Intersectoral Initiatives in Health: Evaluative strategies National School of Public Health FIOCRUZ

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Intersectoral Initiatives in HealthEvaluative
strategiesNational School of Public
HealthFIOCRUZRio de Janeiro, Brazil

• Bodstein, R,Magalhães R, Marcondes W, Marques R,
  Bocca C, Ferreira M, Coelho A, Santos L

April, 2009
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The Principles and the Dimensions of the Local
Program Health promotion principles
intersectoral collaboration and participatory
approach addressing social, environmental,
cultural and economic dimensions of quality of
life. Health is produced in every day life. The
initiative must be supported by, and led to,
community mobilization and participation (bottom
up approach).
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Objectives of the Program

• ? To improve the determinants of health
• ? To increase community leadership, capacity, and
  participation in the project
• ? To improve intersectoral collaboration with
  academic sector, academic health center (primary
  health care local authority), government
  agencies, key community leaders in the area and,
  AIPS project (CPHA/Abrasco)
• ? Enhancing the capacity of ENSP to develop,
  implement, evaluate, and disseminating health
  promotion actions in Brazil

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Local Context

• ? High levels of social inequality
• ? Alarming violence that undermines civic life,
  and solidarity
• ? Unemployment, and idleness among young
• ? Local leaders with great potential to
  strengthen positive sociability, affirm identity,
  and improve self-esteem among residents (cultural
  mediators)

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Evaluation Design

• ? Innovative evaluation practices strengthen
  links between local context, research, and
  program
• ? Program are social constructions
• ? Need a social process to explain actions and
  interactions
• ? Legitimacy of non expert, and local knowledge
• ? Evaluative products are accessible through all
  sectors

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Evaluation Questions

• ? To document changes in community mobilization
  and participation vis-à-vis new public policies
  (Community Forum discussions and agenda)
• ? To analyze the dynamics of intersectoral
  actions through integrative practices between
  researchers, professionals, community leaders,
  and public decision makers
• ? An updating on the Guidebook of Social
  Resources

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Evaluation Strategies of the Local Program

• ? A rapid participatory diagnosis to identified
  the more pressing needs and issues and the spaces
  and strategies for community mobilization
• ? Direct and systematic observation of Forum
  meetings and workshops
• ? Field survey and interviews with key actors
  mapping social organizations and social life in
  the communities
• ? Mapping of activities and social organizations
  (Content analysis)
• ? Content analysis of intersectoral actions

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PAC
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Participation and Social-Cultural Mediation

• ? The Community Forum the most important arena
  for local governance is responsible for
• ? Changes the community mobilization and putting
  together the diversity of social projects in the
  area (a particularly harsh struggle for political
  space and resources)
• ? To design the first local Culture Plan
• ? To have a critical view of the public agenda
• ? A crucial role in legitimize the evaluation
  strategies and health promotion activities

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Guidebook of Social Resources

• ? To identify, publicize, and articulate
  socio-cultural projects and public resources in
  the community. It shows
• ? History, identity, and cultural characteristics
  of the area
• ? A mosaic of community associations and
  organizations with limit scope
• ? The deficit of education and recreation
  activities
• ? The deficit of public policies in all sectors
• ? The strong presence and importance of religious
  groups responsible for social interventions

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Lessons Learned

• ? Social capital as an important mechanism for
  collaboration and cultural mediation in the
  associative life
• ? Mechanisms for innovation are two-way
  government must be open channels for
  participation while community leaders must share
  responsibility for intersectoral action
• ? Political struggles emerge when the issues
  addressed are longstanding and depending on
  larges investments (sanitation, housing, public
  transportation, and so on)
• ? Violence is the most important issue and
  undermines civic and local associative life

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Role of Evaluation

• ? Evaluation as strategy to reinforce positive
  values and resources in the community
• ? Evaluation questions must be constructed in a
  participatory approach
• ? Evaluations important role is to document
  links between technical devices, local actors and
  conditions in local context
• ? The role of evaluation is to produce knowledge
  to guide future action in the same or other
  contexts (Potvin, 2008)

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Thank you

• bodstein_at_ensp.fiocruz.br