This article focuses on antecedents in the evaluation of health programs and highlights the diversity of theories and methods applied to the field. In order to provide support for evaluative research in HIV/AIDS, the article discusses several classical principles in epidemiology, particularly the theory of causal inference and its limits for approaching infectious diseases. The article contends that recent debates concerning the logic and applicability of ecological studies establish convergent interests between epidemiology and evaluative research, concerned with incorporating contextual variables into the analytical models. The principles and typologies of contemporary evaluative research are explained with a view towards defending an analytical model for health-disease processes from the perspective of evaluating actions and programs. The article concludes by highlighting common proposals and convergent trends in epidemiology and evaluative research, serving as the framework for discussion on the limits and potentialities of the proposed model.
The demands and tensions surrounding evidence-based policy (EBP) as part of results-based management have frequently indicated a gap between these concepts and the complex nature of health promotion interventions. This article discusses the challenges associated with the conceptual field of Health Promotion and the requirements for "proof" of effectiveness and efficiency faced by managers, evaluators, and local agents in the development of inter-sector health programs. The authors identify the limitations of epidemiological trials for the evaluation of social policies and use arguments related to "theories of change" in order to discuss the relationship of the "constructs" in the social policy intervention model and provide the basis for the "analysis of the contribution" of its effects. Systematic reviews of the "realist synthesis" type are discussed, due to their capacity for highlighting the theoretical framework of a specific program and explaining the underlying action mechanisms common to different programs and/or contexts. The authors argue that the expression and maintenance of expected social changes require the construction of collaborative processes, considering the set of (bottom-up) stakeholders involved in all stages of the process of developing and evaluating interventions.
Public health policies are, in essence, intersectoral policies. The financial crisis, recognized in the international arena in 2008 and worsen by food shortages, the energy crisis and global warming, reinforce old problems and new challenges, growing in degree and complexity. Today, there is no nation capable of guaranteeing health care for all and to face the social determinants of health without a audacious integration between government sectors. In Brazil, the prospect of social mobility, associated with policies of wealth distribution, employment generation and income suggest a scenario that challenges the old paradox: economic growth and social development. How to establish a health policy that responds to the values of the Brazilian Constitution and the Organic Law of Health in situations where a significant portion of the population is still living below the poverty line? How to ensure good policies in health and education-internationally classified as "low politics" as opposed to security and military spending, "high politics"-when, in times of budgetary restraint, those are the first to be cut? In Brazil, within the health sector, the growing access to primary health care, the improvements and expansion of the medium and the high complexity health care, clearly reflects the advances, hardly conquered in recent years. These achievements, however, coexist with the urgency of ensuring the universality and comprehensiveness of health and medical care, which is directly linked to the historic challenges that we saw through: (1) the sub funding of public health; (2) work conditions and education of health professionals; (3) investment in research and production; (4) improvement of public health regulation procedures, particularly over the growing health plans market and the drugs and medical equipment industry; (5) the health management qualification and the fair provision of health services; and, especially, (6) the health promotion. Agreeing with the critics around the campaign theme-"why treat people without changing what makes them sick?"-propagated by the World Health Organization, it is not to question the unquestionable. It is imperative to ensure health care for all. A firm defense of Health, expressed in the Brazilian Constitution, is an ethical duty. Health is everyone's right and duty of the state. Everyone knows, however, that health includes ensuring health-care, but it is not limited to this. Health Policies require concrete actions on social determinants. In spite of all the guts and commitment, we cannot approve what are stated in the 29th Constitutional Amendment (EC 29) without defining the model of development and political reform in parallel. The effort to ensure adequate and sustainable sources of financing of health policy includes a commitment to consultation and coordination of priorities under the National Health Council (CNS) and the Council of Economic and Social Development (CDES). In Parliament and the Executive. In her inaugural speech, the President Dilma Rousseff, confirming the...
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