A proposal of framework to evaluate community-based obesity prevention interventions in LAC

1. PACO III Workshop: EPODE Population based interventions A proposal of framework to evaluate community-based obesity prevention interventions in LAC Marcia Erazo, Margarita Safdie, Mariana Lazo, Angel Caballero, Richard Visser, Armando Barriguete

2. Background • In Latin America and the Caribbean (LAC) the obesity prevalence has raised at alarmingly pace. • Community-based interventions are the most promising interventionsbecause they can reach the entire population. • These interventions are recommended to address the obesity causes rooted in the society and special needs of the individuals.

3. Background • Ideal community interventions combines specific health promotion and evaluation theory. • In LAC, there is no community interventions probably due to lack of evaluation frameworks. • Limited data are available to guide the implementation and evaluation of these interventions in LAC.

4. Rationale • Standardized and comprehensive evaluation frameworks are key for policy-makers, scientists and stakeholders to evaluate community-based programs

5. Objective To thoroughly examine already available evaluation frameworks (WHO, EPODE, and Victoria proposals) and related literature, and to provide a specific framework to evaluate community-based interventions in LAC.

6. Key stakeholders

7. WHO Steps Evaluation Health promotion programs • Describing the proposed program, policy or initiative • Program logic • Identify group to undertake the evaluation • Baseline data • Identify key issues and concerns • Key outcomes indicators • Stakeholders interests • Design: study, data collection • Data collection as planned • Data analysis • Recommendations • Dissemination of results • Take action Page 55 (28)-56(29)

8. Wimbush and Watson. Evaluation framework for health promotion • Common themes in evaluation (Policy and strategic planning) • Outcomes and effectiveness • Other important components (other stakeholders): • Improvement in quality of program • Improvement in program design Tip of Iceberg Health Education Board Scotland

9. Wimbush and Watson. Evaluation framework for health promotion • Perspectives: • Policy Makers and Strategic Planners: (make decisions and are held accountable) • What works? • What are the best buys? • Program Managers: (role: budget holders, responsible for the delivery) • Success, based on achievement of goals, extent of reachenessand sustainability • Practicioners: (role: operation and running of programs) • Feedback from people involved in the collaborative action • Community/Users: • Avenue to provide feedback, involvement: express concerns, satisfaction • Extent to which program meets their perceived needs

10. Wimbush and Watson. Evaluation framework for health promotion • Stages  Evaluation • Planning • Design and Pilot • Implementation –early start up • Implementation –establishment • Implementation –fully operational • Dissemination

11. Evaluation Framework for Health Promotion and Disease Prevention Programs. Victoria, Australia • Describe the program • Program logic • Evaluation preview: • Process • Outcomes • Implications for Future programs and policy • Focus evaluation design: • Agreed or common indicators • Collect Data • Analyse and Interpret Data • Dissemination of the results

14. EPODE • By level: • Central • Local • Settings • Child • To date, all EPODE programs have initiated continuous monitoring and evaluation practices at central, local and child levels, as well as in certain settings such as schools. • Developingconsistent practices and collecting comparable data across communities and programs remains an important challenge. Obesity Rev 2011

18. Proposal of a framework to evaluate community-based interventions to prevent child obesity LAC Public Policy Policy design Policy process Conceptual framework Logic model Objectives to achieve Political concern Focused on the electorate Objectives not declared Effectiveness Rating HIGH QUALITY Citizen’s feelings and technically correct

19. Good governance Open: Active communication, accessible language, trust between citizens and the institutions. Participation: Wide community participation during development, Implementation and evaluation stages to achieve a public policy with high quality, pertinence, efficacy. Efficacy: Actions must achieve results as planned, evaluating their future impact on the community and considering cumulative experience. Coherence: Policies and actions must be coherent and easy to understand.

20. We need to evaluate both, Policy design and its effectiveness and Policy Process Policy design and its effectiveness Policy process Through key questions That reflect the political Environment and support And Population satisfaction Through rigorous scientific methods

21. Why to evaluate political process? Politically strategic and democratic: Responsibility and accountability (social, economic and technical). Managerial: It helps to improve public management and the quality of the program Transparence: Strong mechanism to create “public value”. Society needs to know the way the money is spent, the results and the impact of the policies. Participation: It strengthens the communities and individuals. It also improves control and efficiency of public administration.

22. Complexity +++ + Nationwide Monitoring and Surveillance Investigation Public Policy Political: Decisions Agreements Actions Problem definition Stakeholders Plans Programs Objetives Logic model Projects/Interventions Public services

23. Policy design

24. Key common issues

26. Proposal of a Comprehensive framework LAC Planning Implementing Results Impact Population feeling Community believes Need / Problem Beneficiaries/Society Normative existance Stakeholders Participation Political commitment Intervention Objectives Actions Intermediate results Final results Health impact Diagnose and design Evaluation Implementation Evaluation Results evaluation Impact evaluation Ex Ante Intermedia Ex post

27. Ex Ante Ex post Intermedia • To analyse and determine if the intervention is adequate to solve the problem • It pretends to guarantee that the intervention will achieve the goals • It must evaluate: • Needs • Program theory • Coverage • Potencial effects, results and impact • It is a critical analysis about the implementation and early results. • It analyses the intervention validity, the pertinence of the objectives, the quality of the managerial and monitoring system. • It encourages to improve the implementation in order to achieve the goals • It evaluates: • The successful of the strategy. • Its flexibility and its capability to adapt the actions according to reality. • Its efficacy and efficiency • Managerial mechanisms

28. Key questions 1. “The circumstances external to the implementing agency do not impose crippling constraints” 2.“That adequate time and sufficient resources are made available to the programme” 3. That the required combination of resources is actually available” 4.”That the policy to be implemented is based upon a valid theory of cause and effect” 5.“That the relationship between cause and effect is direct and that there are few if any, intervening links” 6.“That dependency relationships are minimal” 7.“That there is understanding of, and agreement on, objectives” 8.“That tasks are fully specified in correct sequence” 9.“That there is perfect communication and coordination” 10.“That those in authority can demand and obtain perfect compliance”

29. Thank you!!