Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Lactation and fertility in Rural Bangladesh

Summary Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

There is no low-level fertility and development trap

Summary The theory of the low-level equilibrium trap asserts that an increase in income stimulates population growth sufficiently so that the additional people 'eat up' the 'surplus' over subsistence, and hence drive the level of income back to subsistence. Originally the theory referred primarily to mortality, but nowadays its application is to fertility. In the long-run equilibrium context in which the theory is ordinarily presented, the fact that the long-run elasticity of fertility with respect to income is negative in less developed countries fatally contradicts the accepted version of the trap. But to give every chance for trap theory to be meaningful, the paper presents a period-by-period analysis, embodying larger-than-observed positive elasticities during the early years and the logically necessary counterbalancing negative elasticities during the later years. These elasticities are combined with consumption and production figures for various age groups to estimate the effect in each year after the windfall, and altogether. The results show that even under assumptions not charitable to the conclusion of this paper, additional children do not even come close to 'eating up' the increase in income which induced their births, so that the trap theory is falsified.     

The certainty of judgments in health evaluations

Most evaluators seem to presume that all evaluative studies should result in conclusive evidence. Often, however, less than conclusive evidence may not only suffice, but be the only real alternative under conditions of limited evaluation resources. Three levels of evidence common to evaluation studies are discussed: suggestive evidence, preponderant evidence, and conclusive evidence. Ten factors are also presented which can be used to determine the level of certainty appropriate for a given evaluation study. Consideration of these factors enables the evaluator to specify when less than conclusive evidence is acceptable.     

Reaching children at risk: a model for training child welfare specialists

An innovative model for the training of social welfare students in the special skills essential in child welfare work is predicated upon a classification system of children at risk and a continuum of services.     

Location of community-based treatment centers

Neighborhood opposition to community-based treatment centers (CBTCs) has prompted fears that these centers will become concentrated in inner city, "transitional neighborhoods." These neighborhoods are thought to lack the willingness and/or resources to oppose CBTCs. This paper examines the distribution of CBTCs in a northern metropolitan county. The findings suggests that the fears of "ghettoization" may be real only for certain types of centers. Most centers were located in higher-status city and suburban neighborhoods. However, these centers were physically or visually isolated from the surrounding housing, making them less likely to attract attention and therefore less likely to arouse neighborhood opposition.     

Some factors related to contraceptive behavior among Wind River Shoshone and Arapahoe females

During the summer of 1972 in-depth interviews were conducted with 96 Shoshone and Arapahoe Indian women living on the Wind River Reservation in Central Wyoming. All were aged 15-49 and were users of the reservation health service. It was found the women fell into 4 groups: current contraceptive users, 42.7%; pregnant or seeking to become pregnant, 10.4%; infertile due to menopause or sterilization, 18.8%; and fertile never-users, 28.1%. The contraceptive users tended to be older, married, and have as many children as they want. The fertile never-users tended to be in their teens and generally unmarried. When asked why they did not use contraception their answer was 'because I am not married.' It is suggested that general education on contraception be provided the younger women so that when they achieve desired family size they will be informed as to family planning methods. It was found that religious belief against contraception was important to the young never-users, but not to the women who had completed their families. In fact, 73% of the users said their religion, which most identified as Roman Catholicism, had no influence on their contraceptive use while 27% said they were aware of church disapproval but used contraception anyway.