Evaluating health care decentralization

摘要

The aim of this paper is to discuss a framework for health service evaluation related to the decentralization process in Brazil. Methodological and conceptual issues related to the evaluation steps proposed are analysed: a) contextual analysis; b) strategic analysis; c) management characteristics; d) coverage and effectiveness monitoring; and, e) implementation analysis. Problems and advantages related to an articulated approach between external perspective and empowerment evaluation are discussed. Counties's classification in stages of the decentralization process is analysed related with existing proposals for health services reform. The achievement of theoretical, technical and political consensus is highlighted as a need for transforming evaluation in a tool for the management process.