. The review involves the analysis of the relationship between the program and other sectors, as well as its vertical integration and the participation of social actors in the program’s formulation, implementation, monitoring and evaluation and continuous development. The review process draws from methodological guides to help teams assess how the program works in practice, for whom and under what circumstances and who is left behind in the process. Based on the findings from the review, program managers agree on priorities and objectives for the redesign/reorientation phase. A key contribution of this presentation will be to leverage the Chilean experience to highlight the importance of an elaborate theory of change in health system reform efforts.