AVALIAÇÃO DE PRO GRAMAS E PO LÍTICAS DE SAÚDE NA FRANÇA 2 5 7
Cad . Saúde Pública, Rio d e Jane iro , 15(2):229-259, ab r-jun, 1999
D e p a rt am en t o d e M e d i c i n a , Pre ve n t i va e Soci al, Facu ld ad e d e Ciên cia s M é d i c a s , Un i v ersid a d e Est ad u a l d e Ca m p i n a s , Ca m p i n a s , Bra s i l .
Ga st ã o Wa gn er d e So u sa Ca m p o s
Eva l u a t i o n :f ro m soliloquy to dialogu e
T h e re wa s a t im e wh e n I co n sid e re d Pl a n n i n g h u m a n k i n d ’s la s t a n d gre a t e s t ra t i o n a l i s t d e l i riu m . I wa s c o m p le t e ly wr o n g. Po licy a n d Pro g ra m Evalu a t io n h a s re e m e rge d a t th e tu rn o f t h is ce n t u ry, p rom is in g e ffe ct s ve r y s im ilar t o t h o se t h a t Pla n n in g m e t h o d s c la im e d t o a c h i e ve twen t y or t hirt y yea rs b a ck. Th e u to p ia o f m a kin g life in s o cie t y ra t io n a l! T h e va i n p ro m ise of o r ie n t in g p o licy a cc o rd in g t o a ra -t io n a le ab ove -t h e in -t e re s-t s o f h u m a n gro u p s ! Th e real-socia list co u n tr ie s tu rn ed t h is fan tasy in to a reality p rin cip le a n d left m illio n s o f p eo -p le in t h e lu rch . I b e lie ve t h a t t o a c e r t a in e x-t e n x-t x-t h e In sx-t ix-t u x-t ion alizax-t io n of Evalu a x-t io n Sy s-t e m s h a s co m e s-t o o c cu p y s-t h e vo id le fs-t b e h in d b y t h e re l a t i ve fa ilu re o f P la n n in g. Eva l u a t i n g re su lt s wo u ld b e re p re se n t in g “n e w a p p ro a c h -e s t o go v-e rn a n c-e t h at ar -e ch a n gin g t h -e b a s ic t h in kin g o f m o d e r n p o lit ics”, a s sta t e d b y Jo r-ja n i, q u ot ed o n p a ge 3 o f Ha rt z’ a rt i c l e.
Eva lu a t io n is c h an gin g t h e t h in kin g a n d p ra c t ice o f m o d e rn p o lit ics ! Pla n n e rs in t h e 1960s th o u gh t t h e sa m e. Bu t t im e t a u gh t t h em h ow wro n g th ey we re: p olitical stru g g l e, in b oth t h e Old a n d Ne w Wo r l d s, d a re d t o ke e p fo llowin g it s o ld ru le s: t h e m o t o r fo rce o f d e s ire , llowin -t e re s -t s , a n d n e e d s w o r ke d (o f-t e n -tim e s), r o w-in g u p s t re a m a ga w-in st p la n s ; su b je ct s, clas se s, m o ve m e n t s , a n d id e o lo gie s a lwa ys we n t b e -yon d t h e b o u n d a rie s o f wh at w a s co n sid e re d rat io n a l; an d p owe r, con flict, stru g g l e s, a n d n e-g o t i a t i o n s, fo llowe d b y t h e d e fe a t s a n d t r i-u m p h s o f wid e ly d ive rse p r o t a go n ist s b e lie d t h e b e a u t ifu lly p a in st a kin g t e c h n ica l p la n s. Life p ro ve d t o b e fa r m o re va s t t h a n t h e b e s t an d m ost d em o cra tica lly d ra fte d p la n : g ra n d e s s e rtões e ve re d a s! [Tra n s l a t o r’s n ote : Th e d iscu s-sa n t h a s m a d e a p lay o n wo rd s b y e xc l a i m i n g , “Th e vast h in t e rlan d s a n d p a th wa ys!” in a n a lu sio n t o t he n ovel of th e sam e n a m e by Bra z i l-ia n a u t h o r Gu im a r ãe s Ro sa , a s if t o s a y, “T h e lon g an d win d in g roa d o f Pl a n n i n g ! ” ]
Ne ve rt h e l e s s, Pla n n in g c o n t in u e s t o b e p ra c tic e d . Fa r b e it fro m m e t o s u gge st a n y-t h in g oy-t h e r y-t h a n an Eva lu a y-t io n Po licy for y-t h e Brazilia n Un ifie d He a lt h Syst e m (SU S). On t h e c o n t ra r y, I la u d t h e p io n e e rin g an d s aga cio u s e f f o r t b y Zu l m i ra H a rt z. Howe ve r, a lt h o u gh I t r u st in h e r a ca d e m ic a n d e t h ica l q u alifica -t i o n s, I a m su s p icio u s (in p r in cip le ) o f a n y Eva lu at io n Me t h o d , esp e cia lly an y In s t i t u t i o n -a l i ze d Ev-a lu -a t io n Syst e m . O n e w o u ld h -a ve t o t a ke t h e ra t io n ale re su lt in g fro m su ch s t u d ie s wit h a gra in of sa lt , e ve n wh e n t h e y a re b a se d
o n m ore fle xib le m et h o d s an d co m b in e sta tis-t ica l lo gic witis-t h tis-t h atis-t of su ch o tis-t h ers a s so ciolo gy a n d a n t h r o p o l o g y. Ju s t a s M á rio Te s t a d e co n -s t ru cte d h i-s own lin e of a ctivit y by d em on -st ra t-in g t he lim its of t h e Pla n n t-in g he him se lf h elp ed t o in ve n t, Pro fesso r Zu l m i ra a lso b la st s t h e tot a l i tot a ria n p re tote n se s o f so m e of toth e m o re p r u d -ish sc h o o ls o f Eva lu a t io n . Sh e t h u s p o in t s t o t h e in e vit ab le lin k b et ween e va lu ation p ro c e s s-e s an d Va l u e sth a t a lwa ys ske w th em in d e fin ed d i re c t i o n s. The au t h or e ve n e xp licit ly a ssu m e s t h e id ea t h a t th e cri t e rio n of re d u ct io n o f i n i q-u i t ies sh o u ld u n d e r lie a n y a n d a ll so cia l p o li-c ie s an d t h u s p rovid e t h e re f e re n li-c e fo r a n y e va lu at io n m e t h o d . As q u o t e d in t h e a rt i c l e, it is n o t a m at ter o f re p lacin g p olicy-m a k in g w ith st a t ist ica l logic. Fin e ! Ne ve rt h e l e s s, e ve n co n -s i d e r in g t h e b ro a d fra m e o f re f e re n c e Zu l m i ra e m p l oys t o a n a lyz e e va lu a t ion p o licie s, a fe w co m m e n t s are still wo rt h w h ile on t h e lim its o f e va l u a t i ve m e th o d s in gen e ra l .
H A RTZ, Z. M. A. 2 5 8
C ad. Saúde Pública, Rio de Janeiro , 15(2):229-259, abr-jun, 1999
Evaluation in he alth: re g u l a t i o n , re s e a rc h , and cultu re in th e challen ges of institutionalizatio n
I ce rtain ly d o n ot in te n d t o give a reb u t tal to th e d iscu ssan ts’ com m en ts, sin ce th ey are b oth p er-t in e n er-t a n d re l e van er-t , an d I a m er-t h u s er-t e m p er-t e d er-t o re i t e rate t h e m . Howe ve r, I will m erely h igh ligh t a fe w p o in t s t o avo id re d u n d a n c y. I t h o u gh t it wou ld b e in te restin g to org a n i ze m y re m a rks as clu e s to a n swe rs o r tre a t m en t o f th e q u e st io n s raised b y Yu n e s co n cern in g t he ap p licab ilit y o f th e Fren ch e xp er i e n c e, so a s to fo rm a p re l i m in a ry list of iin gred ie in t s iin a b a sic recip e fo r Iin -st it u t io n a liza t io n , in sp ire d b y in t e rn a t i o n a l c u i s i n e , ye t wit h a Bra zilia n flavo r. Ge ra rd d e Po u vo u rville s h e d s co n sid e ra b le ligh t on t h e m a t te r wh e n h e id en t ifies t h e lim its o f th is e x-p e rie n ce “...w e are st ill far sh o rt of m a n y objec-t i ve s . . .”a n d m a ke s su gge s t io n s t o im p le m e n t in s t it u t io n a liza t io n in Fra n c e, s in c e I b e lie ve t h a t t h e p o t e n t ia l fo r s u ch “g e n e ra l i z a t i o n” is re i n f o rce d by t h e a gre e m en t a m on gst th e va ri-ou s co llea gu es’ p a rticipa t in g in t h is d e b a t e:
1) e valu a t io n a s a n in t r in sic p a rt o f p u b lic s e rvice s m a n a ge m en t, a re q u isit e fo r accou n t -a b ilit y -a n d m o d e rn iz-a t io n o f t h e s t -a t e. In t h is s e n s e , e va lu a t io n p rovid e s t h e t o o ls fo r t h e s t a t e’s r e g u l a t o r y ro l e , cr u cia lly im p o r t a n t to e n s u re “eq u it y” in h ea lth ca re in t h e case o f p rivat izat ion o f p rovid e rs an d h irin g o f lo cal p art -n e r s i-n d e ce -n t ra l i ze d i-n t e rve -n t io -n s (wh ich wo u ld c e rt a in ly in clu d e, b u t n o t b e re s t ri c t e d t o, t h e “old IPD A circ u i t”m e n t ion ed b y Yu n e s ) . Re gu la t io n , a s a n a c t t o fa cilit a t e go ve rn a n c e a n d q u alit y im p r ove m e n t , a n iss u e a lso a p -p ro a ch ed b y Cla u d ia Tra va s s o s , wo u ld re q u i re t h e u s e o f m ore p ar t i c i p a t o r y st ra t e g i e s , w it h f l e x i b l e, d e ce n tr a l i ze d e valu a t io n st r u c t u re s. Ligia Vi e i ra a d d s t o th e d eb a t e by reca llin g t h at t h e u s e o f lo ca l st a n d a rd s sh o u ld n ot r u le o u t t h e p o s s ib ilit y o f co m p a r in g p ro b le m s a n d i n t e r ve n t io n s o n n at io n a l a n d in t e rn a t i o n a l s c a l e s, a n d I fe e l t h a t t e ch n o s cie n t ific co m -m i t t e e s, t oget h e r with sp ecific he alt h p ro g ra -m s o r co u n cils a t va rio u s le ve l s, ca n p rovid e su ch i m p o rt a n t b a c k- u p. It is t h u s in te re s t in g t o high ligh t th e d ifferen t form s o f re g u l a t o ry lo gic
O aut or responde
The autho r re p l i e s
Z u l m i ra Ha rt z
