The analysis and assessment of health programs.

There is a vast gap between methodology and practice in the analysis and assessment of health programs. This presents an acute problem in developing countries where resource allocation decisions at the tight budgetary margin have important practical consequences. The prospects for improving this primitive situation depend critically on progress in analysis of the affordability and effectiveness of health programs. The analysis of affordability--especially on the recurrent cost side--is a necessary condition which can help ensure that proposed programs are unlikely to be vulnerable to implementation delays or underfinancing of operating costs which may seriously compromise the benefits expected from new investments. Improved analysis of effectiveness is also essential in order to help planners choose the best pattern of resource use from among the various combinations of programs that are affordable. To do this will require the devotion of substantial analytical effort to fill the great void of organized empirical knowledge available to those seeking to assess the effectiveness of health interventions. In particular there must be a shift in focus from single interventions directed at communicable diseases in children to a broader concern with multi-purpose interventions, including those directed against the emerging problems of non-communicable disease in adults.