Program evaluation: considerations of effectiveness, efficiency and equity

Health programs should be effective in reaching their objectives and should do so through efficient use of scarce resources. Moreover, the benefits should be equitably distributed among the targeted beneficiaries. The individual desirability of these attributes of program success is unquestioned, but their mutual compatibility should be. Narrowly based programs might be very efficient, whereas expansion into more difficult areas could be costly. Moreover, the difficult areas are likely to comprise disadvantaged groups that are inequitably served at present.The paper argues that measures of effectiveness, efficiency and equity need to be more sharply defined, so that trade-offs in program emphasis can be objectively assessed. Methods of analysis that make the trade-offs clear are pre-sented and applied to real data taken from a family planning study in India.