Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?

Since the beginning of the 1990s, health care reform projects have taken place in many of the former Communist countries, but these projects are rarely evaluated systematically. Evaluation, however, is an important tool for increasing their rationality and continuity. The aim of this paper is to identify the difficulties in the efforts towards systematic evaluation and draw lessons for the future. For this aim, the requirements for a more rigorous, controlled evaluation are compared with our experiences of evaluating a health care reform project in the Slovak republic. From this comparison a number of discrepancies arise: it was difficult to set clear and realistic goals at the start of the project; the outcomes of the project could not always be measured, nor could 'the process' always be distinguished from the outcomes. Systematic evaluation was further hampered by an insufficient degree of structuration of the project, in advance and during the implementation, and by the absence of a tradition and infrastructure for data collection. On the basis of the experiences and relevant literature, recommendations for future evaluations are formulated. The main lesson is that, given the context, often it will not be possible to use an ambitious evaluation design, and concessions need to be made. At the same time, continuous efforts towards more systematic evaluation procedures should be made, but it is wise and more sustainable to do this in an incremental way.