REACH AND EVALUATION OF COMMUNITY HEALTH
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- Title
- REACH AND EVALUATION OF COMMUNITY HEALTH
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RF_COM_H_49_A_SUDHA
PR. PARA S AMAR. M.D.*
SCOPE OF OPERATIONAL RESEARCH TECHNI QUES
IN MEFICAL COLLEGES.
-INTROPUCTION:
The term 'operational research' was coined during
the World War II in connection with the best use of a new invention,
the radar, Since- the war, the term has spread rapidly in Britain and
America and it has come to mean today more than the study of the
use of new inventions - the study of the whole systems of
services rendered in industry, administration, education and
health services.
Operational research is defined as.the application of
scientific methods of investigation to the study of complex human
organisations and services.
In operational research, one is concerned all the time
with the activities of a group of people with the purpose of.
inducing beneficial changes. Thus, operational research is a
sociological science, and has an immense social content which
distinguishes it from pure or applied research. The main
objective of operational research is "to develop new knowledge
about institutions, programmes, use of facilities, the people
working in these activities and the individuals and communities
served by them,’ in order to secure optimal utilisation of
resources in men, material and money in the service of the
community." A new area of operational research is emerging, i.e.,
"health operational research.
PRINCIPALS:
^7
1. It is an omnibus,( iriterdisciplinary)that takes
to any branch of science.
2. ’One man with idea is as much as 100 having
merely interests.
3. It mistrusts verbal arguments and substitutes
aIgebric reasoning for verbal wrangling.
4. It believes "Problems are plenty but practical
actions available is restricted and so" get the
best of the worst bargain"
5. It often yields rather bad answers but improves
on exhisting worse ones.
6. It unmasks hidden incompatibilities in the
complex of organizational goals and targets and
chooses right priorities.
—pTSfessorT'Dep^ • °f Community Medicine “
. tr ?--dical Colleoc, Bangalore.
2
BIASES IM OPERATIONAL RESEARCH:
The procedure- to be adopted in operational research
differs according to the nature of the study. The usual procedure
adopted generally consists of the following phases.
1. Forru_ation of the Problem
2. Collection of relevant data, if necessary, by a
suitable sample
3. Analysis of data and formulation of hypothesis
4. Ferivlng solutions from the hypothesis or "model"
5. Choosing the optimal solution and forecasting
results.
6. Testing of solution, e.g., pilot projects
7. Implementing of the solution in the whole system.
COAWN OPERATIONAL RESEARCH TECHNIQUES:
I; Lingos Programming(L.P.) Often termed as an Optimization technique,
Linear Programme helps to achieve- the following:
a) To minimize the INPUT in terms of resources
b) To maximize the OUTPUT in terms of work done
c) To achieve an optimum "mix" of various resources
subject to constraints.
When the number of resources being studied to determine
the optimum "mix" (or proportion of each resource- to be- used) is
only two resources, then the 2-dimensional method may be employed as^'
described in the example. However, in reality, the number of
resources used arc- inevitably more than two in number.
For such
situations, there' are Linear Programming techniques that involve
multi-dimentional arrays. The- principle of calculation is simple
but the quantity of calculations to be cone becomes laborious and
time-consuming and therefore recourse to a computer is often
necessary.
Some examples of situations where- Linear Programming
techniques may be employed:1. Optimum 'mix' of various drugs in T.B. Chemotherapy,
keeping in view constraints of cost, availability,
potency, side-effects etc.
2. Optimum "mix' of medical/paramc-dical staff in a
Fepa^tment keeping in view constraints of salary
cost, job requirements, qualifications, experience,
patient needs etc.
3. Maximal coverage- with limited staff/other resources.
3
DR . DARA S AMAR
LINEAR : 'CGRAMMINJS (2-dimensional or
simplex method)
Problem:
Two types of protein foods (C± and C2) are being made for a
nutrition programme. C, is cheap.-but contains less protein
than C2 which is costlier. 'What-is the optimum mixture of
and C2 which will maximise the profit function(p) (profit values
measured in terms of grams of proteins).
P
=
2 x + 3y
(Where x and y are the respective number of units
of
each unit of
and CL,, to be mixed, given the condition that
has 2 grams of protein and C2 has 3 grams of
protein.
Thus we have to find out the optimum values of x and y that will
give the maximum value for p(profit) (i.e. maximum amount of
In other-words, for every unit of the cheap
protein).
food,
how many units of the costlier C2-food must be added, to get the
maximum amount of protein (i.e. what is the optimum proportion)
given the following constraints in 2 resources (c.g. two types of
raw material for
and C2.
TABLE OF CONSUMPTION OF MINIMUM RESOURCES
FOR C-j- and C2 foods
■
Units of Resources(R)
.
R1 = Material (.1)
’Minimum resources input per unit
o f Fo od C^
Minimum resources input per unit
of Food C2
Minimum total resources input
for 'x 1 units of Cl and 'y 1 units
of C2 (i.e. proportion)
= ^eriaF(2)
3
2
2
4
3x + 2y
2x + 4y
4
Constraints
(We cannot make just any type of proportion of
Cy and Cg (i.e. x & y) to give highest protein mixture because
of the following resource constraints)
material(i)
(1) The ceiling on
y
(i.e. Bl) for any proportion of
and C£
7 - i.e. 3x + 2y<_'(i.e. cannot exceed)
(i.e. x & y) is
7
(2) The ceiling on T2j) material (2)) for any proportion of
(i.e. x & y) is
e.
i.
and C?
.10
2x + 4y).£ (Cannot exceed) 10
Solution:
So we have 3 algebric equations :-
i.e.
i. 3 x + 2 y
ii. 2x
4y
i i i . 2 x 4s 3y
=
70
,Constraint Eouatrons
- io5
=
P
Profit function equation
Let us now plot the.constraint equations in a graph paper and
solve the profit function equation from the graph:
Graph Co-ordinates:
Eq.(i)
Let x coordinate be = 0
Eq.(ii) Let x coordinate be = 0
. * . 3x0 +- 2y = 7
2x0 +- 4y = 10
.-._y=7/2
• •. y = 5/2
Let y coordinate be = 0
Let y coordinate be = 0
3x + 2x0 = 7
.*
2x + 4x0 = 10
. x = 5
. ‘. x = 7/3
Co-ordinates for Eq. (i)
(xy) = (O,‘ 7/2)
)
(xy) = (7/3, 0)
j Eq. (1)
Coordinates for Eq.(ii)
(xy) = (0,5/2)
(xy) = (5,0
)
)
j Eq-
(11)
i- y axis.
To Optimise P=(i,e. Max, amount of protein)
Substitute the co-ordinates
values in Equation(iii) consecutively
at points 0, A, B, C and find out the point where the P value is
maximal.
Point 0:
0+0
Point B:
Point A:
2x + 3y = P
2x7/3 + 3x0 = P
14
. • . P=-±y- = 4.66
= P
P =_0_
Point C:
2x + 3y = P
2x + 3y - P
2x0 + 3x5_= P
2
• • P =15 = 7.5
2---------:
2xi+ 3x2 = F
•' • p ~JL_
-----
.
2x + 3y = P
Maximal Value of P - 8 (occurs at point b)
Substituting Co-ordinates of E in Eq. (iii)
2x + 3y = P
2(1) + 3(2) = 8
Optimum Proportion of
and
=1 unit of
for every 2 units of C„
6
II. PERT/CPM NETWORK ANALYSIS:
T. PET-T - acronym for programme evaluation and Review Tcchnioue,
It is a network or a graphic plan of all events and
activities to be completed in order to reach an one’ objective.
The- essence- of PERT is to construct an Arrow Diagram (refer example).
The diagram represents the logical sequence in which events must
take- place.
It depicts sone activities that may be- performed
simultanc-usly and other activities that can be- performed only
consecutively.
It is possible with such, a network to gain the
following answers:a) Fetermin.'ng the probability of meeting specified
deadlines in your programmes.
b) Planning, scheduling and monitoring the project.
c) Determining the latest and earliest starting and
finishing time deadlines for individual activities
and workers, keeping in view the deadline- for
completion of the entire- project or programme.
d) Better and more- specific job descriptions in a
project (i.e. number, kind and sequencing of job
activities)
c-) Continuous timely progress reports,.
f) An ideal system for evaluating the- project.
g) PERT identifies trouble spots, often in advance,
and pinpoints responsibility.
2, CPM - acronym for critical path method.
This is the Longest
path in the- PERT'Network, in terms of time taken to complete- theactivities.
If any activity along this critical path is delayed,
the entire project will be- delayed. Whereas PERT, only provided an
in depth, time- - analysis of the project, CPM helps to determine
a time schedule- at minimum cost, i.e: it helps in calculating
the OPTIMUM cost that needs to be incurred if the project is.to
run at the- Optimum duration.
Thus PERT and CPM arc- tools in dealing with the- TIME
and COST analysis of a project.
Examples of PERT/CPM usage cover all activities of a
Medical College- extending from the administrative procedures to
•teaching time schedules, departmental programmes, laboratory proced-ures,"patient care systems, rural and urban health programmes,
planning for research projc-cts etc. A few areas that are'small enough
for PEIv/CPM trials:- a) An immunization camp b) planning for a short •
course/training programme c) organizing a new department d) upgrading
a unit (c-) movement of vehicles during a normal week of college work
7
•
r--l.■‘'•■nino
work tv
■
'.'chedulc- for
7
NETWORK-EASEF TIME ESTIMATES FOR VACCINATION
PROGR/tMME
Predecessor
Event
Successor
Event
1
2
1
3
2
V
3
4
4
4
Survey the population
'Prepare policies and pro
cedure for records and
re po rt s
te E.S. E.F. L.S. L.F.
( days )
17
0
17
0
17
5
0
5
52
57
8
Prepare estimates of
vaccine, equipment, vehicles
’ 8
etc. required
17
25
21
29
17
25
17
25
6
Procure vehicles on loan
from other departments and
got them into position
7
8
53
57
69
Got the forms printed
Plan public meetings
9
Plan strategy to obtain the
cooperation of community
leaders
Orient vaccinators with
respect to project, plans,
jobs, etc.
4
5
■2
2
Activity Fescription
10
Get the vaccinators into
postition
16
12
4
17
33
5
25
17
29
29
69
33
2
25
27
47
49
3
25
2
18
25
25
28
27
43
55
51
25
58
53
43
28
27
32
44
58
53
62
43
Z4
48
43
70
48
72
48
69
29
27
6972
68
72
69
33
49
69
72
72
72
5
5
11
12
Place an order for vaccine
Call tenders for equipment
10
13
11
14
Assign population and post
vaccinators
Receive vaccine
12
14
15
17
Give- contract for equipment
4
17
£=,
Toliver vaccine at FHC
2
15
16
17
Receive equipment
Feliver equipment at PHC
Conduct public meetings
Motivate community leaders
21
3
16
8
17
9
13
17
17
17
J-8
18
19
19
20
39
23
48
46
Help vaccinators to develop
rapport with the- community
Vaccinate
Review performance
10
11
S
32
72
42
83
62
72
72
83
83
91
83
91
Prepare project report and
submit
8
91
99
91
99
E.S.= Earliest Start; E.F.= Earliest Finish; L.S.--- Latest Start;
L.F.=Latcst Finish
70
9
III:
QUEING
THEORY
The above technique c'eals with questions relating
to the following
1. Types of Ques
2. Factors in Que formation
3. Minimizing Que lengths.
There are different types of Ques and each is governed
by such factors as Que discipline., Service capacity etc. The
following is a simple Que system based on the "First come - first
Serve" Easis. The formulae relate to the calculation of certain
important parameters in Que Control.
Example:
A given out patient department of a Hospital, functions
for 8 hours per-day(H'). Eased on a sample survey of this OPD, the
following figures were calculated
(A) Arrival Rate of patients joining the OPE Que =4
patients/hour
Number of doctors serving OPE '
.
=1
(S) Service Rate of patient(i.e. No.of patients ±5
patients/hour
that doctor sees in an hour)
. ’.(W) No. of patients waiting in Que at any
given moment
o
=
= __ A_
,
S(S-A)"
9
4 _ = A-_?
5/5-4)
.‘.Average waiting time per patient = '7
”’a~"
= 3 -2 - 0.8 hours
' 4 ’
or
48 minutes
.‘.Total No. of patients in OPD Area
(i.e. No. of patients waiting outside
+ No. of patients being seen by Doctor )=y
=
A
=
4
S _ A~ 5-4
Service time of Doctor (i.e. No. of hour^lhe
Doctor is actually
.at work).
Idle time of Doctor = (H-
j
—g—'
'= 4 patients
4 xS_g_4 hours
—-g-or
hours 20 mins.)
8-6.4
= 1.6 hours
or
1 hour 36 minutes
11
IV.
1.
MO'ITE CATLO SIMULATION .
.'leant to be- i
_or solving problems too expensive for
experimental solution and too complicated for analytical
treatment.
2.
Many real-life systems are so complicated that it is all
but impossible to transcribe them in mathematical equations
or to solve the equations even if they could be so trans
criber’. -'Therefore in such cases, a step by step verbal
description of the sequence of actions is often possible.
It is such situations that Monte Carlo Technical simulation
has been designed to handle.
In particular it provides simple
possible solutions for queing problems which are otherwise
intraitablc-.
3.
Monte Carlo simulation is a recent operations-research
innovation. The novelty lies in making use of pure chance
to construct a simulated version of the process uncer
analysis, in exactly the so.ne way as pure chance operates
the original system under ’working conditions.
4.
The essence of Monte Carlo simulation is to use random-number
tables to reproduce on paper the operation of any given
system under Its own working conditions.
5.
The selection
? such a random sample is the heart of
Monte Carlo method»
6.
One way of avoiding the tedium and fatigue of an enormous
number of trials is to resort to computer simulation.
7.
A moderately fast’ computer could simulate withing one
minute 100 trials, and a really high-speed one as many
as 5,000 trials.
8.
The accuracy of a Monte Carlo approximation improves only
as the- square- of the number of trials. To double the
accuracy of the estimate the number of trials, has to be
quadrup led; to treble it they must increase ninefold,
and so on.
9.
It is often an adequate substitute for the purely
mathematical formalism and enables us to predict not only
the number of customers likely to arrive during any stipu
lated period but also the very instants at which they do.
12
V. IWEFTOFA—COiHROL:
This is a technique in the- realm of
materials management. The technique helps to solve the- following
problems in the stores and purchase sections for Drugs, Stationary,
Instruments, linen, furniture, lab-reagents vaccines, catering
section etc.
a) Whether to buy all at once or at intervals (analyses demand)patterns
b) Whether to hold buffer stocks and if so how.much (considering
budget limitation, utilization rates etc.)
c) Calculating probabilities of shortage- of individual items in
stores and therefore making alternative plans.
d) How many orders to place per unit time (e.g. per month) taking into.)
consideration delays due to quotations, administrative- lag time ,1^
Delivery lag time etc.
e) Calculating Optimum quantity of goods to order keeping in view
that bulk orders cost less per unit than frequent small orders.
(Refer diagram below)
Optimum
Cost
C
?
i
T;
I
QUANT ITY
Optimum Qt-;
AT LAS idlL- E OPERATION RESEARCH TEC1I ' QUE
HEED TO BE APPLIED
13
Review of currently available literature
.Operations Research studies in the field of Health Services,
reveals a predominance of hospital bo see
*
studies.
However, even
those studies arc confined to a few’large hospitals only. The
following is a list of components in the Health Services system
provided by most medical colleges that may be subjected to
Operations research in order to improve their fur.ctioning.
Many
of these components have- already been studied and some others
are- in the process of being studied. However as mentioned
earlier, data on such studies arc limited.
1. Activity analysis of various categories of workers in the health
care system.
2. Studies towards determining the norms of work-load in terms of
quantum and range of services to be provided, population to be
covered etc., for different categories of health personnel at all
levels.
3. Studies on rationalization of staffing patterns keeping in
view the work-load.
4. Utilisation and maintenance of physical facilities, equipment
and vc-hi.clc-s in all the institutions of health care system.
5. Utilization of hospital beds.
6. Studies on waiting time problems in hospitals and health centres.
7. Studies for development of systems for indenting, storage and
retrieval of medicines and drugs (inventory control and materials
planning).
8. Studies for optimal scheduling and deployment of vehicles
(net work) for rural health services.
9. Studies for scheduling and deployment of vehicles for
emergency services.
10. Scheduling of patients in outpatient departments of hospitals
and health centres.
11. Scheduling of Operation Theatres.
/
12. Inventory control system for X-ray, Laboratory materials,
stores, blood bank etc. in hospitals.
13. Eic-t planning in hospitals.’
14. Studies' on allocation of resources in terms of beds, nurses,
Operation Theatre time etc. to different specialities.
15. Cost
analysis of health care activities.
16. Cost analysis of different hospital services.
Cost of training of different categories of health workers
including professionals.
14
18. Economics of scale- in hospitals, medical colleges and
schools for nursing anc’ other categories of health workers.
19. Cost-benefit analysis anc’ cost-effectiveness analysis of hospital
services.
20. Cost-effectiveness analysis of different training programmes.
21. Studies towards development of suitable management information
systems for individual hospitals and health care institutions.
22. Feasibility studies for introducing 'performance budgeting.
23. Studies in quality of health care services towards development
of standards for quality of health care.
24. Studies in quality of medical care in hospitals.
25. Patterns of private expenditure or health care services by
the population.
W
26. Studies on optimum span of control for different levels of health
services organisation.
SOME COR'CL' JSIOMS
1.
Operation Research is a betterment of exhisting "plans" and so
can be called a scientific criticism of exhisting organization.
So the Operation Research man has to be careful in putting his
ideas across and be very "TACTFULL".
2. Results of Operation Research must he done fast as it relates to
"exhisting and now" condition and not some future. Therefore it
is ever changing and dynamic.
3. Most of Operation Research is "Common Sense" and therefore
requires only basic mathematical reasoning (mostly algebra)
4.
To make use of Operation Research, it neecs "courage" as one
has to "change" age old so called "safe" traditional methods.
5.
Most of us use Operation. Research daily, without even being
aware of it.
*
EVALUATION - THE KEEP, ITS VALUE AND
METHOD
By Dr. Dara S Amar.
1.
'That is Evaluation?
Evaluation, in lay language, would mean the separation of the
most valuable from the less valuable and the value-less.
Evaluation measures
1.1 The degree to which objectives and targets are fulfilled
1.2 The quality of the results obtained
1.3 The productivity of available resources in achieving
objectives
1.4 The cost effectiveness achieved.
Evaluation makes possible the reallocation of priorities and
resources on the basis of changing health needs.
2.
Types of Evaluation:
2.1. Pre-evaluation: It is necessary to establish a baseline at
the beginning of a programme against which tc measure the
results.
2.2 Concurrent evaluation: Evaluation should not be left to the
end but should be made from time to time, so that if the
programme is not progressing successfully, modifications can
be made.
The programme moves thus:-
2.3 Terminal evaluation: The evaluation of the ultimate achievement
of the programme in terms of objectives and sub-objectives
fulfilled and the extent of planned activities carried out.
Evaluation may be approached from the following angle too:
2.4 Evaluation of structure and organization.
2.5.Evaluation of the Process
2.6.Evaluation of the results.
2
3. Tools usee1 for Evaluation:
3.1 Observation schedules
3.2 Records and registers
3.5 Health Examination
3.6 Discussions
3.3.Work diaries
3.4 Personal interviews
3.7 Questionnaires.
4. Provision for Evaluation in your programme :
The following provisions must be made at the stage of
planning itself.
4.1 Person responsible for evaluation should be specified.
4.2 Amount of time, the personnel can give for evaluation work.
4.3 The funds available for evaluation
4.4.Stages of the programme at whichevaluation will be done
4.5 Is there a provision in the planning, for making either
major or minor modifications in the programme, depending on
the "feed-back" from the evaluation.
5. The process of Evaluation :
A systematic procedure should be followed in evaluating any
programme. The theoretical concept of evaluation is relatively.
simple but its practical application can be very difficult,
too often, these difficulties have been used as excuses for not
starting, but the right approach ’ is to begin; for onee begun,
experience, techniques, and data grow rapidly.
It is better
to start even if only with the evaluation of a few aspects of
some activities of a programme, than never to have started at all.
The basic steps in evaluation are as follows:
i) Statement of objectives
'
ii)
Establishment of Easeline Data
iii) Measuring coverage and Uti
lization of services
iv)
Evaluating utilization of
Resources
v)
Evaluating Activities and Atti
tudes of the programme
staff and public
vi) Measuring effectiveness
of programme
vii) Measuring efficiency of
■ programme.
viii) Collection of Tata
ix) Analysis of Data
x) Presentation of Results
and Recommendation.
. . .3
3
5.1 Statement of objectives:
Since evaluation is related to and dependant on objectives,
the statement of objectives must be.sufficiently specific to be
measured.
In fact, the more- specific the objectives, the better
the evaluation.
Two levels of objectives are distinguished.
a) General objective (or aims) which may or may not be
measurable.
•b) Specific objective which are measurable.
General objectives only sc-t out the main intentions but not the
details.
edj; To provide preventive, promotive and curative health
services to the community.
Specific objectives set out measurable details.
The following
are the criteria for making specific objectives.
"primary
/*
vaccination" of all child-?5.11. A clear definition os what is to be attained; for example,/
*
Gn
before they are six months of age.
5.1.2.
A clear statement of the amount or degree of intended
attainment; for example, 100% of the children must
have primary vaccination before, each child is six
months old.
5.1.3
5.1.4
5.1.5
A clear statement of the time in which this degree of
attainment; is expected; for example, "between I July
and I September 1963".
A clear specification of the geographic location of the
programme; for examplej Eata Village.
A clear specification of the particular people, or the
portion of the environment, in which the objective is
to be attained; for example, the parents of all children
under six months of age should have these children vacci
nated .
The objective might read, "To persuade parents of children
under six months of age in Eata village to have all these
children (100%) vaccinated between I July and I September 1963".
Sub-objectives might include the following:
I) "To carry out a house-to-house survey of the village
in order to list the names of all the infants under
six months,"
2) "To identify leaders especially among the women who can
assist with this survey."
The programme's success depends on accomplishment of the
sub-objc-ctivc-s . Sometimes a sub-objective.may not be
directly related to health.
If the objective were "To get
50% of the restaurants in a given locality to reach a speci
fied level of cleanliness in one year", one sub-objectivcmight be "To have restaurant owners buy new uniforms for the
staff".
’
4
542 Establichnc-nt of baseline- Tata:
4 Often termed as "pre-c-valuation", it measures the- current
Health Status and no-cds of the community so that those may be
comparer’ again at the- one’ of the programme in order to measure
the chances in health status and fulfillment of the needs of thccommunity.
The Health Status of the- community is usually studied by
collecting data on:-
i) Age/Sc-x distribution of population
ii) Mobility of population
iii) Socio-economic levels and factors prevalent
iv) Birth Bate
V) Bcath Rate
vi) Morbidity Rates
'
(
vii) K.A.P. Surveys.
The needs of the community may be ’
PERCEIVEP needs(i.e.
the people themselves perceive the need for the programme) and
PROFESSIONAL needs (i.e. what the- medical professionals believe
are the needs of the- community).
Lost often both the needs
arc- beyond the- capacity of the resources available for the
programme, Whereas the change in the Health Status of the
Community at the end of the programme, can be measurc-d quantitatively,
the measurement of the "fulfillment" of the needs is often quali
tative and therefore subjective. Nevertheless, ~n effort must
be made, since without the Easelinc- data, evaluation cannot begin.
5.3 Measuring Coverage- and Utilization of Services:
’
This is often referred as measurement of the "adequacy" of
the programme-.
The- three components measured here are:
i) Geographical coverage
ii' Population coverage
iii) Utilization rate of the programme services.
5.3.1
Geographical coverage:
This refers to the geographical
distribution of the- people- who make- use- of the- programme
services c-.g. Catchment area of a hospital.
If the
geographical area of coverage is large, it could mean
. . .5
5
i) Your programme is popular
ii) Your programme- .is more- of a specialized nature- which is
generally not available.
5.3.2
Population coverage:
This refers to proportion of the
whole- copulation, who are eligible for your programme services.
If your programme is specialized, the coverage is low (co. only
maternity services) but if your programme- is of a general nature
(e.g. Community development projects) the coverage is often 100%.
5.3.3
Utilization Rate: Not everyone eligible for your programme
service, will necessarily use- your services, therefore it is
necessary to measure the proportion of the _eli.q ibl e population
who make use of your services.
5.4 Evaluating utilization of Resources:
Resources are men, material, money and time. These
form the inputs that is consumed or utilized to produce thcoutput of the programme.
Merely because resources are consumed
rapidly, doc-s not signifiy that your programmes is progressing
equally rapidly. What needs to be evaluated or measured, are
the following criteria.
5.4.1
Quantity of Resources available/uscd.
5.4.2
5.4.3
Quality of Resources available/uscd.
Fate of utilization of resources in relation to
programme phascs/duration.
5.4.4
Eistribution of Resources
(The use of resources in measuring the EFFECIENCY of a programme
is denoted later)
Evaluation of resource utilization ar>4
its optimization
can be carried out using techniques in the realm of operations
Research, cost effectiveness studies etc, which arc beyond the
scope of this present paper.
5•5
5.5.1.
Evaluating Activities and Attitudes of
Activities:
staff one Public;
These arc- the number of items, of work (eg.
vaccinating children, making home-visits, registering births etc’)
The evaluation of the activities, to measure their usefulness
/time in terms of the/spent pc-r activity per worker, outcome of
activity, sequencing of activities etc. arc- termed as work study
analysis.
This is a specialized technique.
Another technique
6
that may be- usc-d is the 0 and M technique or the- organization
and methods evaluation which measures such matters as division
of work, delegation of authority, co-ordination, etc. Another
type of activity analysis which is incrc-asing/used
the
P.E.R.T./C.P.or programme evaluation Review Technique-/
Critical path method in Operations Tc-search. Retailed
reviews of the above techniques arc available in specialized texts.
5.5.2 Attitudes: This is most often ignored in any evaluation,
mainly because of its difficult and subjective nature. Thc-
tc-chhiques employed are usually in the form of questionnaires
that arc- framed to provide unambiguous replies and the method
of filling the qucstionaircs is through direct personal
interviews and discussions. However, unless the people are
well informed and sufficiently knowledgable on the matter, most
of the responses are guarded, generalized and do not reflect
true attitudes of the people. Though very difficult and subjective,
the technique of direct observation combined with the above.
technique, aids in arriving at a fair diagnoses of the changes
or otherwise of the attitudes of the- people towards .the
progress of your programme:
5.6
Measuring Effectiveness of the programme:
Very often, due to constraints on resources and often
due to faulty management, many of the objectives planned $•
*
at all or only partially so. Measurement of the EFFECTIVE TESS,
using the following proportion formula, often serves as a
rough guide to y>ur achievement.
prog?amm^ 1^or'Sft?ntn§t
**
accomplished
Effectiveness = No. of objectives actually achieved
No. of objectives originally planned.
To have an idea of the extent of individual objectives achieved,
the- percentage coverage of each objective may also be- calculated.
(3
5.
Measuring efficiency of the Programme:
This constitutes the most important factor for evaluation
of your programme, as far as your funding agency is concerned .
It relates your programme output to the money spent fortho
programme. However,.since money is not the on±y import.nt
consumable resource, the following proportion formula must beindividually calculated for monc-y, materials, men and time .'I
7
Efficiency i No. of objectives actually achieved.
Total cost (direct & indirect)
actually expended.
5.8
Collection of Tata: So far, we discussed WHAT data to collect
for evaluation of a programme. The following points constitute the
main criteria in the actual methodology of collecting the data:i) How should the date be collected
ii) When should the data be collected?
iii) From whom should the data be collected?
iv) By whom should the data be collected?
5.8.1.
How-------: This is usually in the form of a health
survey for which there are 4 approaches :
i) Using exhisting records/registers for gathering data.
ii) Using Questionaires containing unambiguous and well
structured questions.
iii) Personal interviews and discussions
iv) Health examination of individuals.
5.8.8.
When------------ ?: Two points to be remembered are
i) Season of the year: eg. If the base-line data ia collected
during an epidemic of choldra, the morbidity rate will be un
usually high.
ii) Evaluation procedure: Is the data gathering a continuous
procedure throughout the year or is it episodic?
It is preferable to collect basic data continuously (to overcome
problem(i)) but a more detailed data collection must be carried
out at predetermined intervals.
Thus the workload of the data
collecter is not- continuously overburdened.
5.8.3 From whom.--------?: Obviously, larger the number of sources
and people from whom data is collected, better would be the
evaluation. However, practical constraints in resources may
necessiate the employment of SAMPLING TECHNIQUES. Thus
"populations at risk" may be measured first due to the economy
achieved.
If, however, your programme is a unique- and
innovative type, then a group of matched CONTROL population .
must be simultaneously studied in order to claim the unique .
benefits of your programme.
.8
8
5.8.4: . By whom-------- ?: This is entirely dependant on the
resources available for your programme. A lot of project
leaders feel that an independant group of staff, not involved
with the programme, must do the evaluation in order to avoid
any biassed opinions. Though this method may be theoritically
sound, its practical implication can be often futile and
useless. The reason being that many of the project workers
"feel” that an "outsider" knows little about the actual
conditions of work and so his evaluation and recommendations
arc not always right.
In order to avoid such "discontent"
in the organization, a PART of the evaluation team must
consist of the project workers (actual field- workers and
NOT project lc-aders/consultants.')
so that a balanced opinion
and analysis is made.
5.9:
Analysis of Data:
Before analysis, the data must be
"collated" ie : checking of completeness of data and sequencing
and tabulation of the data collected. The work of collation
can go on simultaneously with data collection and not be left
to the end t
The amount and type of analysis required will depend on the
problem and complexity of the programme and can vary from simple
tabulation to complex analysis of multiple variants.
The
services of a statistician is often required.
6.
Presentation of Results and Recommendations:
The presentation of the evaluation report depends upon for
whom it is sent.
If it is to the project agency, then it must
contain all details but if it is for publication then-a lot of
summarization is required. The report should, however, generally
follow the criteria stated below.:
6.1 Be brief as possible
6.2 Results must be tabulated simply
6.3 Emphasize practical implications
rather than theoritical discussions
6.4 Emphasize improvisations especially
for field workers.
6.5 Make clear, practical recommendations.
6.6 Illustrations in the form o-f graphs etc.
should be used.
9
6.7 Figures in tables must not be repeated in the text.
6.8 The FORMAT of the report should be as follows:
- Summary of Report
- Aim of Evaluation
- Methods used for Evaluation
- Results in the form of tables/graphs etc.
- Discussion of results of evaluation
- Recommendations.
7.
Common difficulties in Evaluation:
7.1 Demands and needs often exceed resources and so evaluation
results are often discouraging.
7.2 Inadequate planning, especially for evaluation, before
start of programme.
7.3 Lack of expertise.
Evaluation requires expertise in such
fields as social medicine, statistics, sociology, social
psychology, economics, administration, computer science etc.
Qualified people are thus scarce.
7.4 Techniques and -terminologies in evaluation procedures are
strange to programme/projc-ct staff and so they are often
distrusting and uncooperative. Some terminologies have
forbidding names but are basically simple d-g. cost-benefit
analysis, network analysis, simulation, management audit,
resource allocation model etc.
7.5 Methodological difficulties.
For example, many health
programmes cannot be measured in quantifiable terms and
their benefit to the- people are often subjective, general
rather than specifig and have subtle effects that cannot
be measured.
7.6 Due to the pressure of day-to-day work of the programme,
the "demands" to analyse, record, compile, measure activities
etc. "seem" to be an additional burden.
HOWEVER IT MUST BE REMEMBERED THAT THE OBJECTIVE OF
EVALUATION IS NOT TO CONDEMN OR PRAISE, BUT TO SIMPLY STATE
FACTS SO THAT THE PROGRAMME MAY BE
SUITABLY MODIFIED TO
GIVE ITS BEST TO THE PEOPLE FOR WHOM IT SERVES.
<2. o m H <-+- < j
SOURCE : DEVELOPMENT COMMUNICATION REPORT
H£»KIWG A SPLASH:
- 1991/1
HO’J EVALUATORS CAN BE BETTER COMMUNICATORS
by Michael Hendricks
IF a tree Falls in the forest and one hears it, did it
make a sound ? IF an evaluation report Palls on someone’s
desk and no one reads it, did it snake a splash? Kone whatso
ever, yet wa evaluators still rely too often on long, JargonFilled texts to ”communicate” our analyses. Findings, and
reconmsndations. Ue can, and must do hotter.
Uhy? Becauso the only reason for doing evaluations is to
make that splash, to have that impact, to change situations in
s desired direction. Some call this ’’Speaking Truth to Power”
but what good is speaking Truth if Power isn’t listening ?
Unless wo help our audiences to listen, all our good works will
go for naught,
Ue can do batter in at least two ways. First, we can employ
mars interesting techniques to communicate our findings, thick
reports simply won’t work anymore, if thsy oeer did. Second,
we can remember a few guidings, principles to enhance all our
messages. Let’s first consider some better techniques:
FI HAL REPORTS
L’lf ua must produce Final written reports ( and surprisingly
often these reports are not required), then for everyone's sakeB
let’s make them:
-
shorter: no more than 15 to 20 pages per report, and
always with an executive summary?
-
more truc-to-liFe: perhaps including direct quotes,
personal incidents, short case studies, metaphors and
analogies, and especially photographs whenever possible?
-
mor® powerful:
using active voice and present tense,
Featuring the most important information first, and
using the sorts of graphics discussed beloujpnd
-
visually appealing : using modern graphics dsaign
principles, desktop publishing, and high-quality materials.
OTHER WRITTEN PRODUCTS
In addition to fins! reports, other written products can
be even more useful. Draft reports, for example, can be especially
effective, precisely because they are still subject to change. I
sometimes deliberately include material in a draft report that I
have no intention of including in a final report, usually to raise
sensitive or oven cantrovarsfai issues that are not receiving
enough attention.
- 2
Other written products include interim progress reports,
talking papers, question-and-answer statements, memoranda,
written responses to other speeches, press releases, "op ed"
items in newspapers, speeches, written testimony, newsletters,
and even articles in association or professional journals.
In
short, we evaluators have plenty of opportunities to present our
findings, but we must be more creative at using these opport
unities .
GRAPHICS
Using graphics is not a presentation technique by itself,
but they are so useful they deserve special attention. Pie
charts, historical timelines, maps, small multiples, and picto
graphs are an effective communication technique for several
reasons. They allow a large quantity of data to be displayed
and absorbed quickly, they reveal patterns not otherwise apparent
they allow easier comparisions among data sets, and they can have
a strong impact. Furthermore, we can use these graphics not only
for presentations to audiences at the end but also to help guide
our own analyses as we progress.
However, a book on "How to lie with Graphics" could easily
include sections on clutter, incorrect proportions (especially
by the gratuitous use of three-dimensional effects), an over
emphasis on artistic effects, broken or shifting scales, and
failuer to place findings in perspective or to adjust accordingly
Anjj of these errors could easily confuse or even mislead our
audiences, so graphics must be used carefully.
Two overall suggestions might be useful. First, remember
that selecting the proper graphics is not the first step in
moving from data to graphics. The first step is for you, the
evaluator, to determine your message. Uhat specific point do
you want to taake? A second suggestion is to maximize the amount
of "graphic ink" which presents actual data and to minimize the
amount which presents grids, titles and legends.
Unfortunately,
too may pgraphics are now cluttered with extraneous ink.
PERSONAL BRIEFINGS
Briefings are almost always more effective than written
reports for presenting evaluation findings, and they should
almost always be used. True, they can be risky, since a poor
presenter, poor selection of material, scheduling delays, audience
moods and external events can effect the presentation.
( I once
saw a single briefing interrupted three times by phone calls
from the White House). But the strong advantages to briefings
than offset these risks.
For example, briefings involve all relevant actors in a
common activity, allow these actors a much-needed forum for
discussion, and create a certain momemtum for action.
Most importantly however, briefings fit the way managers
normally operate. Managers rarely sit and read documents for
long strectches of time, so why should we ask them to change their
management s^yle for us ? Instead, we evaluators need to tailor
- 3 -
our communications to fit our addience’s
briefings vit very nicoly.
style, and personal
To plan an effactive briefings, limit the audience to a
select group, select only the most important information, pre
pare 6-10 large briefing charts (or overhead transparencies or
slides if you prefer), selsct a team of one presenter, one assis
tant, and oio high-level Hasten with the audience, study the
audience’s interests and likely questions, and practice, practice
practice-exactly as you plan tn present the briefing and using
a stop uatch.
To conduct an effective briefing, distribute materials in
advance, don’t overlook the lighting and seating arrangements,
immediately grab the audience’s attention, avoid using a micro
phone or notes, provide individual copies of ail briefing, this
means that the formal presentation should finish within 20 minutes
the remaining 40 minutes are for general discussion, the first
and most important purpose of a briefing.
OTHER TECHNIQUES
All evaluators use written reports and personal briefings
to present our findings. But how many of us use less traditional
techniques that may be even better at feeding our findings into
ongoing decision-making?
I once worked for the Inspector Gerwral{IG) of the US Depart
ment of Health and Human Ss;vices, helping to supervise national
level evaluations. The IG, as part of his normal routine, regu
larly held one-on one private lunches with the Secretary and other
top agency officials. Naturally, we wanted him to discuss our
evaluations at these lunches, but it was unrealistic to expect him
to carry along a progress report.
So we began providing the IG with one pocket-sized index card
for each of the evaluations which might bo relevant for his
luncheon partner. Because these cards were convinient, the IG
looked at them on the uay to lunch, and he usually found ways to
interject our information into the discussion. As a result, top
agency officials routinely discussed the IG’s evaluations, not
just an special occasions.
Carefully selected comments at relevant meetings or ’'chance”
hallway encounters can also be useful, and more modern methods
include videotaped and computerized evaluation presentations.
The US Food and Drug Administration, for example, uses computer
graphics to present captivating on-acreen slide shows. In addition
to allowing professional uipos, fsdes, and other transitions, this
program allows an evaluator to build text charts line hy lino,
make the bars of a bar chert grow, and add th® slices of the pie
one by ono. This technique also allows an audience to view the
message over and over, and at his or her leisure.
With these different presentation techniques in mind, let’s
now consider six guiding principles for using these technique most
effectively!
k -
Remember that the burden for ©FfectivRly communicating
out Findings is on us, the evaluators,not on our audiences.
It is out responsibility to convey our messages, and it is
our Failure when this dogs not occur.
“
As thoreau would say” Simplify, Simplyfy." Our typical
audience is usually very busy and balng pulled in many=
different dicectiona, so wg need to para ruthlssaly to
reach our few points. IF thesa create interest, we can
always Follow-up with moro dataila.
—
Know the audience. Go ths homework nocasoary to learn
their backgrounds, interests, concerns, plans, petpeeves,
etc. even somathing as simple as selecting examples From
the home region of a key atiduencs member can help maintain
interest in s report or briefing.
-
Be action-oriented. Bur audiences are rarely interested in
background knowledge; they almost always want information
that will help them right now. Often this requires ub to
offer the time effective rueuwmendations For actions by
taking th-a time to establish a receptive
*
environment and
than carefully develop, present, and Follow-up on our advice
Use multiple communication techniques. Bather then limit
ourselves to one technique or another we can produce several
written products, gibe a personal briefing, develop a Screen
Show presentation, produce a videotape,otc- all filled with
powerful graphics and helpful recommendations.
-
2a aggressive. Instead of waiting for the audiences to
request information, we must actively look for chances to
present cur Information. This implies that we will communi
cate regularly and frequently, appear in person if at all
possible, and target multiple reports »nd briefings to
specific audiences and or issues.
In conclusion, w evaluators can be nnormoualy useful in
many diffarnnt way®, but only if our findings have an lapact. Hou
w© communicate our findings is often the dif Forans
'
*
between creat
ing - tiny oaoripple or making a us-up.er -sel-ssfi.
SCORE SffFT FOR W STUDY 'IF VALUES
DIRECT!QNS :
1 • First make sure that every question has been answered.
Note: If you have found it impossible to answer all the questions,
you may give equal scores to the alternative answers under
each question that has been omitted; thus,
Part I.
for each alternative.
(b) must always equal 3.
The sum of the scores for (a) and
Part II.'2-4 for each alternative. The sum of the scores for the four
alternatives'under each question must al ways equal 10.
2. Add the vertical columns of scores on each page and enter the total in
the boxes at the bottom of the page.
3.
Transcribe the totals from each of the foregoing pages to the columns
below. For each page enter the total for each column (R, S,T, etc)
in the space that is labeled with the same letter. Note that the order
in which the letters are inserted in the columns below differs for the
various pages.
-------
Page
j
Totals
Theore
tical
Economic
I
Aesthetic
The sum of
i
the scores for
each row must
eqial the
figure given
be low.
’olitical
Reli
gious
(X)
(Y)
(T)
(z)
(R)
(Y)
24
24
JSocial
------- ------
PART 1
(R)
(T)
(x)
(z)
(s)
(s)
■ (T)
(S)
(X)
(Y)
(R)
(z)
(I)
21
Page 7
(Y)
(T)
(s)
(z)
(R)
(X)
60
Page 8
(T)
(z)
(r)
(Y)
(x)
(S)
50
9
(R)
(s)
(t)
(X)
(Y)
(Z)
4»
(s)
Page 3
(R)
(z)
Page 4
(X)
Page 5
Page 2
(Y)
21
Part H
Page
24»
Total
Correction
Figures
FINAL TO TAI
+2
-1
-4
-2
+2
-5
240
......
-2 -
4.
Add the totals for the six columns.
figures as indicated.
5.
Check your mark by making sure; that the total score for all six columns
equals 240. (Use the margins for your additions, i'f you wish).
Add or substract the correction
A
1- Extent of inequality in the world today;
a. In 1850, 3/4 of the world's population possessed 5/8 of the
world's wealth.
In 1975, 2/3 of the world's population possessed l/S of the
world's wealth
b.
Whence came this uneven distribution of the world's resources?
"The tilting of tne balance in favour of the West has come about
in the last 130 years. ......through the gun, through colonial plunder,
slave trade, slave labour, child labour, racial discrimination, the
creation of a dispossessed proletariate, and the destruction of the soul
and life-style of many peoples."
(S. Rayan)
c. The growing gap between the rich nations and the poor had
already been pointed out by Barbara Ward in the 1950's but the gap
continues to widen;
"Today'85% and tomorrow 90% rot in misery to make pcssible the
economic comfort of 15% today and 10% tomorrow"
,
( Heder Camara)
d. The result of this inequality is the ABSOLUTE POVERTY of
millions in the "fourth" world:
- 1/3 to 1/2 of tho t wo billion human beings in Asia, Africa
and Latin America suffer from hunger and malnutrition.
- 1/5 to 1/4 of their children die before their fifth birth
day, and millions of those who do survive lead impeded lives, due to
brain damage, stunted physical growth and sapped vitality due to
undernourishment.
- The life expectancy of the average person is twenty years
less than his counterpart in tho affluent world; that is, he is
denied 30% of the life-span of one born in the developed nations;
he is condemned at birth to an early death.
- 800 million of those people arc illiterate and, despite
continued expansion of educational opportunities, even more of their
children are likoly to be so.
e.
Julius Nyerere, President of Tanzania, has warned the rich
nations: "Poverty is not tho real problem of tho modern world, for
we have the knowledge and tho resources wbioh will enable us to over
come poverty.
The real problem of tho modern world, the thing which
creates misery, wars and hatred among men, is the division of mankind
into rich and poor".
f.
It is not so much the question of some having more to eat or
better clothes to wear, while others cannot provide even the basic
requirements; it is rather tho power that this wealth gives to some
to dominate, to oppress and to exploit the others.
in so .doing,
the rich and powerful justify themselves: "We deserve this wealth
and power: we have put our God-given talents to use and have worked
hard.
If the rest of the world is lazy, shiftless and ignorant,
!'•_ can't help that."
-22.
Extent of inequality in India today:
a. While we often and with some justification, blame all our
problems on the greediness of the affluent, developed nations, the
same ever-widening gap between the "haves" and the "have-nots"
appears here even
bo Within'our population of upwards 600 millions of people,
roughly 250 million live below the "poverty line", that dividing
line that demarcates bare minimum of survival for an individual.
This is the bottom 40 per cent, another 250 million live just
above the"poverty line" of human survival, the remaining 15-20
per cent, in an ascending pyramid represent the wealthy, dominant
classes with power, position and quality education: the raw mate
rial for further exploitation of the others.
c. In rural India, the top ten per cent own 50^ of the land,
while the bottom 50 per cent own 4^,; top ten per cent get 1/3 of
annual income of the nation,while the bottom 50^ get less than
this amount for all of their numbers. 0.1^ of the population owns
more than half the wealth of the area.
d. The poor are organised, without political power, and are
taken advantage of. A slum dweller admits: "Even to get a
sweeper’s job, we have to pay a bribe of Rs.200/-"
e. The very poor (bottom 40 percent) have less than Rk-,4j/- per
month to spend.
Most cannot read or write.
A
1- Extent of inequality in the world todays
a. in 1850, 3/4 of the world's population possessed 5/S of the
world's wealth.
In 1975, 2/3 of the world's population possessed l/S of the
world's wealth
b.
idhence came this uneven distribution of the world's resources?
"The tilting of tne balance in favour of the West has come about
in the last 130 years. ......through the gun, through colonial plunder,
slave trade, slave labour, child labour, racial discrimination, the
creation of a dispossessed proletariate, and the destruction of the soul
and life-style of many peoples."
(S- Rayan)
c. The growing gap between the rich nations and the poor had
already been pointed out by Rarbara ijard in the 1950's but the gap
continues to widen:
"Today 85% and tomorrow 90% rot in misery to make possible the
economic comfott of 15% today and 10% tomorrow"
(Heder Camara)
d. The result of this inequality is the ABSOLUTE POVERTY of
millions in the "fourth" world:
- 1/3 to 1/2 of the two billion human beings in Asia, Africa
and Latin America suffer from hunger and malnutrition.
- 1/5 to 1/4 of their children die before their fifth birth
day, and millions of those who do survive lead impeded lives, due to
brain damage, stunted physical growth and sapped vitality due to
undernourishment.
- The life expectancy of the average person is twenty years
less than his counterpart in tho affluent world; that is, he is
denied 30% of tho life-span of one born in the developed nations:
he is condemned at birth to an early death.
- 800 million of these people arc illiterate and, despite
continued expansion of educational opportunities, even more of their
children arc likely to be so.
e.
Julius Nyerere, President of Tanzania, has warned the rich
nations: "Poverty is not tho roal problem of the modern world, for
we have the knowledge and the resources which will enable us to over
come poverty. The real problem of the modern world, the thing which
creates misery, wars and hatred among men, is the division of mankind
into rich and poor".
f.
It is not so much the question of some having more to eat or
bottc-r clothes to wear, while others cannot provide oven the basic
requirements; it is rather the power that this wealth gives to some
to dominate, to oppress and to exploit the others.
In so .doing,
the rich and powerful justify themselves: "We deserve this wealth
and power: we have put our God-given talents to use and have worked
hard.
If the rest of the world is lazy, shiftless and ignorant,
w. can't helo that."
-22.
Extent of inequality in India today:
a. While we often and with some justification, blame all our
problems on the greediness of the affluent, developed nations, the
same ever-widening gap between the "haves" and the "have-nots"
appears here even
b. Within'our population of upwards 600 millions of people,
roughly 250 million live below the "poverty line", that dividing
line that demarcates bare minimum of survival for an individual.
This is the bottom 40 per cent, another 250 million live just
above the"poverty line" of human survival, the remaining 15-20
per cent, in an ascending pyramid represent the wealthy, dominant
classes with power, position and quality education: the raw mate
rial for further exploitation of the others.
c. In rural India, the top ten per cent own 50% of the land,
while the bottom 50 per cent own 4%; top ten per cent get 1/3 of
annual income of the nation,while the bottom 50% get less than
this amount for all of their numbers. 0.1% of the population owns
more than half the wealth of the area.
d. The poor are organised, without political power, and are
taken advantage of. A slum dweller admits: "Even to get a
sweeper's job, we have to pay a bribe of Rs.200/-"
c. The very poor (bottom 40 percent) have less than ft.--.40/- per
month to spend.
Most’cannot read or write.
1.
ro our findings differ according to the section of town we
come from? Why might this be so?
2.
How does this "minimum monthly income" compare with the incomes
of the families we met during our house survey last time?
3.
Dr> the families we met then exceed the number of members of
the "model" family of four we have used on this survey? What
would this mean with regard to their minimum monthly needs?
4.
Jhat may be the consequences when minimum monthly requirements
and income do not meet? Cutting corners? family insecurity?
undernourished and underclothed children? etc.
5.
What are some of the possible consequences of family insecurity?
quarrels? drunkenness? indebtedness bnat becomes chronic? etc.
6.
Who is to blame for so many people in our community living
under or just on "the poverty line"?
7.
Where does your family shop? What type of rice does your
family buy? What typo of cloth? How much rent?
How much
entertainment goes into your miscellaneous expenses?
8.
Was this a new experience for you, or have you iften done
the shopping in the past?
9.
How did you go about choosing the market and the different
shops?
10.
What did you learn from this experience?
D
1.
ro our findings differ according to the section of town we
come from? Why might this be so?
2.
How does this "minimum monthly income" compare with the incomes
of the families we met during our house survey last time?
3.
Do the families we met then exceed the number of members of
the "model" family of four we have used on this survey? What
would this mean with regard to their minimum monthly needs?
4.
What may be the consequences when minimum monthly requirements
and income do not meet? Cutting corners? family insecurity?
undernourished and underclothed children? etc.
5.
What are some of the possible consequences of family insecurity?
quarrels? drunkenness? indebtedness boat becomes chronic? etc.
6.
Who is to blame for so many people in our community living
under or just on "the poverty line"?
7.
Where does your family shop? What type of rice does your
family buy? What type of cloth? How much rent?
How much
entertainment goes into yuur miscellaneous expenses?
8.
Was this a new experience for you, or have you often done
the shopping in the past?
9.
’ l-pw did you go about choosing the market and the different
shops?
10.
What did you learn from this experience?
FOR RESTRICTED USE ONLY
ALLPORT
;
VERNON
: ‘LINDZEY
STUDY OF VALUES
Part I
DIRECTIONS k A number of controversial'statements or questions with two
alternative answers are given below. Indicate your personal preferences
by writing appropriate figures in the boxes to the right- of each question.
Some of the alternatives may appear equally attractive or unattractive to
you. Nevertheless, please attempt to choose the alternative that is
relatively more acceptable to you
*
For each, question you have three points
that you may distribute in any of the following combinations.
1,
If you agree with alternative (a)and disagree with (b), write 3 in
the first box and 6 is the second
box, thus
2.
If you agree with (b); disagree
with fb.) , write
3.
If you have a slight preference j,
for /a) over (b), write
4.
If you have a slight preference'for (b) over (a), write
Do not write any combination of numbers except one of these four.
Th: rc is no time limit, but.do not linger over any one question or
statement, and do not leavc’out arfy of the ouestions;unless you find
it really impossible to make a decision. .
BEHAVIOURAL SCIENCE CENTRffi ST.’XAVIER'S COLLEGE, AHMEDABAD 380 009
2
1. The main object of scientific research
should be the discovery of truth rather
than its practical apolications.
(a) Yes; (b) No.
2. Taking the Bible/Ramayana/Koran as a
whole, one should regard it from the
point of view, of its ■beautiful
mythology and literary.style rather
than as a spiritual revelation.(a) Yes; (b) No.
3. Which of the 'following men do you think
should be judged as contributing more
to the progress of mankind ? .
(a) Aristotle; (b) Abraham Lincoln.
4.
Assuming that you have sufficient
ability would you prefer to be;
(a) a banker; (b) a politician?
5.
Do you think it is justifiable for
great artists to be selfish and
negligent of the feelings of others^
(a) Yes; (b) No.1 , ,
6.
Which of the following branchesof
study do you expect ultimately wijl
prove more important for mankind ?!
(a) Mathematics; (b) Theology
7.
Which would you consider the moie
important function of modern leaders?
(a) to bring about the accomplishment
of practical goals; (b) to enceura^e
followers to take a greater interest
in the rights of others.
8.
When witnessing a gorgeous ceremony
(ecclesiastical or academic, inductbyi
into office, etc.), arc you more im^psed; (a) by the colour and pageantry of
the occasion itself; (b) by the inference
and strength of the group?
k>
total
a .
9.
Which, of these character traits'do you
consider the more desirable? (a) high
ideals and reverence: (b$ unselfishness
and sympathy.
10.
If you were a university professor arid
had the necessary ability, would you
prefer to teach: (a) Pbetry; (b)
chemistry and physics?
11. If you should sec the following news
items with headlines of equal size in
your morning paper, which would you
read more attentively? (a) RELIGIOUS
DIFFERENCES WITHIN ANY COMMUNITY:
(b) GREAT IMPROVEMENTS IN MARKET
COWITIONS.
12.
Under circumstances similar to those
of Question 11 ?. (a) SUPREME COURT
RENDERS DECISION: (b) NEW SCIENTIFIC
THEORY ANNOUNCED.
13.
When you visit a cathedral/temple/
mosque are you more impressed.by a
pervading sense of reverence and
worship than by the architectural
features, (a) Yes; (b) No.
14.
Assuming that you have sufficient
leisure time, would you prefer to
use iti (a) developing your mastery
of a favourite skill; (b) doing
volunteer social or public service
work ?
At an oxponiticti, do you chiefly like
to go to the buildings where you can
see: (a) new manufactured products;(b) scientific.(e.g. chemical)
apparatus?
- . ■'
16. If you had the opportunity, and if
nothing of the kind existed in the
community where you live, would you
prefer to found: (a) a debating society
■ or fprium; (b) a classical music Club
(Sarigeet Sammelan)
15.
- 4 -
17. The aim of the r.qligious orgariiiMtJdns
at-the present’ timeshopld be: (a) to,
'*
,......br^ng.^ur;,alia'uist-iQ-7’-a'ncl charitable’’ :
tendencies; (c) to encourage spiritual
worship and a sense^of communionwith
the. "highest
18.
i
'
If you had some, time to spend fn at
waiting room, and there were only two v/
magazines.to choose from, would you
prefer: (a) SCIENTIFIC AGE; (b). W ..
AND ADECORATIONS?
.
:
,
’■ ■
\
•. •
Would you prefer to hear a series of.
lectures on: (a) the comparative.merits
of the forms of:government in Britain.
and in the
*
United States; (b)' tAe'
A. parative development |f the great
-t~" religious '.faiths?
:
7'f ' . ?
19.
20; Whioji of the following would yotiicd’ri
aider the more important function b<5f
education? ; (a) it^ preparatidn>,'.fo^rt.W/i
practical .achievement ;and f irKifdii’ai
'! reward’s (b) its preparation fpr
..
‘ participation in'community activities
ajid Riding!less .fortunate persons,
21. Arc you more interested in reading
v-accounts -of *
thi "lives -and' works-of
. men such as:(a). Alexander, Julius
’
Caesar, and Ashoka; (c) Aristotle;
Socrates, and ^adhakrighnan
22. Are our modern industrial and scien
tific devrlppment's signs of a greatc:
degree of civilization•than those
■ attained by- any previous society, the
Greeks, for example? (a) Yes; (b) No, ‘
23.■ If you were'engaged in an industrial
organization (and assuming salaries to
be equal), would you prefer to work;
(a) as a counsellor for; employees;
(b) in an administrative position?
- 5 I
24.
Given your choice between two books
to read, arc you more likely to select:
(a) THE STORY OF RELIGION IN INDIA:
(b) TH1. STORY OF INDUSTRY IN INDIA:
25.
Would modern society benefit more from:
(a) more concern for the rights and
welfare of citizens; (b) greater knowa
ledge of the f mdamcntal laws of human |
behaviour.
-—
26.
Suppose you were in a position to help
raise standards of living, or to mould
public opinion. Would you prefer to
influence: (a) standards of living;
(b) public opinion?
27.
Would you prefer to hear a scries of
popular lectures on: (a) the progress
of social service work in your part of i—
the country; (b) contemporary painters? I
'
’
'■
28.
,111 the evidence that has been im- ■
partially accumulated goes to show
that the universe has evolved to its
present state in accordance with
natural principles, so that there is
no necessity to assume a first course,
cosmic purpose, or God behind it.
(a) I agree with this statement;
(b) I disagree
29.
In a paper; such as the New York
Sunday times, arc you more likely to
read: (a) the re"! estate sections
and the account of the stock market;
(b}-the section on picture galleries
and exhibitions?
30.
Would you consider it more important
for your child to secure training in
(a) religion; (b) athletics?
TOTAL
|
- 6 Part .II
DIRECTIONS: Each of the following situations or questions is followed
by four possible attitudes or answers. Arrange these answers in the
order of your personal preference by writing, in the appropriate box
at the right, a score of 4, 3, 2, or 1. .-.To the statement you prefer
most give 4, to the statement that is second most attractive 3, and
so on.
Example: If this were a question and the following statements were
alternative choices you would place:
4
in the box if this statement
appeals to you.
3
in the box if this statement
appeals to you second best.
2
in the box if this statement
appeals to you third best
1
in the box if this statement
represents your interest or
preference least of all.
You nay think of answers which would be preferable from your poin+ of
view to any of those listed. It is necessary, however, that you make
your selection from the alternatives presented, and arrange all four
in order of their desirability, guessing w^en your preferences are not
distinct, if you find it really impossible to state your preference,
you ray omit the question. Be sure not to assign more than one 4,
one 3, etc., for each question.
I
1. Do you think that a good government
should aim chiefly st—(kerie-iber- to give
your first choice 4, £,tc.)
a. more aid for the poor, sick and old
b. the development of manufacturing and
trade
i
c. introducing *
st
high
ethical principles ;
into its policies and diplomacy
d. establishing a position of prestige
_dj
and respect among nations.
In your opinion, can a man who works
in business all the week best spend
Sunday in
a. trying to educate himself by
reading serious books
b. Trying to win at golf, or racing
c. going to anorchestral concert
d. hearing a.really good sermon
b
J~~'
3. If you could influence the educational
policies of the public schools of some
city, would you undertake—
a. to promote the study and participa
tion in music and fine arts.
b. to stimulate the study of social
problems
c. to provide additional laboratory
facilities
d. to increase the practical value of
courses
4. Do you prefer a friend ( of your own
sex) who—
a. is efficient, industrious and of a
practical turn of mind.
b. is seriously interested in thinking
out his attitude toward life as a
whole
possess Qualities of leadership and'
c.
organizing ability.
shows artistic and emotional sensiti
d.
vity
5.
If you lived in a small town and had
more than enough income for your needs,
would you prefer to—
a. apply it productively to assist
commercial and industrial development
b. help to advance the activities of
local religious groups
c. give it for the development of scienti
fic research in your locality
d. give it to the. .Family 'frlfare Society
TOTAL
.- o -
6.
When you go tothe theater, do you,as
a rule, enjoy most—
a. plays that treat the lives of great
mon
b. ballet or similar imaginative neT-for~ances
c. plays that have a theme of human
suffering and love <
d. problem plays that argue consis
ts ntly for some noir.t of view
7.
Assuming that .you are a ">an with the
necessary ability, and that the
salary for each of the following
occupations is the same, would you
prefer to be a —
a. mathematician
b. sales manager
c. religious preacher
d. politician
8.
If you had sufficient leisure and
money, would you prefer to—
a. make a collection of fine sculotures or paintings
b. establish a certr for the care
and training of the feeble-minded
aim
c.
at a membership of Parliament
or a sent tn the Cabinet
d. establish a business or financial
enternrise of your own
9.
At an evening discussion with intimate
friends of your own sex, are you more
interested when you talk about—
a. themeaning of life
b. developments in science
c. literature
d. socialism and social amelioration
10.
Which of the following would you
prefer to do during part of your
next summer vacation (if your ability
and other conditions would pernit)a. write and publish an original
biological essay or article
b. stay in some secluded part of the
country where you can appreciate
fine scenery
c. enter a .local tennis or other
athletic tournament
d- net experience in some new line of
business
TOTAL
□
9 -
11.
Do great exploits and adventures of
discovery such as Columbus's,Magellan's, lord's and. Amundsen's
seer, to you significant because—
a. they represent conquests by man
over the difficult forces of
nature
b. they add to our knowledge of
geography, meteorology, oceano
graphy, etc.
c. they wield human interests and
international feelings throughout
the world
d. they contribute each in a small way
to °n ultimate understanding of the
universe
12
should .one guide one's conduct according
to, or develop one's chief loyalties
toward—
a. one's religious faith
b. ideals of beauty
c. one's occupational organization and
associates
d. ideals of charity
13
To what extent do the following famous’
persons interest you —
a. Florence Nightingale
b. NanoIcon
c. Henry Ford
d. Galileo
14
In choosing a wife would you prefer
a woman who— (Man . answer the
alternative form, below)
a. can achieve social prestige,
commanding admiration from
others
likes
b.
to help people
c. is fundamentally suiritual in
her attitudes toward life
d. is gifted along artistic lines
(For women) Would you prefer a husband
who
a. is successful in his profession,
commanding admiration from others
b. likes tn help people
c. is fundamentally spiritual in his
attitudes toward life
d, is gifted along artistic lines
TOTAL
- 10 -
15. Viewing Ajanta Paintings, would you
tend to think of those —
a. as expressing the highest sniritual
aspirations and emotions
b. as the most priceless and irreplace
able ever painted
c. in relation to their place in histor
d.
the Quintessence of harmony and
design
TOT^L
FOR RESTRICTED USE ONLY
ALLPORT
:
VERNON
: 'LINDZEY
8TOX OF VALUES
Part I
DIRECTIONS : A number of controversial statements or questions with two
alternative answers are given below. Indicate, your personal preferences •
by writing appropriate figures in the boxes to the right of each question.
Some of the alternatives may appear equally attractive■or unattractive to
you. Nevertheless, please attempt to choose the alternative that is
relatively more acceptable to you. For each question you have three points
that you may distribute in any of the following combinations.
1.
If you agree with alternative (a)
and disagree with (b), write 3 -in
the first box and 0 is the second
box, thus
|
2.
If you agree with (b); disagree
with fa) , write
3.
If you have a slight preference
for (a) over (b), write
4.
If you have, a slight preference
'for (b) over (a), write
Do not write any combination of numbers except one of these four.
Th: re is no time limit, but do not linger over any one. question or
statement, and do not leave out any of the questions unless you find
it really impossible to make a decision.
BEHAVIOURAL SCIENCE CENTRpi ST."XAVIER'S COLLEGE, AHMEDABAD 580 009
- 2 -
1. The main object of scientific research
' should be the discovery of truth rathe?
than its practical applications.
(a) Yes; (b) No.
2. Taking the Bible/Ramayana/Koran as a
whole, one should regard it from the
point of view of its beautiful
mythology and literary style rather
than as a spiritual revelation.
(a) Yes; (b) No.
3. Which of the following men do you think
should be judged as contributing more
to the progress of mankind ?
(a) Aristotle; (b) Abraham Lincoln.
4. Assuming that you have sufficient
ability would you 'prefer to bo:
(a) a banker; (b) a politician?
5.
Do you think it is justifiable for
great artists to be selfish and
negligent of the feelings of others?
(a) Yes; (b)
' ’ No.
6.
Which of the following branchesof
study do you expect ultimately will
prove more important for mankind ?i
(a) hfethematics; (b) Theology
?. Which would you consider the more
important function of modern leaders?
(a) to bring about the accomplishment
of practical goals; (b) to encourage
followers.to take a greater interest
in the rights of others.
8.
When witnessing a gorgeous ceremony
(ecclesiastical or academic, induction
into office, etc.), are you more impre
sed; (a) by the colour and pageantry of
the occasion itself; (b) by the influence
and strength of the group?
TOTAL
- 3 -
9.
Which of these character traits do you
consider the more desirable? (a) high
ideals and reverence: (b) unselfishness
and sympathy.
10.
If you were a university professor and
had the necessary ability, would you
.prefer to teach: (a) Poetry) (b)
chemistry and physics?
11.
If you should S' c the following news
items with headlines of equal size in
your morning paper, which would you
read more attentively? (a) RELIGIOUS
DIFFERENCES WITHIN ANY COMMUNITY:
(b) GREAT IMPROVEMENTS IN MARKET
CONDITIONS.
12.
Under circumstances similar to those
of Question 11 ? (a) SUPREME COURT
RENDiRS DSC IS ION: (b) NEW SCIENTIFIC
THEORY ANNOUNCED.
13.
When you visit a cathedral/temple/
mosque- are you more impressed by a
pervading sense of reverence and
worship than by the architectural
features, (a) Yes; (b) No.
14.
Assuming that you have sufficient , ..
leisure time, would you prefer to
use it: (a) developing your mastery
of a favourite skill; -(b) doing
volunteer social or public service
work ?
15. At an exposition;•do you chiefly like
. to go to the buildings where you can
see: (a) new manufactured products;.
(b) scientific (e.g. chemical)
apparatus?
16.
If ycu had the opportunity, and if
’ nothing of the kind existed in the
. community where you live, would you
prefer to found: (a) a debating society
or forum; (b) a classical music club
(Sangeet Sammelan)
- 4 t
17.
Tht aim of the religious organizations.
at the present tine should be:, .(a.) to
bring our altruistic and charitable
tendencies; (c) to encourage spiritual
worship and a sense of communionwith
the highest
■
•:
18.
If you had some time:to spend in a
waiting room and thebe were only two .
magazines.to choose from, would you.... .
prefer: (a) SCIENTIFIC AGE; (b) ARTS
AND DECORATIONS?
19.
Woul^. you prefc-r■ to hear a series of
lectures on: (a) the comparative merits
of the forms of government in Britain
and in the United States; (b) the com
parative development of the. great
religious faiths?
20.
Which of the following would you con
sider the more important function of
education? (a) its preparation for
practical achievement and financial
reward; (b) its preparation for
participation in community activities
and aiding less fortunate persons.
21.
Arc you more interested in reading
accounts of the lives and works of
•men such as: (a) Alexander, Julius
Caesar, and Ashoka; (c) Aristotle,
Socrates, and Radhakrishnan
22.
Are our modern industrial and scien
tific developments signs of a greater
degree of civilization than those
attained by- any previous society, the
Greeks, for example? (a) Yes; (b) No.-
23.
If you were engaged in an industrial
organization (and assuming salaries to
be equal), would you prefer to work;
(a) as a counsellor for employees;.
(b) in an administrative position?
total
■
j
- 5 24.
Given your choice bi tween two books
to read, arc you more likely to select:
(a) THE STOTT OF RELIGION IN INDIA:
(b) THl. STORY OF INDUSTRY IN INDI/i;
25.
Would modern society benefit more fromi
(a) more concern for the rights and
welfare of citizens; (b) greater knowa
ledge of the f -ndamcntal laws of human | I
behaviour.
—1
26.
Suppose you were in a position to help
raise standards of living, or to mould
public opinion. Would you prefer to
influence: (a) standards of living;
(b) public opinion?
27.
Would you prefer to hear a scries of
popular lectures on: (a) the progress
of social service work in your part of t
the country; (b) contemporary painters? [
28.
.,111 the evidence that has been im
partially accumulated goes to show
_that the universe has evolved to its
P"esent state in accordance with
natural principles, so that there is
no necessity to assume a first course,
cosmic purpose, or God behind it.
(a) I agree with this statement;
(b) I disagree
29.
In a inner, such as the Mow York
Sunday times, are you more likely to
read: (a) the renl estate sections
and the account,of the stock market;
(b) the section on picture galleries
and exhibitions?
30.
Would you consider it more important
for your child to secure training in
(a) religion; (b) athletics?
TOTAL
0
- 6 -
Part II
DIPJLCTIOl’S: Each of the following situations or Questions is followed
by four possible attitudes or answers. Arrange these answers in the
order of your personal preference, by writing, in the appropriate box
at the right, a score of 4, 3, 2, or 1. -,To the statement you prefer
most give 4, to the statement that is second most attractive 3, and
so on.
Example: If this were a question and the following statements were
alternative choices you would place:
4
in the box if this statement
appeals to you.
3
in the box if this statement
appeals to you second best.
2
in the box if this statement
. appeals to you third best
1
in the box if this statement
represents your interest or
preference least of all.
You nay think of answers which would be preferable from your poin+ of
view to any of those listed. It is necessary, however, that you make
your selection from the alternatives presented, and arrange all four
in order of their desirability, guessing when your preferences are not
distinct, if you find it really impossible to state your preference,
you may omit the question. Be sure not to assign more.than one 4,
one. 3, etc., for each Question.
1.
Do you think that a good government
should aim chiefly at—(lericnbcr- to give.
your first choice 4, £,tc.)
a. more aid for the poor, sick and old
b. the development of manufacturing and
trade
z
i
c. introducing high'st ethical principles ;
into its policies and diplomacy
d. establishing a position of prestige
and respect among nations.
j■
2.
In your opinion, can a man who works
in business all the week best spend
Sunday in
a. trying to educate himself by
reading serious books
b. Trying to win at golf, or racing
c. going to anorchestral concert
d. hearing a really good sermon
3.
b
J"~‘
If you could influence the educational
policies of the public schools of some
city, would you undertake—
a. to promote the study and participa
tion in music and fine arts.
b. to stimulate the study of social
problems
c. to provide additional laboratory
fac ilities
d. to increase the practical value of
courses
4. Do you prefer a friend, (.of your own
sex) who—
a. is efficient, industrious and of a
practical turn of mind.
b. is seriously interested in thinking
out his attitude toward life as a
whole
possess Qualities of leadership and
c.
organizing ability.
shows artistic and emotional sensiti
d.
vity
If you lived in a small town and had.
more than enough income for your needs,
would you prefer to—
a. apply it productively to assist
commercial and industrial development
b. help to advance, the activities of
local religious groups
c. give it for the development of scienti
fic research in your locality
d. give it to the Family Welfare Society
TOTAL
- 8 -
6.
When you go tothe theater, do you, as
a rule, enjoy most—
a. plays that treat the lives of great
men
b. ballet or similar imaginative per
formances
c. plays that have a theme of human
suffering and love
d. problem plays that argue consis
tently for some noint of view
7.
assuming that you are a man with the
necessary ability, and that- the
salary for each, of the following
occupations is the .same, would you
prefer to be a —
a. mathematician
b. sales manager
c. religious preacher
d. politician
8.
If you had sufficient leisure and
money, would you prefer to—
a. make a collection of fine sculp
tures or paintings
b. establish a cr"t r for the care
and training of the feeble-minded
c. air. at a membership of Parliament
or a seat ■’.n the Cabinet
d. establish a business or financial
enternrise of your own
9.
At an evening discussion with intimate
friends of your own sex, are you more
interested when you talk about—
a. themeaning of life
b„ developments in science
c. literature
d. socialism and social amelioration
10.
Which of the following would you
prefer to do during part of your
next summer vacation (if your ability
and other conditions would permit)a. write and publish an original
biological essay or article
b. stay in some secluded part of the
country where you can appreciate
fine scenery
c. enter a local tennis or other
athletic tournament
d- net experience in some new line of
business
TOTAL
9 -
11. Do great exploits and adventures of
discovery such as Columbus's,
Magellan's, Eyre1 's and Amundsen's
seer, to you significant becausc—
a. they represent conaucsts by man
over the difficult-forces of
nature
b. they add to our knowledge of
geography, meteorology, oceano
graphy, etc.
j.
c. they wield human interests and
int( rnational feelings throughout
the world
d. they contribute each in a small way
to °n ultimate understanding of the
universe
12. should .one guide one's conduct accordii
to, or develop one's chief loyalties
toward—
a. one's religious faith
b. ideals of beautyc. one 's occupational organization and
associates
d. ideals of charity
13. To what extent do the following famous'
persons interest you —
a. Florence Nightingale
b. Nanolcon
c. Henry Ford
d. Galileo
14. In choosing a wife would you prefer
a woman who— (M?® - answer the
alternative form below)
a. can achieve social prestige,
commanding admiration from
others
likes
b.
to help people
c. is fundamentally spiritual in
her attitudes toward life
d. is gifted along artistic lines
(For women) Would you prefer a husband
who
a. is successful in his profession,
commanding admiration from others
b. likes to help people
c. is fundamentally spiritual in his
attitudes toward life
d. is gifted along artistic lines
TOTAL
- 10 -
15. Viewing Ajantn Paintings, would you
tend to think of those —
a. as expressing the highest sniritual
aspirations and emotions
b. as the most priceless and irreplace
able ever painted
c. in relation to their place in histor
d.
the■Quintessence of harmony and
TOT'iL
FOR RESTRICTED USE ONLY
ALLPORT
?
VERNON
:
LINDZEY
STUDY OF VALUES
Part I
.
DIRECTIONS : A rjumber of controversial statements or questions with two
alternative answers are given below. Indicate, your personal preferences .
by writing appropriate figures in the boxes to the right of .each question.
Some of the alternatives may appear equally attractive or unattractive to
you. Nevertheless, please attempt to choose the alternative that is
relatively more acceptable to you. For each question you have three points
that you may distribute in any of the following combinations.
1.
If you agree with alternative (a)
and disagree- with (b), write 3 in
the first box and 0 is the second
box, thus
2.
If you agree with (b); disagree
with (a) , write
■3. If you have a slight'preference
for (a) over (b), write
4.
If you have a slight preference
'for (b) over (a), write
Do not write any combination of numbers except one of these
these; four.
There is no time limit, but do not linger over any one. question ,or
statement, and do not leave out any of the questions unless you find
it .really impossible to make a decision.
BEHAVIOURAL SCIENCE CENTRE, ST. XAVIER'S COLLEGE, 4HMEDABAD 380 009
- 2 1. The main object of scientific research
should be the discovery of truth rather
than its practical apnlications.
(a) Yes; (b) No.
2. Taking the Bible/Ramayana/Koran as a
whole, one should regard it from the
point of view of its beautiful
mythology and literary style rather
than as a spiritual revelation.
(a) Yes; (b) No.
3.
Which of the following men do you think
should be judged as contributing more
to the progress of mankind ?
(a) Aristotle; (b) Abraham Lincoln.
4.
Assuming that you have sufficient
ability would you prefer to be:
(a) a banker; (b) a politician?
5.
Do you think, it is justifiable for
great artists to be selfish and
negligent of the feelings of others?
(a) Yes; (b) No.
6.
Which of the following branchesof
study do you 'expect ultimately will
prove more important for mankind ?
(a) Ifethematics; (b) Theology
?. Which would you consider the more
important function of modern leaders?
(a) to bring about tho accomplishment
of practical goals; (b) to encourage
followers to take a greater interest
in the rights of others.
8.
When witnessing a gorgeous ceremony
(ecclesiastical or academic, induction
into-office, etc.), are you more impres
sed; (a) by the colour and pageantry of
the occasion itself; (b) by the influence
and strength of the group?
TOTAL
- 3 9.
Which of these character traits do you
consider the more desirable? (a) high
ideals. and reverence: (b) unselfishness
and sympathy.
10.
If you were a university professor .and
had the necessary ability, would you
prefer to teach: (a) Poetry; (b)
chemistry and physics?
11.
If you should sre the following news
items with headlines of equal size in
your morning paper, which would you
read more attentively? (a) RELIGIOUS
DIFFERENCES WITHIN ANY COMMUNITY:
(b) GREAT IMPROVEMENTS IN MARKET
CONDITIONS.
,
12.
Under circumstances similar to those
of Question 11 ? (a) SUPREME COURT
RENDERS DSCISION: (b) NEW SCIENTIFIC
THEORY ANNOUNCED.
13.
When you visit a cathedral/temple/
mosque are you more impressed by a
pervading sense of reverence and
worship than by the architectural
features, (a) Yes; (b) No.
14.
Assuming that you have sufficient.
leisure time, would you prefer to
use it: (a) developing your mastery
of a favourite skill; (b) doing
volunteer social or public service
work ?
15.
At an oapoaition, do you chiefly like
to go to the buildings where you can
see: (a) new manufactured products;
(b) scientific (e.g. chemical)
apparatus?
16.
If you had the opportunity, and if
nothing of the kind existed in the
community where you live, would you
prefer to found: (a) a debating society
or forum; (b) a classical music club
(Sangeet Sammelan)
TQT^Jj
I.
17.
The aim of the religious organizations
at the present tine should be: (a) to
bring our altruistic and charitable
tendencies; (c) to encourage spiritual
worship and a sense of communionwith
the highest
18.
If you had some time to spend in a
waiting room and there were only two
magazines to choose from, would you
prefer: (a) SCIENTIFIC AGE; (b) APTS
AM) DECORATIONS?
19.
Would you prefer to hear a. series■of
lectures on: (a) the comparative merits
of the forms of government in Britain
and in the United'States; (b) the com
parative development of the groat
religious faiths?
20.
Which of the following would you con
sider the more important function of
education? (a) its preparation for
practical achievement and financial
reward; (b) its prenaration fqr
participation in community activities
and aiding less fortunate persons.
21.
Arc you more interested in reading
accounts of the lives and works of
men such as: (a) Alexander, Julius
Caesar, and Ashoka; (c) Aristotle,
Socrates, and Radhakrishnan
22.
Are our modern industrial and scien-.tific developments signs of a greater
degree of civilization than those
attained by any previous society,- the
Greeks, for example? (a) Yes; (b) No.
... -
23.
■
.■
.
t-' ■
If you were engaged in an industrial
organization (and assuming salaries to
be equal), would you prefer to work;
(a) as a counsellor for employees;
(b) in an administrative position?
TOTAL
|
'
a
I
1— -
- 5 -
24.
Given your choice bi tween two books
to read, arc you more likely to selects
(a) THE STORY OF RELIGION IN INDIA: .
(b) TH1. STORY OF INDUSTRY IN INDIG:
25.
Would modern society he refit more from:
(a) more concern for the rights md
welfare of cit izens; (b) greater know- ■ a
ledge of the f mdamcntal laws of human | i
behaviour.
26.
Suppose you were in a position to help
raise standards of living, or to mould
public opinion. Would you prefer to
influence: (a) standards of living;
(b) public opinion?
27.
Would you prefer to hear a series of
popular lectures on: (a) the progress
of social service work in your part of -rthe country; (b) contemporary painters?
28.
/ill the evidence that has been io- •
partially accumulated' goes to show
that the universe has evolved t^ its
present state in accordance with
natural principles, so that there is.
no necessity to assume a first course,
cosmic purpose, or God behind it.
(a) I agree with this statement;
(b) I disagree
29.
In a paper, such as the New York
Sunday times, are you more likely to
read: (a) the real estate sections
and the account of the stock market;
(b) the section on picture galleries
and exhibitions?
30.
Would you consider it more important
for your child to secure training in
(a) religion; (b) athletics?
TOTAL
6 Part II
DIPLCTIOKS: Each: .of the fallowing situations or Questions is followed
by four possible attitudes or answers, ir-ange these answers in the
order of your personal preference by writing, in the appropriate box
at the right, a'Score of 4, 3, 2, or 1. \To the statement you prefer
most give 4, to the statement that is sc-cond most attractive 3, and
so on
Example: if this were a question and the following statements were
alternative choices you would place:
in the box if this statement
appeals to you.
T~
|4
in the box if this statement
appeals to you second best.
in the box if this statement
appeals to you third best
1
is
in the box if this statement
represents your interest or
prtference least of all.
You may think of answers which would be preferable from your poin+ of
view to any of those listed. It is necessary, however, that you make
your selection from the alternatives presented, and arrange all four
in order of their desirability, guessing when your preferences are not
distinct, if you find it really impossible to state your preference,
you may omit the question. Be sure not to assign more than one 4,
one 3, etc., for each cuestion.
f
1.
Do you think that a good government
should aim chiefly st—(Kenenber to give
your first choice 4, etc.)
a. more aid for the poor, sick and old
b. the development of manufacturing and
trade
c. introducing high'st ethical principles
into its policies and diplomacy
d. establishing
position of prestige
and respect among nations.
2.
In your opinion, can a nan who works
in business all the week best spend
Sunday in
a. trying to educate himself by
reading serious books
b. Trying to win at golf, or racing
c. going to anorchestral concert
d. hearing a really good sermon
3.
If you could influence the- educational
policies of the' public schools of some
. city, would you undertake—
a. to promote the study and na^ticipation in music and fine arts.
b. to stimulate the study of social
problems
c. to provide, additional laboratory
facilities
d. to increase the practical value of
courses
4.
Do you prefer a friend ( of your own
sex) who—
a. is efficient, industrious and of a
practical turn of mind.
b. is seriously interested in thinking
out his attitude toward life as a
whole
possess Dualities of leadership and
c.
organizing ability.
shows artistic and emotional sensiti
d.
vity
5.
If you lived in a small town and had
more than enough income for your needs,
would you prefer to—
a. apply it productively to assist
commercial and industrial development
b. help to advance the activities of
local religious groups
c. give it for the development of scienti
fic research in your locality
d. give it to the Family Welfare Society
TOTAL
- 8 -
6.
When you go tothe theater, do you, as
a rule, enjoy most—
a. plays that treat the lives of great
i.'.en
b. ballet or similar i’-’g-:native per
formances
c. plays that have a theme of human
suffering and love
d. problem plays that argue consis
tently for some noint of view
7.
Assuming that you are a man with the
necessary ability, and that the
salary for each of the following
occupations is the same, would you
prefer to be a —
a. mathematician
b. sales manager
c. religious preacher
d. politician
8,
If you had sufficient leisure and
money, would you prefer to—
a. make a collection of fine sculp
tures or paintings
b. establish, a cr’'t' r for the care
and training of the feeble-minded
c. aim. at a membership of Parliament
or a seat Jn the Cabinet
d. establish a business or financial
enterprise of your own
9.
At an evening discussion with intimate
.friends of your own sex, are you more
interested when you talk about—
a. themeaning of life
b. developments in science
c. literature
d. socialism and social amelioration
10.
Which of the following would you
prefer to do during part of your
next summer vacation (if your ability
and other conditions would perm.it)a. write and publish an original
biological.essay or article
b. stay in some secluded part of the
country where you can appreciate
fine scenery
c. enter a local tennis or other'
athletic tournament
- - act experience in some new line of
business
TOTAL
- 9 -
11. Do great exploits and adventures of
discovery such as Columbus's,
Magellan's, herd's and Amundsen's
seen to you significant because—
a. they represent conquests by man
over the difficult forces of
nature
b. they add to our knowledge of
gcogranhy, meteorology, oceano
graphy, etc.
c. they wield human interests and
intt rnationnl feelings t’-roughout
the world
d. they contribute each in a snail way
to an ultimate understanding of the
universe
12. should one guide one's conduct according
to, or develop one's chief loyalties
toward—
a. one's religious faith
b. ideals of beauty
c. one's occupational organization and
associates
d. ideals of charity
13. To what extent do the following famous'
persons interest you —
a. Florence Nightingale
b. Napoleon
c. Henry Ford
d. Galileo
14. In choosing a wife would you prefer
a woman who— (ifen . answer the
alternative form, below)
a. can achieve social prestige,
commanding admiration from
others
likes
b.
to help people
c. is fundamentally spiritual in
her attitudes toward life
d. is gifted along artistic lines
(For women) Would you prefc'r a husband
who
a. is successful in his profession,
commanding admiration from others
b. likes to help people
c. is fundamentally spiritual in his
attitudes toward life
d. is gifted along artistic lines
TOTAL
- 10 -
15. Viewing Ajantn Paintings, would you
tend to think of those —
a. as expressing the highest sniritunl
aspirations and emotions
b. as the most priceless and irreplace
able ever painted
c. in relation to their place in histor
d.
the quintessence of harmony and
design
TOTAL
DEPT OF COMMUNITY MEDICINE
ST JOHN'S MEDICAL COLLEGE, BANGALORE 34
RURAL HEALTH EVALUATION RETORT
The following pages contain a number of incomplete stories.
We want you to read and complete them giving your imaginative
best as to what happened from the point where it was left off.
There are no right or wrong conclusions to those stories.
Please do not try to read all of them first and then go
back over them towrite the conclusions.
You have only 5 minutes for each. In order to finish all
of them in the allotted time you will have to write your spontaneo”
reaction immediately after reading each story.
Dr Singh is a young doctor who has finished a year's surgical
house officership in his medical college hospital. He has
to choose between two assignments each for a period of approximate
2 years.
1.
The first is a government primary health centre only 5
miles from the medical college with good road connections so
that it is easy for both patients and the doctor to go back and
forth to the city. The second is a health centre in an isolated
valley in the Himalayas, which is supported by his own religious
organization.
It is in an area of great medical need where
communications with the outside world arc frequently out off by
weather and bad roads.
What choice did he make and why ?
Dr. Banerji is a successful practitioner who had never been
out of Calcutta. He has just returned from his first visit
to a village where he had gone with a wedding party.
In talking w-'
Dr Chatterji, a young colleague who was born and brought up in
a village, he expresses in strong languages his revulsion and
disgust at the lack of laterines in the village. He vows, that
he will never go back to a village again because he can't bear
the- thought of going out to the fields morning and night.
Dr Chatterji responds
2.
Dr Viswanathan had been surprised to find that his 5 years in
primary health centre had passed as a rapid and pleasant
interlude.
His wife and two children aged 4-/ and 2-g- enjoyed the
life in the village and the children played happily with some of
the village children.
One spring day the doctor saw 5 cases of
severe vomitting and diarrhoea in the dispensary. On going home
he- was called next door and found the 4 year old friend of his own
child dying of cholera. Dr Viswanathan immediately
3.
4.
On graduation from the medical college Dr Gupta had three
alternative Choices. He could accept a job in a government
Primary Health Centre where he could start earning Rs.550/- per mont
His maternal uncle who was private practitioner in a big city
invited him to join his clinic as a junior at 200 rupees a month.
He was selected to do post-graduate- work in a subject for which he
had no particular preference. After careful consideration
_ST JOHN'S MEDICAL CCLLEGi
Baikal ore
PARTICIPATION ASSESSMENT (First Step)
1. Check off the things that you did during today's session.
----------
----------
I listened
I engaged in problem
I read
solving individually -------I copied down notes
in a team
I wrote down my own ideas
I related theoretical
I mentally evaluated
concepts to my own field
ideas presented by
experienee
others
I role-played
I offered ideas of my
I participated in practical
own verbally
activity
I took part in small
I created or helped create'
group discussion
a (communication) message
I took part in whole
I got bored
group discussion
I fell asleep .
Any other ? Specify ;
2« Which statement best describes the way you feel in a new group ?
I ge nerally •>
'
prefer to sit quietly and listen to others
feel quite at ease tiling part in discussion
find myself ready for some form of leadership role
sometimes wish I could take over and structure the discussion
feel ill at ease
prefer to listen for a while and then participate after I
jlave
feej_ £or
group
other
3. Imagine that you have been approached by a social reformer who
wants you to change sone aspect of' your lifestyle in the interest
of the nation or of the world, or perhaps just "for your own
good". You appreciate the new point of view, but are also aware
that any change on your part would involve certain personal
risk and criticism from some of your peers. What would you do?
You may check off more than one box, but if so, rank them by
number.
1
’
Take the social reformer *s advice and adopt the change right
away ’wait to see what other people will do.
Actively look for other community members who are interested,
and form
a study group
an action group
’Try to learn’ more about the subject”73tliout letting anyone
~~ know of your interest
ether response (specify)
___
_____ ,
.
,
2
• 2 :
<. Facing problems
1. List 5 specific problems that you and people in your peer
group often face.
2. Number them in order of difficulty of solution.
3. Put an asterisk in front of those that can be solved only
through influential connections.
4. Put a circle around the ones that require a lot of money to
resolve.
5. Underline the ones that affect you in particular.
6. Re-underline the one that v?ould make you most happy if solved
7« Against each of the problems that affect you, write the date
when you last did something towards solving them.
o. Check off the ones that you have been able to solve
9. Consider: what docs this exercise tell you about your
ability to confront problems ?
prk/191281
1ST JOHN'S MEDICAL COLLEGE
BANGALORE
FART1CIPAT1CN. ASSESSMENT (First Step)
1. Check off the things that you did during today's session.
I listened
I read
I copied down notes
I wrote down my own ideas
-I mentally evaluated.
ideas presented by
others
I offered ideas of my
own verbally
I took part in small
group discussion
I took part in whole
group discussion
Any other ? Specify .
I engaged in problem
solving individually -------in a team
I related theoretical
concepts to rny own field
experience
I role-played
I participated in practical
activity
I created or helped create
a (communication) message
I got bored
I fell asleep
2- I.'hich statement best describes the way you feel in a new group ?
I generally.
prefer to sit quietly and listen to others
feel quite at ease taking part in discussion
find myself ready for some form of leadership role
sometimes wish I could take over and structure the discussion
feel ill at ease
prefer to listen for a while and then participate after I
have a feel for the group
other
3. Imagine that you have been approached by a social reformer who
wants you to change sone aspect of your lifestyle in the interest
of the nation or of the world, or perhaps just "for your own
good". You appreciate the new point of view, but are also aware
that any change on your part would involve certain personal
risk and criticism from some of your peers. What would you do?
You may check off more than one box, but if so, rank them by
number.
’
’
Take the social reformer *s advice and adopt the change right
away Wait to see what other people will do.
Actively look for other community members who are interested,
and form
a study group
an action group
’Try to lear’n mo
know of your interest
Other response (specify)
2
: 2 :
4. Facing problems
1. List 5 specific problems that you and people in your peer
group often face.
2. Number them in order of difficulty of solution.
3. Put an asterisk in front of those that can be solved only
through influential connections.
4. Put a circle around the ones that require a lot of money to
resolve.
*
5. Underline the ones that affect you in particular.
6. Re-underline the one that would make you most happy if solved.
7. Against each of the problems that affect you, write the date
when you last did something towards solving them.
8. Check off the ones that you have been able to solve
9. Consider: what does this exercise tell you about your
ability to confront problems ?
prk/191281
_ST JOHN'S MEDICAL CCLLEGE
BANGALORE
PARTICIPATION ASSESSMENT (First Step)
1. Check off the things that you did during today's session.
I listened
I engaged in problem
I read
solving individually -------I copied down notes
in a team
I wrote down my own ideas
I related theoretical
_
mentally evaluated
concepts to my own field
ideas presented by
experience
others
I rcl'c-played
X offered ideas of my
I participated in practical
own verbally
activity
X took part in small
I created or helped create
group discussion
a (communication) message
I took part in whole
I got bored
group discussion
I fell asleep
Any other ? Specify .
t
-------------------
2» Which statement best describes the way you feel in a new group ?
I generally;
-prefer to sit quietly and listen to others
feel quite at ease taking part in discussion
find iryself ready for some form of leadership role
sometimes wish I could take over and structure the discussion
feel ill at ease
prefer to listen for a while and then participate after I
have a feel for the group
other
3« Imagine that you have been approached by a social reformer who
wants you to change sone aspect of your lifestyle in the interest
of the nation or of the world, or perhaps just "for your own
good". You appreciate the new point of view, but are also aware
that any change on your part would involve certain personal
risk and criticism from some of your peers. What would you do?
You may check off more than one box, but if so, rank them by
number .
Take the social reformer's advice and adopt the change right
away ■
Wait to see what other people will do.
Actively look for other community members who are interested,
and. form
a study group
an action group
'Try to learn' more about the subjecfw^’tliout letting anyone
know’ of your interest
Other response (specify)
_____
2
: 2 •’
4. Facing problems
1. List 5 specific problems that you and people in your peer
group often face.
2. Number them in order of difficulty of solution.
3. Put an asterisk in front of those that can be solved only
through influential connections.
4. Put a circle around the ones that require a lot of money to
resolve.
■»
5. Underline the ones that affect you in particular.
6. Re-underline the one that would make you most happy if solved.
7. Against each of the problems that affect you, write the date
when you last did something towards solving them.
8. Check off the ones that you have been able to solve
9. Consider: what does this exercise tell you about your
ability to confront problems ?
prk/191281
-2-
Pleasant
8
7
6
5
4
3
1
Unpleasant
Friendly
8
7
6
5
4
321
Unfriendly
Rejecting
8
7
6
5
4
321
accepting
Helpful
8
7
6
5
4
321
Frustrating
Unent husiastic
’ 8
7
6
5
4
3
1
Enthusiastic
■Tens e
8
7
6
5
4
321
Relaxed
Distant
8
7
6
5
4
321
Close
Cold
8
7
6
5
4
321
Warm
Co-op erat ive
8
7
6
5
4
321
Uncooperative
Supportive
8
7
6
5
4
321
Hostile
Boring
8
7
6
5
4
3
2
1
Interesting
Quarrelsome
8
7
6
5
4
3
2
1’
Harmonious
Self-assured
8
7
6
5
4
3
2
1
Hesitant
Efficient
8
7
6
5
4
3
2
1
Inefficient
Gloomy
8
7
6
5
4
321
Cheerful
Open
8
7
6
5
4
321
Guarded
2
2
LEAST PREFERRED COLLEAGUE QUESTIONWIRE
Direct ions:
Please read these instructions carefully. Think of the person
you can work least well with.
He may be someone you work with now,
or he may be someone you knew in the past.
He need not be the per
son you like least, but rather should be that person with whom you
have (had) the most difficulty in getting a job done.
Describe this
person as he appears to you. Circle the number most appropriate for
the person
Pleasant
8
7
6
5
4
3
2
1
Unpleasant
Friendly
8
7
6
5
4
3
2
1
Unfriendly
Rej ecting
u
7
6
5.
4
3
2
1
Accepting
Helpful
8
7
6
5
4
3
2
1
Frustrating
Unenthusiastic
6
7
6
5
4
3
2
1
Ent husiastic
Tense
8
7
6
5
4
3
2
1
Relaxed
Distant
8
7
6
5
4
3
2
1
Close
Cold
8
7
6
5
4
3
2
1
Harm
Co-op erat ive
8
7
6
5
4
3
2
1
Uncooperative
Supportive
8
7
6
5
4
3
2
1
Host ile
Boring
8
7
6 . 5
4
3
2
1
Int eresting
Quarrelsome
8
7
6
5
4
3
2
1
harmonious
Self-Assured
0
7
6
5 . 4
3
2
1
Hesitant
1
7
6
5
4
3
2
1
Inefficient
Gloomy
8
'7
6
5
4
3
2
1
Cheerful
Open
8
7
6
5
4
3
2
1
Guarded
Efficient
,
MOST PREFERRED COLLEAGUE QUESTIONWIRE
Directions:
Please read these instructions carefully. Think of the person
with wbjhi you can work best with.
He may be someone you work with
now, or he may be someone you knew in the past.
He does not have to
be the person you lil^e most, but should be the person with whom you
had little or no difficulty in getting a job done.
Describe this
person as he appears to you.
Circle the number most appropriate for
this person.
SOLVING PROBLEMS ANU MAKING DECISIONS
When a group (or an individual) is faced with solving a
problem or making a decision, there are five steps which can
be followed. These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they will also lead to a better final decision.
1•
Define the problem
^sk yourselves "What is the real problem before us?”
If
you cannot agree on what the problem is, you certainly will
not agree on the solution!
A clearly-defined problem is
already a great help towards a solution.
What appears to be the problem may be only a superficial
sympton.
Underneath there may be larger and deeper issues.
Express the problem in ''How to...' terms.
Do not say,
the problem ife moderating discussion,,
ut, ” The problem is
how to learn to moderate discussions effectively'.
2.
dollect
POSSIBLE SOLUTIONS
Ask yourselves, 'what are the possible solutions to
this problem?” Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
vThe process is similar to 'brain-storming';.
It is important to separate the collecting of ideas in
this step from evaluation: The evaluation should come only
in the third step.
If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible.
Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.
3• jzvaluate the po s s i b 1e solutions and choose the best
Ask yourselves, "Of all the alternatives we have listed,
which is the best solution?”
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group.
This will help in the completed examination
of every possibility.
Beware of easy agreements-they
probably have not been thought through completely.
At the
same time, avoid being defensive or making others feel
defensive.
Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision. Ask yourselves, :Ioes
this decision accomplish our purpose? Will it effectively
solve the problem?' The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
af terwards!
-2Consider whether the group itself is ready to make a
decision.
Sometimes groups (like individuals') need, time to
'think over' a decision before finally making it.
4. Implement the decision
Decide on the steps for implementing the decisions. Ask
yourselves, “who is going to do what? When? How? Be sprcific
plut names against actions.
A decision which does not include details of how the
decision is to be implemented may be ineffective and even
useless. Lots of good ideas are never translated into action
because their implementation is not taken care of..
As well as deciding who will do what, when and how, there
may be other guestions, such as, 'who else should be informed
of this decision?.
5.
Follow-up
Ask yourselves, “How will we check on how this decision
is working in action?" It is important that the group decides
at tha tima they make the decision how they are going to
arrange for follow-up and feedback.
Source? McGrath, E.H., Basic Flanagerial Skills for All,
XLRI, Jamshedpur, 1978.
PEOPLE IN DEVELOPMENT • A Trainer's Manual for
groups John Staley.
Training Pace.
VII
SOLVING PROBLEMS AND MAKING DECISIONS
When a group (or an individual) is faced with solving a
problem or making a decision, there are five steps which can
be followed. These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they will also lead to a better final decision.
1 •
Define the J^robl.m
Ksk yourselves :Uhat is the real problem before us?”
If
you cannot agree on what the problem is, you certainly will
not agree on the solution!
A clearly-defined problem is
already a great help towards a solution.
What appears to be the problem may be only a superficial
sympton.
Underneath there may be larger and deeper issues.
Express the problem in ”How to...' terms.
Do not say,
'the problem it moderating discussion
ut,
The problem is
how to learn to moderate discussions effectively .
2•
collect
POSSIBLE SOLUTIONS
Ask yourselves, 'what are the possible solutions to
this problem?” Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
kThe process is similar to 'brain-storming';.
It is important to separate the collecting of ideas in
this step from evaluation: The evaluation should come only
in the third step.
If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible.
Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.
3.
Evaluate the possible solutions and choose the best
Ask yourselves, :I0f all the alternatives we have listed,
which is the best solution? 1
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group.
This will help in the completed examination
of every possibility.
Beware of easy agreements-they
probably have not been thought through completely.
At the
same time, avoid being defensive or making others feel
defensive.
Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision. Ask yourselves, ;Ioes
this decision accomplish our purpose? Will it effectively
solve the problem?” The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
af terwards!
-2Consider whether the group itself is ready to make a
decision.
Sometimes groups (like individuals) need time to
’think over' a decision before finally making it.
4.
Implement the decision
Decide on the steps for implementing the decisions.
Ask
yourselves, ‘‘who is going to do what? When? How? Be specific
p!ut names against actions.
A decision which does not include details of how the
decision is to be implemented may be ineffective and even.
useless. Lots of good ideas are never translated into action
because their implementation is not taken care.of
As well as deciding who will do what, when and how, there
may be other questions, such as, ‘who else should be informed
of this decision?.
5.
Follow-up
Ask yourselves, “Hou will we check on how this decision
is working in action?’’
It is important that the group decides
at the time they make tha decision how they are going to
arrange for follow-up and feedback.
Sources McGrath, E.H., Basic Managerial Skills for All,
■XLRI, Jamshedpur, 1978.
PEOPLE IN DEVELOPMENT- A Trainer’s Manual for
groups John Staley.
Training Paper VII
SOLVING PROBLEMS AND MAKING DECISIONS
When a group (or an individual) is faced with solving a
problem or making a decision, there are five steps which can
be followed. These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they will also lead to a better final decision.
1.
Define the probl m
Ask yourselves ”What is the real problem before us?” If
you cannot agree on what the problem is, you certainly will
not agree on the solution!
A clearly-defined problem is
already a great help towards a solution.
What appears to be the problem may be only a superficial
sympton.
Underneath there may be larger and deeper issues.
Express the problem in ”How to... ' terms.
Do not say,
’the- problem it moderating discussion
ut, ” The problem is
how to learn to moderate discussions effectively'.
2•
COLLECT POSSIBLE SOLUTIONS
Ask yourselves, ’what are the possible sollitions to
this problem?” Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
;The process is similar to 'brain-storming1/.
It is important to separate the collecting of ideas in
this step from evaluation: The evaluation should come only
in the third step.
If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible.
Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.
3. Evaluate the possible solutions and choose the best
Ask yourselves, ”0f all the alternatives we have listed,
which is the best solution?”
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group.
This will help in the completed examination
of every possibility.
Beware of easy agreements-they
probably have not been thought through completely.
At the
same time, avoid being defensive or making others feel
defensive. Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision. Ask yourselves, :Ioes
this decision accomplish our purpose? Will it effectively
solve the problem?” The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
afterwards!
-2Consider whether the group itself is ready to make a
decision.
Sometimes groups (like individuals) need time to
'think over’ a decision before finally making it.
4. Implement the decision
Decide on the steps for implementing the decisions. Ask
yourselves, “who is going to do what? When? How? Be sprcific
plot names against actions.
A decision which does not include details of how the
decision is to be implemented may be ineffective and even
useless. Lots of good ideas are never translated into action
because their implementation is not taken care of
As well as deciding who will do what, when and how, there
may be other questions, such as, ‘who else should be informed
of this decision?.
5.
Follow~up
Ask yourselves, ”How will we check on how this decision
is working in action? ‘
It is important that the group decides
at tha time they make the decision how they are going to
arrange for follow-up and feedback.
Source; McGrath, E.H., Basic Flanagerial Skills for All,
XLRI, Jamshedpur, 1978.
PEOPLE IN DEVELOPS;ENT - A Trainer’s Manual for
groups John Staley.
Training Paotj., VII
development 'Worker:
1.
You are a comtnunity Development worker and have chosen to
work in the particular village simulated'in the Game.
2.
The other -players in the game represent families which live
in this village.
3.
during the course of the Game the village will pass.through
a series of consecutive years.
4.
You may visit the village at any time after the third year.
(.This interval is simply to give the other players time to
learn their roles in the Game).
The Assistant Organiser will
inform you when the third year ends.
5.
The villagers will not know who y you are, nor why you have
come.
You will have to introduce yourself and explain your
i ntentions.
6.
You will also have to find out for yourself about, the village,
the villagers, and their problems.
7.
If you wish, you can plan any one of four different kinds of
relief and development progrnmr.-ps.
6.
You ■ = '.'•? no financial or other resources yourself, but if you
wish you c-n apply on one of the prescribed forms to a donor
agency for 'unitsA for a programme.
In that case there are
certain procedures of the donor agency to be followed:
(a)
An application must be submitted in writing.
be handed to the Organiser of theGame.
(b)
You will be informed of the agency's decision on the
application after some time.
(c)
If /ou receive a grant you can use it only for the
purpose requested.
If you want to change the purpose
you myst apply again and wait for the agency's decision.
It should
(d.i You can make more than one application, but only if you
have spent or returned any previous grant.
9. The programmes possible are as follows:
(a) Relief: Up to 10G0 units can be requested for direct
distribution.
If a grant is made, this programme can be
implemented immediately.
•,b) Y.edical Programme: 1000 units can be requested for a medical
programme.
If this programme is implemented it will reduce
the risk of malnutrition and disease by 25%.
However if the
village is willing to contribute another 1G00 units, th?
risk can be reduced by 53%.
If a grant is made, this
□rogra-me can become effective in the following year.
<C; Agricultural Programme: *>n application can be made for three
wells costing 500 units each.
If a grant is made, the wells
can be sunk by the year after the grant is received.
A
successful well irrigates three fields, and paddy can he
sown.
lach field of paddy will normally yield 150 per year
irrespective of the monsoon.
However not all well are
success!ul .
2
-2Alternatively an application can be made for three pumpsets
costing 300 units each.
immediately.
If a grant is made these can be installed xtnwRC
-ith a successful well and a pumpset, five fields
can be irrigated.
BASELIME
SURVEY
Voluntary Health Association of India
Telegrams : VOLHEALTH
C-14, Community Centre,
New Delhi-110016
Safdarjung Development Area.
T , .
658071
Telephones . 668q72
New Delhi-110016
BASE LIKE
SURVEI
In the process of selecting our target area and. then the specific villages
in which we trill work, we would have found that the people of each trill age
live with a number of problems. As a team of health workers, we have to
find out which of these problems are more important to the community.
A good, way to find out this information is by conducting a baseline survey.
Such a survey helps us to determine the initial health status of a popula
tion.
What is a baseline survey?
A survey is a systematic way of collecting information about the community.
The baseline survey is done before we start a comprehensive Community Health
Programme. Because this survey gives data about the health status of
people before the programme is started it is called a baseline survey.
The baseline survey is done CNET ONCE.
The baseline survey can help us in:
1.
2.
3.
4.
5.
6.
assessing the health needs of a community
enabling local leaders to become more aware of the health
conditions in their community
increasing the community's awareness of the health problems
facing them
setting objectives for a comprehensive community health
programme with the community
identifying the 'At Risk' population (that heeds special care)
evaluating achievements and draw backs of the programme and
resetting priorities at a later stage.
when to do a baseline survey?
Vfe should do the baseline survey
A.
AFTER WE HAVE
1.
2.
selected the villages we want to work in
intensified visits to these villages
also
B.
AFTER THE COMMUNITY
1.
2.
3.
4.
has had time to understand our motives
has realised the need for a community health programme
has understood the concept of community involvement
has understood why we want to do a survey and know how
we will use the information collected.
When the staff of a health centre does a survey before they know th©'
community and the community knows them, people misunderstand the'purpose
of the survey. The people may resist and give false information, distrust .
’the staff, and ill feelings on both sides can be generated. The staff
may even decide to discontinue work in the vi 11 age, ■ It is therefore very
important that the community be well prepared before doing the survey.
......2/
2
Viho does the survey?
We are likely to get .more accurate information if we ask members of
the community to do the survey. Help of the following groups or indi
viduals can be taken:
1.
2.
3.
4.
5.
School teachers
'
Members of local youth clubs, Farmers’ Slubs, Mahila Mandals
Local leaders both formal and informal ■
etc.
The village health worker ( if the community has already
chosen one)
Any interested member of the canmunity
It is important that the people chosen to do the survey have a good
relationship with a majority of the people.
What information do we collect?
The health status of a community is reflected in the health of the
mother and child, as these are two of the most vulnerable groups in
the community. Therefore to begin with we collect information about
these groups. If wo want to start a specialized programme such aS
programme for leprosy control, IB control, etc., data can be collected
for these purposes also.
How to record tho data?
life can use a note book or register for this purpose. You'can record
the baseline data in the first pages of this register. A sample table
giving-the information to be recorded is attached at the end of this
paper. (Table I).
The information for each family should be entered under each of the
headings.
Sane Definitions:
House Number is the same as Malaria Surveillance House Number.
Family is a group of people
-
'who are blood relatives ■
living under the same roof;
and sharing the same kitchen.
If the people are living in the same house, but have 2 kitchens,they are
considered as two separate families. In this case, it should be
recorded as follows:
S. No.
H. No.
Head of Family
4
5
15
15
Ganesh Chand
Babulal
3/
3
Head, of Family
-
The person who takes all major decisions in the family.
(If in a family the son earns but the father takes the
decisions, the father is still considered head of the
family)
How to use the data collected?
3.
Total all the columns at the end of each page. Then make a grand total
for each column so that you have the total figures for the village.
Total of column
Total of column
Total of column
= Total num’c.r of households
= Total population of village
= Total number of married women in the
reproductive age group
Total of column
= Total number of pregnant women at the time
7
of the survey
Total of column
= Total number of children (5-1 years
9
(Total number of births in the last year)
Total of column 10
= Total number of children 1-5 years
Total of column 9+-10 = Total number of under fives
Total of column 11
= Number of children already' immunized
Total of column 12(a) = Total number of deaths in children
between 0-1 year in the last year
(infant mortality)
Total of column 12(b) = Total number of deaths in children between
11-5 years
"
" 12(a) + I2(b)= Total number of deaths in children between
0-5 years
Total of column 12(c) = Total number of maternal deaths
"
2
5
6
l2(a)+(b)+(c)+(d)= Total number of deaths in the village
Guidelines for checking if the collected information is correct:
If our results differ greatly from the average figures given below, it is
because:
either the figures do not tell the whole story which may be due to
unsupervised work
faulty addition of the figures
faulty questions used
Harijan quarters or some other part of the village not
■ visited
- small village, chance variation from the average
-
or
the village is much different from the average which may be
due to
-
progressive village or block, district or state
previous health work done in the area
sane other cause
:
4
:
Average figures for a population of 1000:
1.
Number of houses
-
125 to 200
2.
Number of women in the reproductive
age (.15.- 45 years)
-
200 (15 - 20/4 of the
population)
3.
Number of children between the ages
of 0-5 years
150 (15% of the population)
This figure may be higher in
areas where nutrition is good
or family planning services
are poor. This figure may be
loxver in areas where ven er al
disease (which causes sterj^ty)
is high, or where there is
poor nutrition.
4.
Number of malnourished children
between the age of 0-5 years
-
90 to 120 (60 to 80% of underfive population)
5.
Number of children bom per year
-
30 to 40 '
6.
Number of pregnant,mothers in one year -
7.
Number of obviously pregnant mothers
at any one. time in a village (after
6 months of pregnancy)
8.
10 to 13 (l/3 of the number of
. births in the village)
Cases of tuberculosis
a.
b.
9.
45 to 60 ( 1g times the number
of births in the village)
Number of people with sputum
positive tuberculosis.
Number of people with sputum
negative tuberculosis
Number of people with leprosy
-
2 to 8
-
11 to 17
-
This may vary from 0 to 25 or
even more.
How to set priorities on the basis of baseline data?
Eg.
1.
If there is a high infant mortality due to diarrhoea, then the
priorities would be:
■
a)
b)
Eg.
2.
health education of mothers on the importance of
rehydration drink;
to improve the drinking water supply of the village.
If 90$ of the married women are in the reproductive age (15 years
to menopause) and the average number of children per family is
four, family planning programme should be a priority.
It is import ant to discuss the findings of the survey with the ccmunity
before any definite strategies are planned. Programmes planned with the
community have a greater chance of success.
J£x=
chtt:pt:25.6.'8l
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EVALUATION
CF
A
SECTION
PRCGRAMM .. u,^, .JL •
0c'3f'00 of/n(f
I
Evaluation is a procsss by which the outcome (result) of an
activity is judged. By judging the outcome we can decide wh'jther the
activity should be continued, modified or stopped. Therefore evaluation
is a tool that helps us to work in a better way.
For evaluation to be
of use we must have an open mind to be critical about our own work. We
must also be willing to learn from past mistakes.
When to think of evaluation
Evaluation of a programme is a continuous process. It begins as
we are making our plans. This is to help us to bo sure that activities
we plan are related to the needs wo want to meet. We will need to
evaluate at regular intervals during the implementation of the programme
to see if we are^ going in the right direction or need to mako any change.
At the end of an activity we will want to evaluate to know if we have
reached the desired result.
I - EVALUATION WHEN PLANNING A PROGRAMME
When we plan any activity we usually have some idea as to what
we hope to achieve through this activity. Very often ths idea may be as
vague as "We want to improve the health of the people". This statement
is too general and is difficult to evaluate. A better way is to state in
more specific terms how we are going to improve th© health status and how
we are going to measure this improvement in the health status. For
example, we all know that infant mortality rate (IMR)
*
is very high in
our country. Our country cannot be called healthy unless we reduce the
IMR. In other words a reduction in IMR shows (indicates) an improvement
in the health status of the population. Measuring the reduction in IMR
automatically means a measurement of health status. Infant mortality
rate is therefore called a health indicator. Other examples of health
indicators are maternal mortality rate and morbidity rate.
From the above it is clear that if we want to evaluate our pro
gramme we will have to be clear at the time of planning
- what we hope to achieve through the activity
- how we are going to meansure the achievement.
Going back to our example of IMR, we all know that more children die in
families with poor incomg. So when we say that we want to reduce IMR
we are indirectly saying that wc will focus our attention on the infants
who come frcS^ranilies. The infants from poor families arc now our
target group.'
If we do not ask ourselves the right questions at the time of
planning, we are bound to meet problems at a later stage. While planning
a programme the following questions should be kept in mind.
r
- Is the proposed programme directed to an important
problem of the community ?
- Is this problem a real priority with the people ?
- How much of the problem does the programme plan to solvo ?
- How effective do we expect the planned activities to be
in solving the problem ?
©
Infant Mortality Rate is the number of deaths in children
below one year of age per 1000 live births.
2.
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:2:
- What desirable and undesirable side effects can be
anticipated ?
•
- How are we going to involve the village people in the
activities ?
- How much will the programme cost to achieve the results ?
- Who is going to meet the cost of the programme ?
Good planning helps in the evaluation of the. programme.
II
- EVALUATION DURING THE IMPLEMEMTATIOM CF.THE 2RD1RAMME
Here, we are trying to judge the outcome (result) of an activity.
Depending on the activity-we could evaluate it at frequent intervals
during the activity and also once at ths end of the activity.
What Do We Want to Evaluate
A-
Effectiveness of the 'services:
In order to measure the effectiveness of the services it is neces
sary to measure the extent to which people get the services that were
planned to meet their needs. We would also have to decide whether tho
services have been of real benefit.
For example, in our village we may have found that the incidence of
whooping cought is very high. We may have decided to immunize all the
under five children with DPT. After one year of tho programme, we want to
evaluate the effectiveness. For this we would have to find :
- the total number of under five children who received all
the 3 dsos of DPT at the correct interval
- the total number of under five children in the village.
On the basis of this, wo can .calculate tho percentage coverage.
village
Total number of Under Five immunized in/ x
Percentage coverage of DPT= Total number of U.F. in village r. ' '
This gives us an indication as to how effective our coverage is, i.e.
the total percentage of children receiving the 3 doses of DPT at the
correct interval.
But our immunization programme can be said to be df benefit only
if we are able to show that it has significantly reduced tho incidence
of whooping coughi. in the area. To find out this we would have to know :
- how many cases of whooping cough were there in the year
before the immunization programme ?
- how many cases there were in tho year following the
.immunization programme ?
Supposing we have immunized at least 90/ of the’under five children in
the project area with DPT but the incidence of whooping cough has not
come down, we would then have to find out - whether the time interval between doses was correct ?
- whether all the 3 doses were given ?
- was the vaccine kept undcr the necessary conditions ?
3
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B-
The process by which the result was achieved;
The main thrust in a Community Health Programme is to organize the
community to make a collective effort towards improving the health status.
The same result can be achieved in different ways. But each way will be
qualitatively different.
For example, in village A, there is lack of clean drinking water.
Due to this lack of clean drinking water there are many cases of diarrhoea.
Mow this village needs a tube well. There are. many ways in which the
village can get a tube well.
- the health team can apply to a funding agency for money
and dig the well;
- the vi11 age people can write up a petition to the BDO
for a tube-well;
- the village people can contribute part of the expenses
(either cash or labour) to supplement the cost;
- the village people could wait for 2000 AD (when there
will bo health for all).
Applying to a funding agency is an easier way. It does net involve
much decision making or involvement at the community level. The health
team assesses the need of the village, writes to a funding agency and
gets the well dug. In this process the village people are merely passive
on-lookers.
0
In the second method, the writing up of a petition or sending a
delegation to the BDO will need the involvement of the vil1 age people.
Many meetings will have to be called, the people will have to decide
on many issues (who should go, who should write the application, what
is the next step or action if BDO is not forthcoming). Going to the BDO
also means the beginning of an initiative, a realization of their strength.
The process of dealing with the Government structure collectively might
itself become a great educational process. Probably the time taken for
the Tell to be dug will be much longer than in the earlier case but the
emergence of an organized group of people would have been worth it.
When we want to evaluate the process by which a result was achieved
the following questions should be.kept in mind :
- Were the village people involved in any decision making
related to planning and implementation of the programme ?
- How many of the village people were involved in this decision
making and which group did they belong to ?
- What was the process of decision making ?
- Did the activity result in the emergence of an organized
action in the village ?
- Has the process of decision making followed in this activity
set an example for future activities ?
C-
Equity:
Equity should be'a primary focus of all health programme. So, the
question is not merely has. health improved, but lias it improved for the
poorest section of tho village ? How many of the most disadvantaged
group are covered by the programme ? How many of their children are
immunized ?
4.
C-9 /244(c)
m:"n,12.82
:4:
In Pushpa Health Centre, the daily OPD attendance was 60.
Patients came from far and wide and the dispensary was making good
income. But an analysis of the'OP records for one year showed that
70% of the patients came from ohtsidc the target area and belonged
to the richer section. The dispensary staff wore spending 70% of
their time on rich people. The question before the staff was ■;
- Should they continue to spend so much time for the
rich people ?
Or
- Should they work in a different way so that the poor people
(who form 80% of the population) make better use of the
services ?
D~
Changes in behavioural patterns:
Many community health programmes spend more time collecting
numerical facts like the number of children immunized, the number of
tube well?dug, the number of mothers who got tetanus toxoid etc. While
numerical data is important, they are not necessarily the true indicators
of change in a community. It is more important to assess attitudes and
changes in behaviour in the community. For example, if a V.H.H’. has
convinced a mother that her relatively healthy looking child is becoming
undernourished when he fails to gain weight, or if a traditional birth
attendant (dai) has started sending pregnant mothers' for antenatal
checkups, great strides have been made towards changing the health status
in a community. We must remember that knowledge alone doos not change
attitudes and practices.
E-
Functioning of the health team:
A health team is a group of people working together to make health
care possible in a community. The members of a health team include all
those working together. For example, the supporting staff - a clerk, a
driver, a cleaner - are all part of the team. It is important that their
work and help they give be recognized as well as that of the medical
assistants, nurses and community workers.
People work well together when they agree with one another.
i.
Do all the members in the team know and understand the objectives
of the organization ? (People who do not know what those objectives
are may waste a lot of time in other activities. People who don’t
agree with the objectives may obstruct the work of the organiza
tion).
ii.
Are the members involved in planning and carrying out the
programmes ?
iii.
Are the members involved in decision making related to the major
issues (the direction the work should take, what activities must
be done) ?
iv.
Is work shared by all ?
v.
Are these responsibilities divided in the'best way ?
vi.
How are the member and their work supervised ? Does supervision
take the form of support or is it done in an autocratic way ?
(i.e. do what you are told and don’t ask questions).
vii.
Is each person in the team treated with respect or is respect
given only to those in the decision making position (e.g. Doctor)
Does each person have specific work to do?
5.
C-9/244(c)
m:13.12.82
viii.
Is ther>- effort to meat regularly to evaluate.- the work and to get
feedback. Are the minut s of the meeting recorded ?
ix.
How are inter-personal conflicts resolved in the team ? How are
the personal problems of staff solved ? How are disputes
prevented or settled ?
x.
What is the salary structure in the organization ?
parities too great ?
xi.
Does the health team continuously upgrade its knowledge and
ski!Is ? It is also important for each team member to evaluate
his own and other team members' work. (Arc the work objectives
being met, what the. quality of output, initiative, ingenuity,
enthusiasm shown in the job ?)
F-
Functioning of team with the village people:
Arc the dis
- What do the village people feel about the health team ?
- Does the community trust and act on the advice received
from the health team ?
-Do the village people know and understand the reason behind
the work of the health team ?
- At what stages of the programme are the village, people involved ?
- What is the attitude of the health team towards the village
people ?
- Is there effort on the part of the health team to develop
leadership other than the formal one already in the. village ?
- How arc messages communicated from the health team to the
village and vice versa ?
- Is the working schedule more to suit the convenience of the
village people or to suit the convenience of tho team ?
- What is the process by which the"village people are involved
in decision making ?
- How many village- meetings have been conducted, what was the
purpose, what were the decisions taken, how were they carried
out and what was the role of the health team ? Are minutes
recorded ?
These are some of the questions which the health team should ask them
selves. There may be more specific questions related to each of the
activities, that are being implemented (e.g. Under Five Programme,
VHW Programme, Feeding Programme etc.)
G-
Cost of the Programme:
- What is the total cost of the programme ?
-Where dors the money como from ?
■w•
- What kind of resources are used from" community (labour, cash
buildings) ?
- Are government resources being used (those available from the
DHO, BDO, etc)
- Has the dependency on outside funds decreased over the years ?
C-9/244(c)
m:13.12.82
,
! !
It is important for the health team to find out if the cost of
the programme was justified in view of its results. As resources are
limited we must be careful to use them in a way that would benefit the
great .-st number of people.
Two nurses decided to have a Community Health Programme which
was to cover 6 villages with a total population of 5000. The objec
tives of the programme were worked out with the people of the village
whers the Nurses intended to start their programme. The total cost
(recurring cost) was estimated as Rs. 30,600/- per yoar for the 5000
people. This cost would cover the salaries of the two nurses, the
doctor's salary while he would visit the villages, the stipends of 6
VHWs and the maintenance of a vehicle.
The nurses started their work in the first village which had an
average of 800 people. They got so much involved in that village that
they never went to the other 5 vii i agns which should have been part of
the programme.
At the (aid of three years the programme was evaluated. The :
result of the work was very positive; all children had been vaccinated
and had received Vitamin A treatment, the dais had been trained
the village had chosen three Village Health Workers, the VHWs had been
trained by the Nurses and the village premised to pay them once their
training was completed, and did it at the rate of Rs. 30/- per VHW
per month. So all seemed perfect.
But then, when evaluating the cost of the programme it was
realised that it had cost about Rs. 40/- per person per yoar (an
average of Rs. 200/- per family per year) to insure a minimal health
service in this vilIago.
Considering the very limited financial resources available in
India can wc expect the people to bo able to moot tho cost of such a
programme ?
Tho two questions that tho health team should ask arc :
- Could tho same resources achieve better results ?
- Gould tho same results be achieved with loss resources ?
H-
Unforeseen side effects:
Side effects are generally unforeseen and can be good or bad.
For example, a food for work programme was organizedin a vi 11 age, The
The programme included the digging of wells for irrigation purpose.
The wells dug were, good and thus land owners benefitted much from this
programme. It was now possible for the big land owners to have two
crops in a year. Unfortunately the majority of the village people who
had no land were unable to make use of this programme. Tho poor people
in the village developed a feeling of hatred towards tho health team
and the health team could no longer work with the poor people. In this
case, the side effect of tho programme was bad.
In another village, tho leaders chose a low caste woman to bo
the VHW? because they considered the tasks performed by a V.H.W. as
''dirthyl The health team was not happy with their choice because she
was illiterate. After one yoar tho health team realized that the VHW
was able to bring about a considerable change in the low caste popula
tion of the village which also was the poorest section in that village
Since the objective of the health team was to reach out to tho poor
people, this was achitvod.
In this case the side effect of the programme was good.
7.
9/244(c)
:7:
III
- VJHAT DO WE REQUIRE TO BE ABLE TO EVALUATE OUR WORK
A-
Knowledge of the area before the programme was started:
i.
Knowledge regarding health situation - birth rate, infant morta
lity rate, morbidity rates etc. This information can easily bo
obtained from the PEG, DHO.
ii.
Knowledge about the facilities available in the area
iii.
Knowledge about socio-economic status, cultural beliefs, etc.
It may not be possible; to know everything about the area. Some informa
tion is required before wo start and more can be collcctodjinformally
as wo work.
B~
Baseline data and records:
We have: described the collection and usefulness of baseline data
in a previous handout. This data is important as wo cam not only plan
our services but also evaluate our work. As explained in another handout,
records maintained for ongoing programme are also necessary for evaluating
our work.
C-
A well planned programme:
If we ask ourselves the right questions as stated .in tho beginning
part of this paper, it will be clear to us where we want to go. What wo
want to achieve through our programme and activities will also bo clearer.
D-
Village diary:
This is a record of the events as wo observe during our village
visits. This also contains a report of tho various village mootings hold
and decisions taken. This is a useful way of finding out if there has
been any change in the attitude of the village people towards us, whether
there has been any changes in some of tho cultural practices, etc. These
attitudes are hard to assess in statistical terms but they are much more
important than statistical data.
E-
Minutes of the team meeting, records of tasks each member is
supposed to do.
F-
Open-mindedness:
Finally we need to be open enough to look at our work critically
and objectively. If an activity we have put our heart and soul in, does
not turn out to be of much value, wo should be able to accept it, loam
from the failure and change our direction if necessary.
IV
* TO SUMMARIZE
The purpose of an evaluation is to find out if
-
- the activities of the programme aro meeting the most; important
neods of tho people
- the- activities aro satisfactorily mooting tho noods
- the people of the community aro involved in tho programme ■ .
- there has been any unforeseen harmful side effect
- the result justifies the cost.
Answers to these questions will holp us to decide if our programme
has been of value and whether we should continue, modify or change tho
activities.
1
C-9/244(c)
m:13.12.82
:8:
SECTION
II
So far, we have discussed the methodology of evaluating a community
health programme. Three basic issues, however, still remain to be examined.
We shall discuss these one by one.
I - THE ROLE OF AN EXTERNAL EVALUATOR
It is unfortunate that normally evaluation is associated with an
outside evaluator and many C H. programmes wait for an outside "expert"
to evaluate their work. It is the function and responsibility of each
member of the team to evaluate his/her work and the team's work.
Ideally in Community Health the evaluation must be carried out by
the team members along with the people of the vil]age. Since they have
been involved right from the beginning they would be in a better position
to say if some of the attitudes and practices have changed over the time
period. Evaluation should be built into on-going management of a C.H.
programme.
Evaluation carried out by outside experts is a particularly
threatening situation and explains much of the resistance to evaluation.
The word "evaluation" itself has come to be very emotional for many
people, as are words like "police". But if it becomes a management tool
controlled by those involved, this throat is removed.
This does not mean that there is no role for external evaluation.
Fresh and possibly, more objective insights, brought in by external
evaluators, can be useful, provided there is a viable mechanism for
feedbak into the decision-making process. Lack of such feedback is
usually the main problem in external evaluations.
II
-
OBJECT IV TTY
There is an assumption that evaluation must be scientifically
objective. Such an assumption implies a lack of involvement in and
commitment to a programme. But being part of a programme is not only
compatible with objectivity but it is essential for a sympathetic under
standing of the objectives and problems of th-:, programme.
•yc.j
■
’
' .
•’
i :.
Furthermore, it is increasingly clear that there is no such thing
as objective, evaluation. Objectivity tends to bo defined within the limits
of the priorities and perceptions of the evaluators. Decisions about the
information to be collected, choice of samples, selection of criteria,
relative weighting, methods of statistical treatment and presentation of
results all involve value judgements which need to be stated clearly.
There is another trend in evaluation in the health field; a
tendency to reject information which is not in the form of hard statistical
data. Some of the most important aspects of a programme may not be mea
surable. Tn the words or one social scientist, "Truth in the field of
human affairs is better approximated by statements that are rich with a
sense of human encounter". Too rigid an evaluation framework may turn
out to be mistaken. Evaluation can yield new questions as it is carried
out provided investigators have an open mind. A sense of open inquiry and
a willingness to learn must be encouraged.
Ill
-
EVALUATION FOR WHOM
In considering an evaluation, very important questions are : Who is
the evaluation for ? Whose questions will ba answered ? Are they those
of the external funding agency ? The programme managers or top level
planners ? The health workers involved at the intermediate and field
levels ? The beneficiaries themselves ? Which beneficiaris ? The poor ?
C-9/244(c)
m: 13.12.82
The women ? All these groups have a right to ask questions. There may be
overlapping interests, but the questions each group considers important
are likely to differ. The emphasis today on a participatory approach to
evaluation recognizes that investigators and their subjects perceive .
different realities. It is arrogant, exploitative and counter-productive
for researchers, funding agencies or health planners alone to determine
what should be investigated. All have their biases and value systems.
Some would argue that if different'groups have such conflicting interests,
then agreement among professionals, managers and consumers is unlikely in
the real world. When resources are scarce, there is likely to be consi
derable conflict on how they should be used. Much depends on who defined
the health needs, but no voice, such as women. This conflict is one
reason why objectives and targets are so often ill-defined. Hidden con
flicts are manageable if they remain vague, incoherent and mystified. To
sharpen them would be to expose these conflicting interests. While
agreement is a goal, it should bo recognized that different people have
different perceptions of need and objectives. Those concerned about
evaluation must be sensitive to different groups, particularly those who
have few means to tell their needs.
The people themselves will want to ask many questions. Are they
getting what they think they need from this health programme ? What do
they really need ? Has anything improved for them ? Do less children
die each year ? Are there less poor people in their community ? How is
sickness contributing to their poverty ? What can they themselves do to
change the situation ? How can they get moro power to influence tho
decisions about getting public resources ? Priorities regarding the
various interests served by the evaluation must be known at the beginning.
Evaluation for whom ? Whose indicators ? Whose objectives ?
Note:
This paper has been prepared keeping in mind the requirements
for a small community health programme. We have therefore not
gone into the question of selecting control population, samples,
etc. We have also not talked about how to use rates as indi
cators of change as it is not applicable to a small population.
Acknowledgements:
1.
"International Health and Measuring Progress" Proceedings,
1980 International Health Conference, June 11-13, 1980.
Published by the National Council for International Health,
Washington.
2.
"On Being In Charge" - A guide for Middle Level Management
in Primary Health Care: by McMohan, Barton & Piot :
Published by WHO, Geneva.
EEALTg STATUS? IN TgE CQNTpXl >F INDIAN SOCIETY
(Formator Seminar : 11—12 Dec. 1933)
1
Major features >f the system pf health care services
1.
Ignoring the indigenous belief systems, life-styles and health care
institutions and practices which farmed an organic unity and the
introduction »f the western system of medicine in toto.
2.
Urban-biased, top-down (trickle down theory) and elite-oriented
approach of the British period still continues to dominate the
health services. The bilk of the expenditure on these services is
still incurred in urban centres, their benefits largely in favour
cf upper and middle classes. They still fail to reach the
periphery i.e. the poor and outlying villages.
3.
The •verwhelming curative orientation of the health services still
continues to dominate to the neglect «f promotive and preventive
programmes.
4.
Most of the 6000 hospitals and 450,000 beds are in towns and cities
and consume substantial proportion of the funds available.
5.
The system is highly centralized and bureaucratized so that it is
not able to cope with problems of distance nor to organize good
referral services.
6.
The system depends too much on doctors who lack the right type of
training and orientation and are not willing to work in rural areas.
7.
The system is highly medicalised. Injections and drugs are becoming
status symbols of a consumer society.
8.
The cultural alienation of the medical profession has led to over
sophistication and mystification.
9.
The over-production of drugs and doctors has created a vested interest
in the continuance or expansion of ill-health.
10.
There is no involvement of the community.
11.
The roles of the private and the public sector are not clear and
the overwhelming profit motive of the private sector both medical
and pharmaceutical .vitiates the entire medical system.
12.
In brief after independence we have followed a linear expansion of
the .medical system initiated by the British to suit their colonial
interests! Efforts at improving training, organisation and adminis
tration of this system cannot bear fruits. The meagre results
obtained during the past 36 years point to the futility and wastefulness
of continuing in the same direction. The basic principles and
approaches are to be questioned and alternatives appropriate to the
life and needs of'tho people are to be thought of creatively and a
new model of health care services has to be created.
Ashirvad a/5
2
LI. Basic Principles and Approaches of the Alternative Model
1.
The urban biased, centralized, bureaucratic, cver-pr<fessionalized
top-down approach should be abandoned and health care services
tn. uld strongly be based in the connunity so that people could be
intensively involved in planning and implementing programmes for
their own health care.
I 2. Most of the problems (preventive, proactive and sinple curative
health problens) oust be taken care of by the connunity itself and
none than half of the expenditure on health services should be
incurred within this community. From. here health services should rise
to the top (referral, specialised and super-specialised s’ervices
at the district, state and national levels.)
J. Health volunteers from the connunity (CHV) can effectively undertake
nany functions done by paranedical and even nedical personnel.
4. Out of the per capita expenditure of Rs.JO/-, Rs.19/- will be spent
within the connunity, sc that the connunity becomes the heart of the
system and not its periphery.
5. Over-emphasis on large hospitals (high cost-low efficiency) to be done
away with by establishing a small community hospital of about JO beds
in every community of 100,000 people. ’General specialists' could
tackle most of the health problems. The present Primary Health
Centres (PHC) lack the facilities of a hospital and so are under
utilized. So they are no substitute for the efficient community
t.‘ spital.
6.
Proactive, preventive and curative functions be integrated at all
levels of the alternative system (District, CHC, sub-caste and
village centre)
7.
Redefine the role of the doctor and drugs in this new model.
8.
A model in which people will be considered as subjects of health and
would be democratic, decentralised and participatory i.e.-people
will be in charge at different levels to manage health care services.
It implies that the people will have the political right to control
then effectively(i,e. financial and administrative control)
9.
Give a national orientation by critically incorporating the culture
and traditions of the people as well-as the positive elements in
other cultures into our system of health care.
10.
Provide adequate support to the different systems of indigenous
medicine. Make use of the- JOO,000 registered practitioners of tho
indigenous systems and probably an equal number of ncn-registored
practitioners in the development of the national health care system.
11.
All nedical colleges should have courses in other systems sc that
an integrated multi-system care be provided and a national system
emerge on the long run.
12.
Adept an economical model, yet spend liberally sc that the genl of
health for all
realised by 2000 A.D.
Ashirvad A/5
3
III.Reccmmendaticns cf the Committee cn 'Health for All: An Alternative strategy'
We therefore cake the following rvccmnendaticns;
1.
The Government cf India shculd, in consultation with all concerned,
formulate a comprehensive national policy on health dealing with all its
dimensions, viz., philosophical and cultural, socio-economic, nutritional,
environmental, educational, preventive and curative. The -coordinated and
planned ’.plementation of this policy shculd be the collaborative and
cooperative responsibility cf individuals, families, local communities,
lealth personnel and State and Central Governments.
2.
The basic objectives of this policy should be
a)
to integrate the development of the. health system with the overall
plans of socio-economic-political transformation;
b)
to ensure that each individual has access to adequate food and is
provided with an environment which is conducive to health and adequate
immunization, where necessary;
c)
to devise an educational programme which will ensure that every
individual has the essential knowledge, skills and values which would
enable him to lead an effectively healthy life and to participate
.1
meaningfully in understanding and solving the health problems of
the family and the community.
d)
to- replace the existing model of health care services by an alternative
new model which will be
-combining the best elements in the tradition and culture of the people
with modern science and technology,
-integrating promotiye, preventive and curative functions,
-democratic, decentralised and participatory,
—oriented to th. people, i.e. providing adequate health care to every
individual and taking special care of the vulnerable groups,
-economical, and
-firmly rooted in the community and aiming at involving the people in the
provision of the services they need and increasing their capacity to
solve their own problems, and
e)
to train the personnel, to produce drugs and materials and to organise
research needed for this alternative health care system.
5^ a detailed time-bound programme-.should be prepared, the-needed administra
tive machinery created and finance provided cn a priority basis so that
this new policy will be fully implemented and the goal cf "Health for
All" be reached by the end of the century.
Ashirvad
A/5
HEALTH STATU? TN TgE COHTEM
INDIAN SOCIETY
(Foi-nstor. Seminar : 11 - 12. Dec" !983)
I
Major feature^ toe ^st^n^f
care services
1. Ignoring the indigenous belief systems, life-styles and health care
institutions and practices which formed an organic unity and the
introduction ef the western system of medicine in toto.
2.
Urban-biased, top-down (trickle down theory) and elite-oriented
approach of the British period still continues to dominate the
health services. The bulk of the expenditure on these services is
still incurred in urban centres, their benefits largely in favour
of upper and middle classes. They still fail to reach the
periphery i.e. the peer and outlying villages.
3.
The overwhelming curative orientation of the health services still
continues to dominate to the neglect of promotive and preventive
programmes.
4.
Most of the 6000 hospitals and 450,000 beds are in towns and cities
and consume substantial proportion of the funds available.
5.
The system is highly centralized and bureaucratized so that it is
not able to cope with problems of distance nor to organize good
referral services.
6.
The system depends too much on doctors who lack the right type of
training and orientation and are not willing to work in rural areas.
7.
The system is highly medicalised. Injections and drugs are becoming
status symbols of a consumer society.
8.
The cultural alienation of the medical profession has led to over
sophistication and mystification.
9.
The over-production of drugs and doctors has created a vested interest
in the continuance or expansion of ill-health.
10.
There is no involvement of the community.
11.
The roles of the private and the public sector are not clear and
the overwhelming profit motive of the private sector both medical
and pharmaceutical .ptiates the entire medical system.
12.
In brief after independence we have followed a linear expansion of
the medical system initiated by the British to suit their colonial
interests. Efforts at improving training, organisation and adminis
tration of this system cannot bear fruits. The meagre results
obtained during the past 36 years point to the futility and wastefulness
of continuing in the same direction. The basic principles and
approaches are to be questioned and alternatives appropriate to the
life and needs of the people are to be thought of creatively and a
new model of health care services has to be created.
Ashirvad a/5
2
II . Basic Principles and Approaches of the Alternative Medel
1. The urban biased, centralized, bureaucratic, cver-pr<fessicnalized
tep-dewn approach should be abandoned and health care services
L.^uld strongly be based in the ccnnunity so that people could be
intensively involved in planning and implementing programmes for
their own health care.
?2. Most cf the problens (preventive, proactive and simple curative
health problens) must be taken care of by the community itself and
□ore than half of the expenditure on health services should be
incurred within this ccnnunity. Fret', here health services should rise
to the top (referral, specialised and super-specialised services
at the district, state and national levels.)
3.
Health volunteers from the community (CHV) can effectively undertake
nany functions done by paramedical and even medical personnel.
4.
Out cf the per capita expenditure of Rs.JO/-, Rs.19/- will be spent
within the connunity, sc that the ccnnunity becomes the heart cf the
systen and not its periphery.
5.
Over-enphasis on large hospitals (high cost-low efficiency) to be done
away with by establishing a snail community hospital of about JO beds
in every connunity of 100,000 people. 'General specialists' could
tackle cost of the health problems. The present Primary Health
Centres (PHC) lack the facilities of a hospital and so are under
utilized. So they are no substitute for the efficient ccnnunity
hospital.
6.
Promotive, preventive and curative functions be integrated at all
levels of the alternative systen (District, CHC, sub-caste and
village centre)
7.
Redefine the role of the doctor and drugs in this new model.
8.
A nodel in which people will be considered as subjects of health and
would be democratic, decentralised and participatory i.e. people
will be in charge at different levels to manage health care services.
It inplies that the people will have the political right to control
then effectively(i.e. financial and administrative control)
9.
Give a national orientation by critically incorporating the culture
and traditions of the people as well as the positive elements in
other cultures into cur system of health care.
10.
Provide adequate support tc the different systeims of indigenous
medicine. Make use cf the 300,000 registered practitioners of the
indigenous systems and probably an equal number of ncn-registored
practitioners in the devel pment cf the national health care system.
11.
All medical colleges should have courses in other systems sc that
an integrated, multi-system care be provided and a national system
emerge on the long run.
12.
Adopt an economical model, yet spend liberally sc that the goal cf
health fcr all te realised by 2000 A.D.
Ashirvad a/5
3
III.Recommendations cf the Gcmm.ittee cn 'Health for All; An Alternative Strategy'
We therefore make the foil-owing rcccmendaticns;
1. The Government cf India shculd, in consultation with all concerned,
formulate a comprehensive national policy on health dealing with all its
dimensions, viz., philosophical and cultural, socio-economic, nutritional,
environmental, educational, preventive and curative. The coordinated and
planned : xplementation cf this policy shculd .be-the.collaborative and
cooperative responsibility cf individuals, families, local communities,
lealth personnel and State and Central Governments.
The basic objectives of this policy should be
2.
a)
to integrate the development of the health system with the overall
plans cf socio-economic-political transformation;
b)
to ensure that each individual has access to adequate food and is
provided with an environment which is conducive to health and adequate
■ immunization, where necessary;
c)
to devise an educational programme which will ensure that every
individual has the essential knowledge, skills and values which would
enable him to lead an effectively healthy life and to participate
.i
. meaningfully in understanding and solving the health problems of
the family and the community.
d)
to replace the existing model of health care services by an alternative
new model which will be
-combining, the best, elements in the. tradition and culture of the. people
with modern science and:.technology,
-integrating promotive, preventive and curative functions,
-democratic-,, .decentralised and- participatory,
—-oriented to th' people, i .e.-providing adequate health care to every
individual and taking special care of the vulnerable groups,
-economical, and
-firmly rooted in the community and aiming at involving the people in the
provision of the services they need and increasing their capacity to
solve.their own problems, and
■
•
e)
to train the personnel, tc produce drugs and materials and tc organise
research needed for this alternative health care system.
3• a detailed time-bound programme should be prepared, the needed adninistrative machinery created and finance provided cn a priority basis, so that
this new policy will be fully implemented and the goal cf "Health for
All" be reached by the end1of the century.
Ashirvad
A/5
HEALTH STATUS IN.THE CHjTJSX'l
iF INDIAN SOCIETY
(J’oi^tor.. Seminar : 11 - 12 Dec. 1985)
I
features^ ^ system
servicos_
!• Ignoring the indigenous belief systems, life-styles and health care
institutions end practices which f-rmed an organic unity and the
introduction rf the western system of medicine in toto.
2.
Urban—biased, top-down (trickle down theory) and elite-oriented
approach of the British period still continues to dominate the
health services. The bulk of the expenditure on these services is
still incurred in urban centres, their benefits largely in favour
of upper and middle classes. They still fail to reach the
periphery i.e. the poor and outlying villages.
3.
The (overwhelming curative orientation of the health services still
continues to dominate to the neglect cf promotive and preventive
programmes.
4.
Most of the 6000 hospitals and 450,000 beds are in towns and cities
and consume substantial proportion of the funds available.
5.
The system is highly centralised and bureaucratized so that it is
not able to cope with problems of distance nor to organize good
referral services.
6.
The system depends too much on doctors who lack the right type of
training and orientation and are not willing to work in rural areas.
7.
The system is highly mcdicaliscd. Injections and drugs are becoming
status symbols of a consumer society.
8.
The cultural alienation of the medical profession has led to over
sophistication and mystification.
9.
The over-production of drugs and doctors has created a vested interest
in the continuance or expansion of ill-health.
10.
There is no involvement of the community.
11.
The roles of the private and the public sector are not clear and
the overwhelming profit motive- of the private sector both medical
and pharmaceutical . ^.tiates the entire medical system.
12.
In brief after independence we have followed a linear expansion of
the medical system initiated by the British to suit their colonial
interests. Efforts at improving training, organisation and adminis
tration of this system cannot bear fruits. The meagre results
obtained during the past 5° years point to the futility and wastefulness
of continuing in the same direction. The basic principles and
approaches are to bo questioned and alternatives appropriate tc the
life and needs of the people are to be thought of creatively and a
new model of health care services has to be created.
Ashirvad a/5
f
2
LI. Basic Principles and Approaches of the Alternative Model
1. The urban biased, centralized, bureaucratic, cver-pr<fessicnalized
tep-dewn approach should be abandonee and health care services
Liquid strongly be based in the connunity so that people could be
intensively involved in planning and inplementing programmes for
their own health care.
r'2. Most of the problems (preventive, proactive and sinple curative
health problens) nuet be taken care of by the connunity itself and
acre than half of the expenditure on health services should be
incurred within this community. Free. here health services should rise
tc the top (referral, specialised and super-specialised services
at the district, state and national levels.)
J. Health volunteers fron the community (CHV) can effectively undertake
nany functions done by paranedical and even nodical personnel.
4. Out of the per capita expenditure of Rs.30/-, Rs.19/- will be spent
within the community, sc that the community beccnes the heart of the
systen and not its periphery.
5. Over-emiphasis on large hospitals (high cost-low efficiency) to be done
away with by establishing a snail community hospital of about 30 beds
in every coimunity of 100,000 people. 'General specialists' could
tackle nost of the health problems. The present Prinary Health
Centres (PHC) lack the facilities of a hospital and so are under
utilized. So they are no substitute for the efficient community
hospital.
.
'
6.
Proactive, preventive and curative functions be integrated at all
levels of the alternative systen (District, CHC, sub-caste and
village centre)
7.
Redefine the role of the doctor and drugs in this nevi nodel.
8.
A no-del in which people will be considered as subjects of health and
would be denocratic, decentralised and participatory i.e. people
will be in 'charge at different levels to nanage health care services.
It inplies that the people will have the political right to control
then effectively(i.e. financial and adninistrative control)
9.
Give a national orientation by critically incorporating the culture
and traditions of the peox-le as well as the positive elements in
other cultures into cur systemi of health care.
10.
Provide adequate support tc the different systems of indigenous
medicine. Make use of the 300,000 registered practitioners of tho
indigenous systems and probably an equal number of ncn-registcred
'practitioners in the devel. pnent of the national health care system.
11. All nedical colleges should have courses in other systens sc that
an integrated uulti-systen care be provided and a national system
energe on the long run.
12. Adept an economical nodel, yet spend liberally sc that the goal cf
health for all
realised by 2000 A.D.
Ashirvad A/5
3
ill.Recc:nnendations of the Committee cn 'Health for All; An Alternative fatrategy'
We therefore make the following. recommendations:
1. The Government cf India should, in consultation with all cincerned,. .
f emulate a cooprehensive national policy on health dealing with all its
dimensions, vi.z., philosophical and cultural, socio-economic, nutritional,
environmental, educational, preventive and curative. The coordinated and
planned Iplementation of this policy should be the collaborative and
cooperative responsibility of individuals, families, local communities,
health personnel and State and Central Governments.
2. The basic objectives of this policy should be "
a) to integrate the.development of the health system with the overall
plans of socio-eConcmic-political transformation;
b) to ensure that each individual has access to adequate feed and is
provided with an environment which is conducive to health and adequate
. immunisation, where necessary;
c)
to devise an educational programme which will ensure that every
individual has the'essential knowledge, skills and values which would
enable him. to lead an effectively healthy life and to participate%
.i
meaningfully in understanding and 'solving the health problems of
the family and the community.
d)
to replace the existing model of health care services by an- alternative
.new model which will be
-combining the best elements in the tradition and culture of the people
with modern science and technology,
-integrating promotive, preventive and curative functions,
-democratic, decentralised and participatory,
—oriented to th: people, i.e. providing adequate health care to every
individual, and taking special care of the vulnerable groups,
-economical, and
-firmly rooted-in the community and aiming at involving the people in the
provision of the services they need and' increasing their capacity to
I
solve their, own problems, and
e)
to train the’personnel, to produce drugs and materials and tc organise
research needed for this alternative health care system.
3- u detailed tine-bound programme should be prepared, the needed administra
tive machinery created and finance provided on a priority basis sc that
this new policy will be fully implemented and the goal cf "Health for
All" be reached by the end cf the century.
...ii
Ashirvad
A/5
HEALTH STATUS IN THE CONTEXT OF INDIAN SOCIETY
C.R.I. Session
Ashirvad
J anuary 1984
A reading list:
1. Health For All - an alternative strategy
ICMR/iCSSR Report
Rs.18.00
(1981)
2. The Quest for Health, ed. J.C.
McGilrray (1979)
3.
Statement «f National Health Policy
Government of India (1982)
4.
Health Care - Which way to go ?
Ed. Abhay Bang & Ashvin Patel,
MFC (1982)
Rs.10.00
5.
In Search »f Wholeness --- Healing and Caring
Contact : Special Series No. 2. June 1979
6.
The New Orientation of Health Services, with respect to Primary Health
Care Work
Cor Unum, 1976.
7.
Community Health Programme - a new vision and philosophy
CHAI, 1985.
8.
Church and Social Justice
fatan Lourdusamy,
9.
C.S.A. 1979-
Rs.4.00
Health Care in India
George Joseph, John Desrochers, Mariamma Kalathil
C.S.A.
10.
1985
Rs.4.00
Rethinking the Healing Ministry of the Indian Church
Jacob Chand,
CISRS,
CLS
Madras 600 005 (1970)
Nos 1-5 available from
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110 016
Nos 6-7 available gratis from
Community Health, Department
Catholic Hospital Association of India
CBCI Centre
Goldakkana
New Delhi IIP 001
Nos 8-9 available from ■
Centre for Social Action
Gundappa Block
64, Pemme Gowda Road,
Bangalore 560 006
Ashirvad a/8
SOLVING PROBLEMS AND MAKING DECISIONS
When a group (or an individual) is faced with solving a
problem or making a decision, there are five steps which can
be followed. These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they will also lead to a better final decision.
1•
Define the problem
Ksk yourselves "What is the real problem before us?" If
you cannot agree on what the problem is, you certainly will
not agree on the solution!
A clearly-defined problem is
already a great help towards a solution.
What appears to be the problem may be only a superficial
sympton.
Underneath there may be larger and deeper issues.
Express the problem in "How to..." terms.
Do not say,
’the problem ife moderating discussion .,
ut, '■ The problem is
h'ow to learn to moderate discussions effectively'.
2.
COLLECT POSSIBLE SOLUTIONS
fisk yourselves, 'what are the possible solutions to
this problem?" Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
kThe process is similar to 'brain-storming';.
It is important to separate the collecting of ideas in
this step from evaluation: The evaluation should come only
in the third step.
If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible.
Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.
• Evaluate the possible solutions and choose the best
Ask yourselves, "Of ull the alternatives we have listed,
which is the best solution?"
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group. This will help in the completed examination
of every possibility.
Beware of easy agreements-they
probably have not been thought through completely.
At the
same time, avoid being defensive or making others feel
defensive. Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision.
Ask yourselves, 'loes
this decision accomplish our purpose? Will it effectively
solve the problem?" The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
af terwards!
-2Consider whether the group itself is ready to make a
decision.
Sometimes groups (like individuals) need time to
'think over' a decision before finally making it.
4. Implement the decision
Decide on the steps for implementing the decisions. Ask
yourselves, :,uho is going to do what? When? How? Be sprcific
plot names against actions.
A decision which does not include details of how the
decision is to be implemented may be ineffective and even
useless.
Lots of good ideas are never translated into action
because their implementation is not taken care of
As well as deciding who will do what, when and how, there
may be other questions, such as, ‘who else should be informed
of this decision?.
5. Follow-up
Ask yourselves, ''How will we check on how this decision
is working in action?"
It is important that the group decides
at the time they make the decision how they are going to
arrange for follow-up and feedback.
Sources McGrath, E.H., Basic Managerial Skills for All,
XLRI, Oamshedpur, 1978.
PEOPLE IN DEVELOPMENT- A Trainer’s Manual for
groups John Staley.
Training Pa
V11
PrcParcd by
f'on>mun)(y
tinnier/ fie;; *** TMm
C-9/244(c)
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EVALUATION
CF
A
r'4’1
PRCGRAfW Qcn
—---------------------------------------------------
SECTION
/ ^eQ[fe s D
1'< iU 016
•
•
I
Evaluation is a procsss by which the outcone (result) of an
activity is judged. By judging the outcome we can decide wh-sther the
activity should be continued, modified or stopped. Therefore evaluation
is a tool that helps us to work in a better way.
For evaluation to be
of use we must have an open mind to be critical about our own work. We
must also be willing to learn from past mistakes.
When to think of evaluation
Evaluation of a programme is a continuous process. It begins as
we are making our plans. This is to help us to bo sure that activities
we plan are related to the needs wo want to meet. We will need to
evaluate at regular intervals during the implementation of the programme
to soe if we ar ongoing in the right direction or need to mate any change.
At the end of an activity we will want to evaluate to know if we have
reached the desired result.
I - EVALUATION WHEN PLANNING A PROGRAMME
When we plan any activity we usually have some idea as to what
we hope to achieve through this activity. Very often the idea may be as
vague as "We want to improve the health of the people". This statement
is too general and is difficult to evaluate, A bettor way is to state in
more specific terms how we. are going to improve the health status and how
we are going to measure this improvement in the health status. For
example, we all know that infant mortality rate (IMR.)
*
is very high in
our country. Our country cannot be c-al led healthy unless we reduce the
IMR. In other words a reduction in IMR shows (indicates) an improvement
in the health status of the population. Measuring the reduction in IMR
automatically means a measurement of health status. Infant mortality
rate is therefore called a health indicator. Other examples of health
indicators are maternal mortality rate and morbidity rate.
From the above it is clear that if we want to evaluate our pro
gramme we will have to be clear at the time of planning
- what we hope to achieve through the activity
- how we are going to meansure the achievement.
Going back to our example of IMR, we all know that more children die in
families with poor income. So when we say that we want to reduce IMR
we- are indirectly saying that wc will focus our attention on the infants
who come frJtP/S^milies. The infants from poor families are now our
target group. x
If we do not ask ourselves the right questions at the time of
planning, we are bound to meet problems at a later stage. While pl anning
a programme the following questions should be kept in mind.
- Is the proposed programme directed to an important
problem of the community ?
- Is this problem a real priority with the people ?
- How much of the problem does the programme plan to solvo ?
- How effective do we expect the planned activities to be
in solving the problem ?
* Infant Mortality Rate is the number of deaths in children
below one year of age per 1000 live births.
2.
—
C-9/244(c)
m:13.12.82
:2:
- What desirable and undesirable side effects can bo
anticipated?
- Hot are we going to involve the village people in the
activities ?
- How much will the programme cost to achieve the results ?
- Who is going to meet the cost of the programme ?
Good planning helps in the evaluation of the programme.
II
- EVALUATION DURING THE IMPLEMH'iTATIOM CF.THS 2KD1RAMME
Here, we are trying to judge the outcome (result) of an activity.
Depending on the activity we could evaluate it at frequent intervals
during the activity and also once at the end of the activity.
What Do We Want to Evaluate
A-
Effectiveness of the services:
In order to measure the effectiveness of the services it is neces
sary to measure the extent to which people- get tho services that were
planned to meet their needs. We would also have to decide whether the
services have been of real benefit.
For example, in our village we may have found that the incidence of
whooping cought is very high. We may have decided to immunize all tho
under five children with DPT. After one year of tho programme we want to
evaluate the effectiveness. For this we would have to find :
- the total numbar of under five children who received all
the 3 dsos of DPT at the correct interval
- the total number of under five children in tho vil1 ago.
On the basis of this, we. can calculate the percentage coverage.
village
Total number of Under Five immunized in/ y
Percentage coverage of DPT= Total number of U.F, in v~i 11 ago r.
This gives us an indication as to how effectives our coverage is, i.e.
the total percentage of children receiving the 3 doses of DPT at the
"orrect interval.
But our immunization programme can be said to be of benefit only
if we are ablo to show that it has significantly roducod tho incidence
of whooping cough; in the area. To find out this we would have to know :
- how many cases of whooping cough were there in the year
before tho immunization programme ?
- how many cases there were in tho year following tho .
•immunization programme ?
Supposing we have immunized at least 90% of the under five children in
the project area with DPT but the incidence of whooping cough has not
come down, we would then have to find out - whether the time interval between doses was correct ?
- whether all the 3 doses were given ?
- was the vaqcine kept undc-r tho necessary conditions ?
3
G-9/244(c)
m:13.12.82
:3:
B-
The process by which the result was achieved;
The main thrust in a Coramunity Health Programme is to organize the
community to make a collective-, effort towards improving the health status.
The same result can be achieved in different ways. But each way will be
qualitatively different.
For example, in village A, there is lack of clean drinking water.
Due to this lack of clean drinking water there are many cases of diarrhoea.
Mow this village needs a tube well. There are many ways in which the
village can get a tube well.
- the health team can apply to a funding agency for money
and dig the well;
- the vi.ll age people can write up a petition to the BDO
for a tube-well;
- the village people can contribute part of the expenses
(either cash or labour) to supplement the cost;
- the village people could wait for 2000 AD (when there
will be health for all).
"
Applying to a funding agency is an easier way. It doesnot involve
much decision making or involvement at the community level. The health
team assesses the need of the village, writes to a funding agency and
gets the well dug. In this process the village people are merely passive
on-lookers.
Tn the second method, the writing up of a petition or sending a
delegation to the BDO will need the involvement of the village people.
Many meetings will have to bn called, the people will have to decide
on many issues (who should go, who should write the application, what
is the next step or action if BDO is not forthcoming). Going.to the BDO
also means the beginning of an initiative, a realization of their strength.
The process of dealing with the Government structure collectively might
itself become a great educational process. Probably the time taken for
the veil to be dug wi11 be much longer than in the earlier case but the
emergence of an organized group of people would have been worth it.
When we want to evaluate the process by which a result was achieved
the following questions should be kept in mind :
- Were the village people involved in any decision making
related to planning and implementation of the programme ?
- How many of the village people were involved in this decision
making and which group did they belong to ?
- What was the process of decision making ?
- Did the activity result in the emergence of an argani
action in the village ?
- Has the process of decision making followed in this activity
set an example for future activities ?
C- ,
Equity:.
Equity should be a primary focus of all health programme. So, the
question is not merely has health improved, but lias it improved for the
poorest section of the village ? How many of the most di sadva.nt.agod
group are covered by the programme ? How many of their children are
immunized ?
4.
C-9 /244(c)
m: 13.12.92
In Pushpa Health Centre, the daily OPD attendance was 60.
Patients came from far and wide and the dispensary was making good
income. But an analysis of the'OP records for one year showod that
70% of th? patients came from ohtsidc the target area and belonged
to the richer section. The dispensary staff wore spending 70% of
their time on rich people. The question before the staff was :
- Should they continue to spend so much time for the
rich people ?
Or
- Should they work in a different way so that the poor people
(who form 80% of the population) make better use of the
services ?
D-
Changes in behavioural patterns:
Many community health programmes spend more time collecting
numerical facts like the number of children immunized, the. number of
tube weLP dug, the number of mothers who got tetanus toxoid etc. While
numerical data is important, they are not necessarily the truo indicators
of change in a community. It is more important to assess attitudes and
changes in behaviour in the community. For example, if a V.H.¥. has
convinced a mother that her relatively healthy looking child is becoming
undernourished when he fails to gain weight, or if a traditional birth
attendant (dai) has started sending pregnant mothers for antenatal
checkups, great strides have been made towards changing the health status
in a community. We must remember that knewledge alone doos net change
attitudes and practices.
E-
Functioning of the health team:
A health team is a group of people working together to make health
care possible in a community. The members of a health team include all
those working together. For example, the supporting staff - a clerk, a
driver, a cleaner - are all part of the team. It is important that their
work and help they give be recognized as well as that of the medical
assistants, nurses and community workers;
People work well together when they agree with one. another.
i.
Do all the members in tho team know and understand tho objectives
of the organization ? (People who do not know what these objectives
are may waste a lot of time in other activities. People who don’t
agree with the objectives may obstruct the work of the organiza
tion).
ii.
Are the members involved in planning and carrying out tho
programmes ?
iii.
Are the members involved in decision making related to the major
issues (the direction the work should take, what activities must
be done) ?
iv.
Is work shared by all ?
v.
Are these responsibilities divided in the best way ?
vi.
How are the member and their work supervised ? Does supervision
take the form of support or is it done in an autocratic way ?
(i.e. do what you are told and-don't ask questions).
vii.
Is each person in the team treated with respect or is respect
given only to those in the decision making position (e.g. Doctor)
Does each person have specific work to do?
5.
C-9/244(c)
m:13.12.82
:6:
It is important for the health team to find out if the cost of
the programme was justified in vicsw of its results. As resources are
limited we must be careful to use them in a way that would benefit the
greatest number of people.
Two nurses decided to have a Community Health Programme which
was to cover 6 villages with a total population of 5000. The objec
tives of tho programme were worked out, with the people, of the- village
where the Nurses intended to start their programme. The total cost
(recurring cost) was estimatid as Rs. 30,600/- per year for tho 5000
people. This cost would cover the salaries of tho two nurses, the
doctor's salary while he would visit the villages, the stipends of 6
VHWs and the maintenance of a vehicle.
The nurses started their work in the first village which had an
average of 800 people. They got so much involved in that vi1 lags that
they never went to the other 5 vi11 ages which should have been part of
the programme.
At the end of three years the programme was evaluated. The :
result of the work was very positive; all children had been vaccinated
and had received Vitamin A treatment, the dais had been trained
the village had chosen three Village Health Workers, the VHWs had been
trained by the Nurses and the village premised to pay them once their
training was completed, and did it at the rate of Rs. 30/- per VHW
per month. So all seemed perfect.
But then, when evaluating the cost of the programme it was
realised that it had cost about Rs. 40/- per person per year (an
average of Rs. 200/- per family per year) to insure a minimal health
service in this village.
Considering the very limited financial resources available in
India can wo expect the people to bo able to meet tho cost of such a
programme ?
Tho two questions that the health team should ask arc :
- Could the same resources achieve bettor results ?
- Could tho same results bo achieved with loss resources ?
H-
Unforeseen side effects:
Side effects are generally unforeseen and can bo good or bad.
For example, a food for work programme was organizedin a vi11 age. The
The programme included the digging of wells for irrigation purpose.
The wells dug were good and thus land owners benefitted much from this
programme. It was now possible for the big land owners to have two
crops in a year. Unfortunately the majority of tho village people who
had no land were unable to make use of this programme. Tho poor people
in the village developed a fooling of hatred towards tho health team
and the health team could no longer work with the poor poople. In this
case, the side effect of the programme was bad.
In another village, the leaders chose a low caste woman to be
the VHW^ because they considered the tasks performed by a V.H.W. as
f'dirthy'. The health team was not happy with their choice because she
was illiterate. After one year tho health toam reali7 nd that the VHW
was able to bring about a considerable change in the low caste popula
tion of the village which also was the poorest section in that vi11 age,
Since the objective of the health team was to reach out to tho poor
people, this was achieved.
In this case the side effect of the programme was good.
7
C->9/244(c)
III
- WHAT DO WE REQUIRE TO BE ABLE TO EVALUATE OUR WORK
A-
Knowledge of the area before the programme was started:
i.
Knowledge regarding health situation - birth rate, infant morta
lity rate, morbidity rates etc. This information can easily bo
obtained from the PHO, DHO.
ii.
Knowledge about the facilities available in the area
iii.
Knowledge about socio-economic status, cultural beliefs, etc.
It may not be possible to know everything about the area. Some informa
tion is required before wo start and more can be collectodfinformally
as we work.
B-
Baseline data and records:
We have described the collection and usefulness of baseline data
in a previous handout. This data is important as we cam not only plan
our services but also evaluate our work. As explained in another handout,
records maintained for ongoing programme are also necessary for evaluating
our work.
C-
A well planned programme:
If we ask ourselves the right questions as stated in the beginning
part of this papsr, it will be clear to us where we want to go. What wc
want to achieve through our programme and activities will also bo cloaror.
D-
Village diary:
This is a record of the events as wo observe during our village
visits. This also contains a report of the various village mootings hold
and decisions taken. This is a useful way of finding out if there has
been any change in the attitude of the village people towards us, whether
there has been any changes in some of the cultural practices, etc. Those
attitudes are hard to assess in statistical terms but they arc much more
important than statistical data.
E-
Minutes of the team meeting, records of tasks each member is
supposed to do.
F-
Open-mindedness:
Finally we need to be open enough to look at our work critically
and objectively. If an activity we have put our heart and soul in, does
not turn out to be of much value, wo should be ablo to accept it, learn
from the failure and change our direction , if necessary.
IV
- TO SUMMARIZE
The purpose of an evaluation is to find out if
- the activities of the programme are meeting the most important
needs of the people
- the activities are satisfactorily mooting the needs
- the people of the community arc involved in the programme
- there has been any unforeseen harmful side effect
- the result justifies the cost.
Answers to these questions will help us to decide if our programme
has been of value and whether wc should continue, modify or change the
activities.
C-9/244(c)
m: 13.12.82
SECTION
II
So far, we have discussed the methodology of evaluating a community
health programme. Three basic issues, however, still remain to be examined.
We shall discuss these one by one.
I - THE ROLE OF AN EXTERNAL EVALUATOR
It is unfortunate, that normal ly evaluation is associated with an
outside evaluator and many C H. programmes wait for an outside "expert"
to evaluate their work. It is the function and responsibility of each
member of the team to evaluate his/her work and the team's work.
Ideal 1 y in Community Health the evaluation must be carried out by
the team members along with the people of the vil1 age. Since they have
been involved right from the beginning they would be in a better position
to say if soma of the attitudes and practices have changed over the time
period. Evaluation should be built into on-going management of a C.H.
programme.
Evaluation carried out by outside experts is a particularly
threatening situation and explains much of the resistance to evaluation.
The word "evaluation" itself has come to be very emotional for many
people, as are words like- "police". But if it boccmos a management tool
controlled by those involved, this throat is removed.
This does not mean that there is no role for external evaluation.
Fresh and possibly, moro objective insights, brought in by external
evaluators, can be useful, provided there is a viable mechanism for
fetdbak into the decision-making process. Lack of such feedback is
usually the main problem in external evaluations.
II
-
OBJECTIVITY
There is an assumption that evaluation must be scientifically
objective. Such an assumption implies a lack of involvement in and
commitment to a programme. But being part of a programme is not only
compatible with objectivity but it is essential for a sympathetic under
standing of the objectives and problems of the programme.
Furthermore, it is increqsingly clear that there is no such thing
as objective evaluation. Objectivity tends to be defined within the limits
of the priorities and perceptions of the evaluators. Decisions about the
information to be collected, choice of samples, selection of criteria,
relative weighting, methods of statistical treatment and presentation of
results all involve value judgements which need to be stated clearly.
There is another trend in evaluation in the health field; a
tendency to reject information which is not in the form of hard statistical
data. Some of the most important aspects of a programme may not be mea
surable. In the words or one social scientist, "Truth in the field of
human affairs is better approximated by statements that are rich with a
sense of human encounter". Too rigid an evaluation framework may turn
out to be mistaken. Evaluation can yield new questions as it is carried
out provided investigators have an open mind.
sense of open inquiry and
a willingness to learn must be encouraged.
Ill
-
EVALUATION FOR WHCM
In considering an evaluation, very important questions are : Who is
the evaluation for ? Whose questions will be answered ? Are they those
of the external funding agency ? The programme managers or top level
planners ? The health workers involved at the intermediate and field
levels ? The beneficiaries themselves ? Which beneficiaris ? The poor ?
c-9/244(c)
m:13.12.82
:9:
The women ? All these groups have a right to ask questions. There may be
overlapping interests, but the questions each group considers important
are likely to differ. The emphasis today on a participatory approach to
evaluation recognizes that investigators and thuir subjects perceive
different realities. . It is arrogant, exploitative and counter-productive
for researchers, funding agencies or health planners alone to determine
what should be investigated. All have their biases and value systems.
Some would argue that if different groups have such conflicting intorosts,
then agro ament among professionals, managers and consumers is unlikely in
the real world. When resources are scarce, there is likely to be consi
derable conflict on how they should be used. Much depends on who defined
the health needs, but no voice, such as women. This conflict is ono
reason why objectives and targets aro so often ill-dofincd. Hidden con
flicts are manageable if they remain vague, incoherent and mystified. To
sharpen them would be to expose these conflicting interests. While
agreement is a goal, it should bo recognized that different people have
different perceptions of need and objectives. Those concerned about
evaluation must be sensitive to different groups, particularly those who
have few means to tell their needs.
"
The people themselves will want to ask many questions. Are they
getting what they think they need from this health programme ? What do
they really need ? Has anything improved for them ? Do less children
die bach year ? Are there less poor people in their community ? How is
sickness contributing to their poverty ? What can they themselves do to
change tho situation ? How can thoy get moro power to influence the
decisions about getting public resources ? Priorities regarding the
various interests served by the evaluation must be known at the beginning.
Evaluation for whom ? Whose indicators ? Whose objectives ?
Note:
This paper has been prepared keeping in mind the requirements
for a small community health programme. Vie have therefore not
gone into the question of selecting control population, samples,
etc. We have also not talked about how to use rates as indi
cators of change as it is not applicable to a small population.
Acknowledgements:
1.
"International Health and Measuring Progress" Proceedings,
1980 International Health Conference, Juno 11-13, 1980.
Published by the National Council for International Health,
Washington.
2.
"On Being In Charge" - A guide for Middle Level Management
in Primary Health Care: by McMohan, Barton & Plot :
Published by WHO, Geneva.
Voluntary Health Association of India
C-14, Community Centre,
Safdarjung Development Area
New Delhi-110016
RECORDING CHANGES I
Telegrams : VOLHEALTH
New Delhi-110016
Phone : 652007, 652008
BASELINE SURVEY
When we did the baseline survey we found out many details about the
people of a village. However, things do not remain the same. The
population of a village is constantly changing. People leave the village,
some newcomers may settle in the village, people marry, children are born,
some people die. It is important that we record some of the above mentioned
changes so that we can have correct information about the villages in which
we are working.
What changes do we need to record:
This depends on the information that has been collected in the baseline
survey. According to the paper on the baseline survey given before, the
information to be recorded and a sample table to record this information
is given at the end of this paper.
How to maintain these records:
1.
In column 1, enter date on which you are recording a change.
2.
To record a change for a family, find out the name of the head of the
family and enter it in column !+. This will be the same as in the
baseline survey.
3.
See the serial Number given to this family in the baseline survey and
write this same serial number in column 2.
4.
In column 3, write the same House Number for the family as in the
baseline survey.
5.
If the head of the family'has changed write the name of the new head
of the family in column 5. If the previous head of the family has died,
enter death in column 8 also.
6.
If a new member joins the family permanently, eg: new daughter-in-law
comes to family, or any other relative comes to live permanently in
family, write number of additions to family in column 6 (a).
Also
write in remarks column if this person is under five, pregnant, etc.
7.
If a member of the family leaves the village permanently eg: daughter gets married and leaves village, or any other member leaves village
permanently, write number of people that have left family in column
6 (b).
Also write in remarks column if this person was an under-five,
a pregnant mother etc.
8.
If a child is born in the family enter in column 7.
9.
If a member of the family dies enter in column 8.
10,
If a new family comes to live in the village: turn to the section in
which you entered 4he baseline survey. Draw a line at the end of the
baseline survey and give the next serial number to the. new family.
Enter the details along the columns of the baseline survey.
11.
If a family leaves the village permanently fill in columns 1 to 4 and
write in the remarks column "left village".
12.
In remarks column enter details like death of any member of the family,
reason for death, and any other relevant information.
.....2/
2
When do we record these charges:
If we have trained Village. Health Workers, we should find out from them
if any changes have taken place in the village. In fact, they should
report changes to the health team regularly, atleast once in two weeks.
If we do not have VHWs then
we would have to collect this information
ourselves by systematically visiting each family atleast once in six weeks
*chtt:pt:26.8.'81
......... .......
Date
-1
Serial No.
M
House No.
Name of Head of the
Family
Name of NEW
Head of family
6
No .o f
Left family
members
Joined family
1
-J
Births
8
9
Maternal
REMARKS
1-5 yrs.
,.D B a T H S
0-1 yr.
Others
;
H -(-p9) A.
3 Weeks with 24 Courses in
Quantitative Medical Research
Rotterdam
The Netherlands
August 10 - August 28
1998
Programme and
course information
Biostatistics
Clinical Research
Epidemiology
Health Services Research
Human Genetics
Public Health
8th Erasmus Summer Programme
The 1998 Erasmus Summer
V
Programme
[The Erasmus Summer Programme
The Erasmus Summer Programme emphasizes an understanding of principles and
methods of quantitative medical research. Open to all health professions, the pro
gramme focuses on the basics common to all applied medical and health care research.
In addition, the programme provides courses for the particular interests of those in clin
ical medicine, general practice and public health as well as for epidemiologists, geneti
cists and biostatisticians. Six main areas are covered by the Erasmus Summer
Programme: biostatistics, clinical research, epidemiology, health services research,
human genetics and public health research. The first week provides introductory cours
es, the second week is devoted to methodology courses and the third week offers
advanced courses. It is possible to subscribe for 1, 2 or 3 weeks in a single discipline or
to mix and match courses from different disciplines in order to design your own indi
vidual programme.
Biostatistics
Clinical Research
A very important aspect of quantitative
medical and epidemiological research is
data-analysis. The courses on biostatis
tics and data-analysis provide a compre
hensive and thorough understanding of
the data-analytic methodology current
ly used. The course levels range from
introductory to advanced. The first
week provides for an introductory level
course and a more advanced course on
meta-analysis. In the second week an
extensive course on regression analysis
is given, and a course on survival analy
sis. The third week gives an advanced
course on statistical modelling in epi
demiology.
Clinical research increasingly depends
on quantification of risk, diagnosis,
prognosis and therapy. Knowledge
principles and techniques of the quar^J
tative approach used in clinical medicine
is indispensable for effective clinical
research. The courses on clinical research
will provide an in-depth treatment for
those with little background in statistics
and epidemiology. The first two weeks
of this course will focus on the method
ology of quantitative clinical research. In
the third week, the principles of experi
mental drug research will be treated in
depth.
2
Epidemiology
Human Genetics
As a science, epidemiology is fundamen
tal to clinical and community medicine,
and to public health. In combination
with basic medical science and clinical
research, epidemiology provides the
tools with which we can learn more
about the etiology and effects of dis
ease, the opportunities for prevention,
the cost and effectiveness of various
diagnostic and therapeutic approaches,
and the health status and risks of indi
viduals and populations. Introductory,
^jarmediate and advanced courses in
epidemiological research methods will
be presented in combination with
courses in clinical research, biostatistics,
human genetics and health services
research. This approach enables partici
pants to gain insight into the ways in
which the underlying epidemiological
principles are implemented in the vari
ous areas of medical research.
The courses on human genetics focus on
the principles and practice of genetics
with an emphasis on the statistical and
epidemiological aspects of genetic
research. The first week includes a gen
eral course on principles of research in
medicine with some examples from
genetic epidemiologic research. The sec
ond week has a course on genetic epi
demiology. The second week also pre
sents a course for those who wish to be
introduced into the basics of molecular
genetics. In the third week a course on
genetics of complex diseases will be
given.
Health Services Research
The quality, costs and benefits of thera
peutic and preventive measures are
hotly debated issues. Research in this
field is becoming increasingly significant
and will, in the near future more than
ever before, provide the foundation for
policy decisions in health care. Health
^rvices research is a multidisciplinary
Jlld which shares a common ground
with epidemiology, economics and med
ical management. The objective of the
courses on health services research is to
provide insight into the relationship
between these individual disciplines in
order to give an understanding of
research methods used in determining
and evaluating management, insurance
options and policy decisions.
Public Health Research
A series of courses is dedicated to public
health research methodology. Public
health research is a multidisciplinary
area with the health of populations as
the objective. The programme provides
for an introduction to public health in
the first week. The second week gives a
course on methods of public health
research in which study designs and
analytic methods specific to public
health research will be presented.
Further, a course on epidemiology and
health policy will show how epidemio
logical data and measures of effect can
be used for public health decision mak
ing. In the third week, a course on pub
lic health bridging research and practice
will deal with the translation of prob
lems in public health into research ques
tions, and of research results into public
health practice.
Course Schedule
Time
Week 1: August 10 - August 14, 1998
8:45 - 11:45
Principles of Research in
Medicine and Epidemiology
Albert Hofman
EBCGH P
13:00 - 16:00
Introduction to Data-analysis
Theo Stijnen
EB CG
Clinical Decision Analysis
Job Kievit and Jacobus Lubsen
C
Meta-analysis
Anders Ahlbom
Introduction to Health Services Research
Niek Klazinga
Introduction to Public Health
E BCP
H
E H I
Louise Gunning-Schepers
16:30 - 18:00
Introduction to Data-analysis
Theo Stijnen
Epidemiology for Clinicians
Albert Hofman
4
E B CG
August 10 - August 28, 1998
Week 3: August 24 - August 28, 1998
Week 2: August 17 - August 21, 1998
Regression Analysis
Stanley Lemeshow
E B CG P
EC
Methods of Clinical Research
Diederick Grobbee
Methods of Public Health Research
Johan Mackenbach
Molecular Genetics for Clinicians
and Epidemiologists
•tfer Heutink and Ben Oostra
Survival Analysis
David Kleinbaum
E BCG P
Advanced Study Design
Olli Miettinen
ECH P
E H P
Advanced Statistical Models in Epidemiology
David Clayton and Michael Hills
EGC
ECG
Genetics of Complex Diseases
Lodewijk Sandkuijl, Bertram Muller
and Cornelia van Duijn
EGC
H P
Medical Technology Assessment
Paul Kind and Frans Rutten
Public Health Bridging Research and Practice
Louise Gunning-Schepers
CE
Pharmaco-epidemiology
Bruno Stricker
Regression Analysis
Stanley Lemeshow
E BCG P
E H P
E BCG P
Survival Analysis
David Kleinbaum
E CH P
Genetic Epidemiology
Lodewijk Sandkuijl and Cornelia van Duijn
E G
Advanced Study Design
Olli Miettinen
Health Economics
Wijnand van de Ven and Eddy van Doorslaer
H P
Advanced Statistical Models in Epidemiology
David Clayton and Michael Hills
EGC
ECH
Genetics of Complex Diseases
Lodewijk Sandkuijl and Cornelia van Duijn
E GC
Advanced Medical Decision Analysis
Myriam Hunink
Design, Conduct and Analysis of Clinical Trials
Jan Tijssen
Epidemiology and Health Policy
Louise Gunning-Schepers
Genetic Epidemiology
Lodewijk Sandkuijl and Cornelia van Duijn
Conducting Epidemiologic Research
Erasmus Summer Lectures
E G
CE
H PE
E BCG H P
E CP
Deirdre van der Kuip
E = Epidemiology, C = Clinical Research; B = Biostatistics; G = H uman Genetics, H = Health Services Research; P = Public Health
5
Week 1: August 10 - August 14, 1998
The principles of quantitative research
8:45 - 11:45
Principles of Research in Medicine and Epidemiology
Albert Hofman
This course will provide an orientation to medical research from a quantitative and epi
demiological viewpoint. The course will give an introduction to the design of clinical
and public health research, and it will discuss measures of disease frequency and asso
ciation, and the validity of research in medicine. It will give an overview of elements of
data-analysis (15 hrs).
Prerequisites: none.
13:00 - 18:00
Theo
Introduction to Data-analysis
This course will concentrate on statistical methods for the well known clinical and epi
demiological frequency and effect measures, such as rate and risk, relative risk, risk dif
ference and odds ratio. Furthermore, Mantel-Haenzsel methods for stratified analysis and
simple survival analysis will be covered. The course will consist of lectures as well as prac
tical. In the latter an overview will be given of the main statistical computer packages
that are used in clinical and epidemiological research, and their relative merits will be dis
cussed. No prior experience with statistical programs or computers is required (22.5 hrs).
Prerequisites: some familiarity with basic statistical concepts.
13:00 - 16:00
Clinical Decision Analysis
Job Kievit, Jacobus Lubsen
This course will give a framework for optimal decision making in the clinical setting based
on probability theory and the rational use of available information. All theoretical princi
ples will be applied to decision problems involving the individual patient. The course will
provide for a practical on the use of decision making computer software (15 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology.
13:00- 16:00
Anders Ahlbom
Meta Analysis
The purpose of the course is to provide knowledge about various methods that can
used to synthesize the epidemiologic evidence on a particular topic. The course will
describe the different methods that are available and discuss their limitations and
underlying assumptions. Methods to obtain combined estimates on the assumption of
uniform effects across studies as well as approaches for non-uniform effects will be cov
ered. The course will emphasize issues related to differences across studies. The teach
ing will consist of lectures, exercises, and analyses and discussions of case studies. This
intermediate level course is intended forthose with experience in data-analysis (15 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology;
Introduction to data-analysis; Regression Analysis.
6
Week 1: August 10 - August 14, 1998
The principles of quantitative research
13:00 - 16:00
Introduction to Health Services Research
Niek Klazinga
This course provides a common starting point for all those who follow courses in the
area of health services research in the Erasmus Summer Programme. Case studies will be
used to illustrate the contribution to health services research of different disciplines,
such as epidemiology, economics and policy analysis. Topics which will be covered
include: needs and demands; health care utilization; equity and efficiency in the deliv
ery of health care services; outcome evaluation; quality assessment; economic evalua
tion; international comparison of health care systems (15 hrs).
•^requisites: none.
13:00 - 16:00
Introduction to Public Health
Louise Gunning-Schepers
Public health defined as the organized efforts of society to protect, promote and restore
the health of populations is a field in which many disciplines meet: medicine, econom
ics, law, social sciences, epidemiology, etc. In this course an introduction to public health
will be given in a historic context to illustrate the contribution of these different diciplines and to explore the different functions in which professionals in public health can
be expected to function (15 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology.
16:30 - 18:00
Albert Hofman
Epidemiology for Clinicians
This course will give an introduction to clinical epidemiology. The topics that will be cov
ered include risk (determinants of disease, pathogenesis), diagnosis (evaluation of diag
nostic tests), prognosis (prediction of disease outcome), and therapy (evaluation of effi
cacy and safety) (7.5 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology.
7
Week 2: August 17 - August 21, 1998
The methodology of quantitative research
8:45 - 16:00
Regression Analysis
Stanley Lemeshow
This intermediate level course aims at providing theoretical and practical training for
epidemiologists, clinicians and other professionals of related health disciplines in statis
tical modeling with particular emphasis on linear, multiple and logistic regression.
Included topics are: review of straight line regression and correlation, ANOVA for
straight line regression, appropriateness of straight line model, polynomial regression,
multiple regression analysis, partial F-test, dummy variables, statistical interaction, com
paring straight line regressions, analysis of covariance, the logistic regression model and
estimation and interpretation of its coefficients, goodness-of-fit, multivariate model^)
and statistical adjustment, interaction and confounding, stratified analysis via logisro
regression. The following texts will be used: Applied Regression Analysis and Other
Multivariate Methods by Kleinbaum, Kupper and Muller; Applied Logistic Regression by
Hosmer and Lemeshow (30 hrs).
Prerequisites: Introduction to Data-analysis.
8:45- 11:45
Methods of Clinical Research
Diederick Grobbee
This course develops the design of occurrence relations for clinical research problems of
diagnosis, prognosis and intervention. It also discusses the research methods for this.
The course will be based on real life clinical problems, and it will discuss a variety of
examples. The course will include a number of exercises (15 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology, or equivalent
knowledge.
8:45 - 11:45
Methods of Public Health Research
Johan Mackenbach
This course is intended to provide an introduction to a number of analytic methods and
study designs frequently used in public health research. Examples are: standardization
of morbidity and mortality rates; life table analysis; calculation of measures of associ^
tion and potential impact of relevance to public health; ecological studies and stud^j
of disease clusters; evaluation of cancer screening programmes. In addition, a number
of substantive issues will be discussed, such as inequalities of health; public health
aspects of ageing; and the causes of cancer. The course will be relevant to those who
have a basic knowledge of epidemiology, and who wish to start a career in public health
research (15 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology, or
equivalent knowledge.
8
Week 2: August 17 - August 21, 1998
The methodology of quantitative research
8:45 - 11:45
Molecular Genetics for Clinicians and Epidemiologists Peter Heutink, Ben Oostra
Molecular genetics plays an increasingly important role in medical research. The aim of
this course is to provide insight into the basic techniques and definitions in molecular
genetics. The course will introduce how a linkage study is to be set up in the laborato
ry and how to interpret the results from such a study (linkage analysis, haplotyping).
The course will further focus on the various ways how to follow up such a study and
how to identify (disease) genes. The course is particularly intended for clinicians and
epidemiologists who wish to be introduced into the basics of molecular genetics and its
tactical applications (15 hrs).
mere will be an attunement between this course and the courses "Genetic
Epidemiology" and "Genetics of Complex Diseases".
Prerequisites: Familiarity with general genetic concepts.
13:00 - 18:00
Lodewijk Sandkuijl, Cornelia van Duijn,
Genetic Epidemiology
This course gives an introduction to various statistical methods of genetic epidemiolo
gy. The focus of the course is on the identification of genetic determinants of disease
through epidemiologic and genetic research. Factors that determine the frequency of
monogenetic and complex genetic disorders are introduced. Theoretical and practical
aspects of segregation, linkage and association studies are discussed. New methodolog
ical developments in the field of genetic epidemiology will be addressed. Determinants
of frequency of genetic disorders will be studied via series of interactive computer pro
grams. Simple likelihood calculation
will be introduced. Through discussion of published articles, methodologic pitfalls in
genetic and epidemiologic studies will be addressed. The course is intended for epi
demiological and clinical or laboratory researchers who wish to acquire general knowl
edge of statistical genetics (22.5 hrs)
Prerequisites: Clinical Genetics course or equivalent knowledge.
1^:00 - 16:00
Eddy van Doorslaer, Wynand van de Ven
Health Economics
This course is an introduction to health economics and can be followed without formal
training in economics. It sets out to illustrate the usefulness of economics to the under
standing of public policy and services provision in the health care sector. Special emphasis
will be given to the analysis of the demand of health care for health insurance.
Furthermore, the coexistence of a variety of health care systems will be discussed in terms
of their implications for efficient and equitable allocation of health care resources (15 hrs).
Prerequisites: Introduction to Health Services Research.
9
Week 2: August 17 - August 21, 1998
The methodology of quantitative research
13:00 - 16:00
Advanced Medical Decision Analysis
Myriam Hunink
This course deals with advanced topics in medical decision making. Topics to be dis
cussed include: 1) dealing with bias in evaluating diagnostic tests, 2) ROC and Summary
ROC analysis, 3) determining the optimal operating point on the ROC curve, 4) problems
with utility assessment and multi-attribute utility theory, 5) Markov process models and
6) Monte Carlo simulation modeling. The course will focus on practical application of
techniques and how to interpretate the published literature in this area (15 hrs).
Prerequisites: Introduction to Data-analysis, Clinical Decision Analysis, or equivalent
knowledge.
16:30- 18:00
Conducting Epidemiologic Research
Deirdre van der Kuip
An essential part of epidemiologic research concerns the collection and handling of
data. This course will discuss the main issues in the conduct of epidemiologic research.
It will cover ways and means to obtain participation of subjects, practical issues in datacollection, and important aspects of data-handling. The course will include a series of
practicals. This course is focussed on individuals who have had no or little practical expe
rience in conducting epidemiologic research (7.5 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology.
e
10
l/l/eek 3: August 24 - August 28, 1998
Advanced courses and current topics in quantitative research
8:45 - 16:00
Survival Analysis
David Kleinbaum, Holly Hill
This course will provide an introduction on the concepts and methods of survival analy
sis. We begin with an overview of the general goals of survival analysis, basic notation
and terminology, the data layout, and some simple examples. We then describe the
Kaplan Meier (KM) approach for estimating survival curves and the logrank test used for
comparing KM curves. We then introduce the Cox Proportional Hazards (PH) model and
describe its characteristics, including the reason for its popularity and the meaning of the
PH assumption. This is followed by a discussion of methods for assessing the PH assumpfcon, and options for the analysis when the PH assumption is not satisfied. One of these
options is called the "stratified Cox procedure", which will be described and illustrated
using computer output. The other option involves using time-dependent covariates,
which will also be described and illustrated. A general description will also be given on
the use and characteristics of the "extended Cox model", which considers time depen
dent variables of any type. We conclude with several examples of the use of the extend
ed Cox model to analyze survival data involving time dependent variables (30 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology, and Introduction to
Data-analysis. Familiarity with computer procedures for regression modeling is not
essential but desirable. Some applied knowledge of maximum likelihood techniques is
also desirable.
8:45 - 16:00
Advanced Study Design
Olli Miettinen
This course is founded on the premise that applied clinical and public health research is
occurrence research, i.e., concerned with the frequency of some outcome event or state
in relation to determinants of this frequency. The course challenges received wisdom in
applied medical research. Study design is addressed as a matter of two broad topics:
designing the occurrence relation as the object of study, and designing the experience
that is to provide information about it. Examples will be drawn from both clinical and
□public health research (30 hrs).
Prerequisites: Principles of Research in Medicine and Epidemiology, or equivalent
knowledge.
11
Week 3: August 24 - August 28, 1998
Advanced courses and current topics in quantitative research
8:45 - 16:00
Advanced Statistical Models in Epidemiology
David Clayton, Michael Hills
The course describes what regression models are and how they are used in epidemiolo
gy. It covers Poisson regression for follow-up studies, logistic regression for matched and
unmatched case-control studies, and Cox's regression model. The morning sessions con
sist of lectures based on Part II of Statistical Models in Epidemiology by Clayton and
Hills, and the afternoon sessions are spent analysing a variety of different data sets
using a computer package (30 hrs).
Prerequisites: elementary statistical methods as applied to follow-up and case-control
studies. The abovementioned book will be available at the Erasmus SummA
Programme, but preliminary reading of Part I is recommended.
8:45 - 16:00
Lodewijk Sandkuijl, Cornelia van Duijn and
Bertram Muller
Genetics of Complex Diseases
This course gives a comprehensive overview of theoretical and statistical aspects of
genetic studies of complex diseases. Classical and recently developed methodology will
be discussed. New developments in the design of studies that will be addressed include
the use of parent controls, selected inbred populations and haplotypes. The statistical
power of the various strategies will be compared. Theoretical aspects of the statistical
analysis will be introduced and practical exercises using computer programs will be dis
cussed. The course is intended for researchers working in the field of genetics and epi
demiology (30 hrs).
Prerequisites: Genetic Epidemiology.
8:45 - 11:45
Medical Technology Assessment
Paul Kind, Frans Rutten
The course emphasizes economic evaluation of health care technology as the core ele
ment of medical technology assessment. Methodological and practical issues are bein^
considered and illustrated using examples based on ongoing studies. The relatio^
between medical technology assessment and health policy is highlighted and attention
is given to the measurement and valuation of health related quality of life. The course
is open to researchers in the clinical and health services research field as well as to
health professionals and health policy makers (15 hrs).
Prerequisites: Introduction to Health Services Research.
12
Week 3: August 24 - August 28, 1998
Advanced courses and current topics in quantitative research
8:45 - 11:45
Bruno Stricker
Pharmaco-epidemiology
Pharmacoepidemiology pertains to the study of the use and of the effects of drugs. It
links clinical pharmacology and epidemiology. This course provides, at an intermediate
level, the theoretical basis for studying the intended effects as well as the adverse
effects of drugs used in humans. The course will mainly focus on drug research after
marketing, including post marketing surveillance and drug risk assessment (15 hrs).
Prerequisites: Methods of Clinical Research.
k45 - 11:45
Public Health Bridging Research and Practice
Louise Gunning-Schepers
In this course the central theme is the application of results of research in public health
in decision making. It will look at both the translation of problems in the field of pub
lic health into research questions as well as the translation of the research results for
public health practice. In addition, the course will provide a case study on the relation
between research and decision making concerning the policy decision to offer breast
cancer screening (15 hrs).
Prerequisites: Introduction to Public Health, Principles of Research in Medicine and
Epidemiology, Methods of Public Health Research.
13:00 - 16:00
Design, Conduct and Analysis of Clinical Trials
Jan Tijssen
This course presents the principles and methods for designing and analyzing random
ized clinical trials. The purpose of this course is to provide practical guidelines for the
conduct of a clinical trial. Topics such as randomization, patient recruitment and ethics
will be discussed. The methods of analyzing trials of various designs are presented (15
hrs).
Prerequisites: Epidemiology for Clinicians, Methods of Clinical Research or equivalent
knowledge.
13:00 - 16:00
Epidemiology and Health Policy
Louise Gunning-Schepers
In this course the central theme is the use of epidemiological data and measures of
effect for public health decision making. It will look at the interactions between risk fac
tors, disease categories and demography and will discuss their application to decision
making in health policy. It will also explore epidemiologic simulation models. This
course is meant for those involved in public health decision making, either at the poli
cy level or at the health research level (15 hrs).
Prerequisites: Methods of Public Health Research.
13
ERASMUS SUMMER LECTURES
For the 1998 Erasmus Summer Lectures the following speakers have been invited (final
programme has still to be decided):
Health Services Research: Saviour or Chimera?
Professor Nick Black, FFPHM, London School of Hygiene and Tropical Medicine, London, UK
Monday August 24, 1998, 16:00 - 17:00 hrs.
Study Design in Clinical Research
Professor Olli Miettinen, McGill University, Montreal, Canada
Tuesday August 25, 1998, 16:00 - 17:00 hrs.
The Future of Epidemiology
Professor Dimitrios Trichopoulos, Harvard University, Boston, Massachusetts, USA
Thursday August 27, 1998, 16:00 - 17:00 hrs.
Erasmus Summer Lectures: Auditorium 5,
Erasmus University Medical School,
Dr. Molewaterplein 50, Rotterdam.
Entrance is free for participants of the Erasmus Summer Programme, faculty and
students of the Netherlands Institute for Health Sciences and Erasmus University.
For others, please contact Ms. Marie Louise Bot,
Office for Post Graduate Medical Education.
Phone:
010- 4087881,
Fax:
010 - 4367271,
E-mail:
secr@paog.fgg.eur.nl
Internet: http://www.eur.nl/fgg/paog/esp
14
The Netherlands Institute for Health Sciences
The Erasmus Summer Programme is organized in collaboration with the Netherlands
Institute for Health Sciences (NIHES). The NIHES aims at identifying, on the basis of
quantitative research, the determinants of health and disease, and the factors which
contribute to the effectiveness and efficiency of health services. Core disciplines in the
NIHES are (clinical) epidemiology, health services research and medical informatics.
Master of Science and Doctor of Science programmes in each of these disciplines are
organized. Structured theoretical training and the conduct of a research project are an
integral part of all programmes. Participants may take part in exchange programmes
with the University of Cambridge, Karolinska Institute, Columbia University and the
New England Epidemiology Institute. The NIHES and the Netherlands School of Public
Health (NSPH) offer, in cooperation, a Master of Public Health programme.
The Netherlands Institute
for Health Sciences
15
The MSc programmes
Master of Science programmes are organized in epidemiology, clinical epidemiology,
health services research and medical informatics. These programmes provide a first
semester of theoretical training with a shared core curriculum, consisting of courses in
study design, biostatistics and data-analysis. In the second semester a research project is
carried out and a research paper is prepared under the guidance of a personal tutor. In
this semester participants will also follow more advanced courses.
The DSc programmes
Doctor of Science programmes are organized in each of the disciplines. These prA
grammes consist of four semesters. The first two semesters will provide elaborate theo^
retical training of participants. During the four semesters participants will be able to fol
low advanced courses in study design, biostatistics, data-analysis as well as advanced dis
cipline specific courses. A research project will be carried out after the first semester
under the guidance of a senior tutor.
The MPH programme
The Master of Public Health is a full-time one-year programme. It provides a first semes
ter of theoretical training consisting of basic courses in epidemiology, study design, bio
statistics and data-analysis, followed by more specific courses dealing with population
health status, public health research, public health policy and management, and health
promotion. The second semester consists of courses organized around concentrations:
such as international health, health management and intervention, and occupational
and environmental health. Within the domain of one of the concentrations a final
paper is written under the guidance of a personal tutor.
Summerschool MSc programmes
The NIHES provides the opportunity to obtain a Master of Science in epidemiology or
clinical epidemiology degree in three summers primarily based on courses in the
Erasmus Summer Programme. Participants may combine short theoretical modules in
the Erasmus Summer Programme in three consecutive summers in addition to modules
from a full-time NIHES Master curriculum. This Master of Science curriculum consists of
four visits to Erasmus University: three visits during consecutive summers, and 1 visit dur
ing a spring semester. The first visit of in total 6 weeks includes the introductory cours
es of the Erasmus Summer Programme and an additional 3-week module on Study
Design. The second and third visit of 4 weeks each will be focused on the intermediate
and advanced courses in the Erasmus Summer Programme. During the fourth visit in the
16
spring semester participants will follow short courses on specific advanced
topics in epidemiology.
The further conduct of a research project under shared guidance in the
home institution will enable participants to qualify for a Master degree.
The NIHES has formed an exchange programme with the New England
Epidemiology Institute. The Summer School Master of Science in
Epidemiology or Clinical Epidemiology may be obtained by attending one of
the summer schools in the Epidemiology Summer Program at the New
England Epidemiology Institute. All other courses for degree fulfillment may
be obtained from the NIHES at Erasmus University.
Students wishing to apply for exchange with the New England Epidemiology
Institute must first enroll in the NIHES Summer School programme.
For a full brochure on the postgraduate programme of the Netherlands
Institute for Health Sciences, including detailed information about de
Summer School Programmes, please contact:
Ms. Soeja de Groot
Course secretary Netherlands Institute for Health Sciences
Room Ee 2122
Erasmus University Medical School
PO Box 1738
3000 DR Rotterdam
The Netherlands
Phone : +31 (0)10 408 8288/7099
Fax
:+31 (0)10 436 5933
E-mail : nihes@nihes.fgg.eur.nl
Internet: http://www.eur.nl/fgg/nihes
/z
General Information
The Erasmus Summer Programme is host
ed by Erasmus University Rotterdam, The
Netherlands. The Erasmus University
Medical School is one of the larger centers
of medical research and teaching in
Europe. It reflects the spirit of Rotterdam,
a city with a great contrast between a
modern part built after the Second World
War and a 16th century part called
'Delftshaven'. Since 1945, Rotterdam has
gradually developed into one of western
Europe's major industrial and distribution
centers. It is the largest seaport in the
world today.
Cancellations
If you have registered by sending back the
signed applicationform and are unable to
attend, a substitute delegate is welcome
at no extra charge. Please be sure that he
or she can present identification and a let
ter from the registered participant.
Cancellations must be sent in writing to
Office for
Post Graduate Medical
Education.
For cancellations postmarked before July 1,
1998, a service charge of Dfl 150,- will lAj
due. For cancellations postmarked after
July 1, 1998, no refund will be possible
and the tuition fee will remain due
payable.
Fees
Fees are based on participation per week.
Participants may choose freely from the
courses offered. Accommodation is pro
vided for by the Information Centre for
International Relations (ICIR) in the
International House of Erasmus University,
which can only be reserved for 3 weeks.
The International House offers student
apartments consisting of 2 separate single
rooms with shared kitchen and sanitary
facilities. Hotel Inntel is situated at walk
ing distance from the Erasmus University
Medical School. Enrolment fees include all
materials of the course(s) as well as partic
ipants' lunches and dinners from Monday
to Friday.
Tuition fee
1 week
Dfl 2250
2 weeks
Dfl 2750
3 weeks
Dfl 3250
Deadline for Application
Application is possible only by returning
the signed application form before June
1, 1998. Applications received after this
date cannot be garanteed. A down pay
ment of Dfl 1000,- is required before July
1, 1998. If the down payment is not
booked in our account before July 1,
1998, all reservations (at the hotel and/or
at the Erasmus International House) will
be cancelled and participation in the cho
sen courses cannot be garanteed any
longer.
e
Tuition fee including
accommodation in
Erasmus International
House
Hotel Inntel
Dfl 115 per night
per person
Dfl 4000
18
Payment
Social programme
Payment is possible:
- by enclosed bank cheque;
- by money order payable to the Office
for Post Graduate Medical Education,
Erasmus University Rotterdam, account
no. 49.69.70.933, ABN/Amro Bank
Rotterdam;
- Visa, Master or EuroCard.
A special social programme has been
organized for the enjoyment of partici
pants. A welcoming reception will be held
in the first week for all participants and
faculty. On both Sunday, August 16 and
Sunday, August 23 there will be a social
event. An informal dinner will be given
for participants and faculty in the second
week. On Thursday, August 27 a farewell
party will be given for participants and
faculty, during which the certification cer
emony will take place.
Except for the welcoming drink a small
financial contribution will be charged for
the social events. You can register during
the programme for all events at the regis
tration desk.
On receipt of the application form a letter
of confirmation and an invoice will be
sent to the participant.
^^aximum number of courses
Due to the intensity of the courses, the
organizers strongly recommend registering
for a maximum of 3 courses in one week, 5
courses in two weeks, and 6 courses in 3
weeks. Forthose interested, syllabi of other
courses are available at Dfl 15,- each.
Practical points
The Netherlands has a maritime climate.
The average temperature in August is
20^C or 70=»F. The currency used in The
Netherlands is the Dutch guilder (Dfl), for
which the exchange rate is approximately
$1 = Dfl 2.00.
Meals
Lunches and dinners are included in the
tuition fee. This does not hold true, how
ever, for the weekends during which the
courses will not be held. Participants are
therefore expected to make arrangements
for lunches and dinners on Saturdays and
Sundays. Please note that on Friday the
restaurant of the Erasmus University
^^ledical School closes at 16:00 hrs.
^p-eakfasts are not included in the tuition
fee nor in the hotelprice.
Organization and further information:
Ms. Marie Louise Bot
Office for Post Graduate Medical
Education
Erasmus University Medical School
PO Box 1738
3000 DR Rotterdam, The Netherlands
Phone :+31 (0)10 408 7881
Fax
:+31 (0)10 436 7271
E-mail : secr@paog.fgg.eur.nl
Internet : http://www.eur.nl/fgg/paog/esp
Certification
Participants who successfully complete
the Erasmus Summer Programme will
receive the official Erasmus Summer
Programme Certificate. The certification
party will take place on Thursday, August
27, 1998.
19
Faculty
David G. Kleinbaum, PhD
professor of Biostatistics
The Rollins School of Public Health
Emory University, USA
Anders Ahlbom. PhD
professor of Environmental Medicine
Karolinska Institute. Stockholm. Sweden
David G. Clayton
senior lecturer in Biostatistics
MRC Biostatistics Unit, Cambridge, England
Deirdre van der Kuip, MD PhD
research coordinator
Erasmus University Rotterdam, The Netherlands
Eddy K.A. van Doorslaer. PhD
professor of Health Economics
Erasmus University Rotterdam, The Netherlands
Stanley Lemeshow, PhD
professor of Biostatistics
University of Massachusetts. USA
Cornelia M. van Duijn, PhD
associate professor of Epidemiology
Erasmus University Rotterdam, The Netherlands
Jacobus Lubsen, PhD
professor of Clinical Decision Sciences
SOCAR, Nyon, Switzerland
Diedenck E. Grobbee, MD PhD
professor of Clinical Epidemiology
University of Utrecht, The Netherlands
4
Johan P. Mackenbach, MD PhD
professor of Medical and Social Determinants of Pum
Health
Erasmus University Rotterdam, The Netherlands
Louise J. Gunning-Schepers, PhD
professor of Social Medicine
University of Amsterdam
Olli S. Miettinen, MD PhD
professor of Epidemiology, Biostatistics and Medicine
McGill University, Montreal, Canada
Peter Heutink. PhD
assistant professor of Clinical Genetics
Erasmus University Rotterdam, The Netherlands
Bertram Muller, MD PhD
assistant professor of Clinical Genetics
Ludwig Universitat, Munchen, Germany
Holly Hill, MD PhD
professor of Biostatistics
The Roilins School of Public Health
Emory University, USA
Ben A. Oostra, PhD
associate professor of Clinical Genetics
Erasmus University Rotterdam, The Netherlands
Michael Hills, PhD
senior lecturer in Biostatistics
London School of Hygiene and Tropical Medicine, England
Frans F.H Rutten, PhD
professor of Medical Technology Assessment
Erasmus University Rotterdam, The Netherlands
Albert Hofman, MD PhD
professor of Epidemiology
Erasmus University Rotterdam, The Netherlands
Lodewijk A Sandkuijl, MD
consultant in Clinical Genetics
Erasmus University Rotterdam, The Netherlands.
Myriam Hunink, MD PhD
professor of Epidemiology
University of Groningen, The Netherlands
Theo Stijnen, PhD
associate professor of Biostatistics
Erasmus University Rotterdam, The Netherlands
Job Kievit, MD PhD
professor of Surgery
University of Leiden, The Netherlands
Bruno H.Ch. Stricker, MD PhD
associate professor of Pharmaco-epidemiology
Erasmus University Rotterdam, The Netherlands
Paul Kind
senior research fellow
University of York, England
Jan G P. Tijssen, PhD
professor of Clinical Epidemiology
University of Amsterdam, The Netherlands
Niek Klazinga, MD PhD
associate professor of Social Medicine
Erasmus University Rotterdam, The Netherlands
Wynand P.M.M. van de Ven, PhD
professor of Health Insurance
Erasmus University Rotterdam, The Netherlands
20
The Erasmus Sunder Programme
Application form
(This form is not applicable for participants of the NIHES-programmes. Please contact the NIHES-office!)
(please write in capital letters)
First name Prof / Dr / Mr / Ms / Mrs
Last name
Initials ------------------------------------------------------------------ Date of Birth
Nationality
Mailing address
City---------------------------------------------------------------------- Zipcode
Country
Telephone------------------------------------------------------------ Telefax
E-mail
Please tick the course(s) you wish to attend
Week 1: August 10 - August 14, 1998
Principles of Research in Medicine
and Epidemiology
Week 2: August 17 - August 21, 1998
Week 3: August 24 - August 28, 1998
Regression Analysis
Survival Analysis
Methods of Clinical Research
Advanced Study Design
Methods of Public Health Research
Advanced Statistical Models in
Epidemiology
Introduction to Data-analysis
Clinical Decision Analysis
Meta-analysis
Introduction to Health
Services Research
Molecular Genetics for Clinicians
and Epidemiologists
Genetics of Complex Diseases
Genetic Epidemiology
Pharmaco-epidemiology
Health Economics
Medical Technology Assessment
Advanced Medical Decision Analysis
Public Health Bridging Research and
Practice
Introduction to Public Health
Epidemiology for Clinicians
Conducting Epidemiologic Research
Design, Conduct and Analysis of
Clinical Trials
Epidemiology and Health Policy
Please indicate
which accommodation
arrangement you wish
(please tick)
Duration
of stay
1 week
2 weeks
3 weeks
No
accommodation
Room in Erasmus
International House
Room in
Hotel Inntel
Day of Arrival
Day of Departure
Q
The undersigned hereby declares to have taken notice of the payment and cancella
tion conditions of the Erasmus Summer Programme.
Date
Signature
Please return this form to:
Mrs. Marie Louise Bot, Office for Post Graduate Medical Education,
Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam,The Netherlands,
Phone: +31 (0)10 408 7881, Fax: +31 (0)10 436 7271, E-mail: secr@paog.fgg.eur.nl, Internet: http://www.eur.nl/fgg/paog/esp
The 8th Erasmus jammer Programme • Aug us A 0 - August 28, 1998
- Media
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