Introduction
With the development of policies specifically relating to rural health and health care provision, it seems appropriate to consider evaluating their outcomes. Although little has been done that specifically studies policy or processes, much of rural health research implicitly ‘measures’ policy effects;
Given what is known about the policy-making process, rural health researchers should beware of thinking that policy outcome evaluation might be straightforward or that evidence produced from evaluation will seamlessly influence future or evolving policy.
Objective and Methodology
The authors employ a systematic review of literature published from 1983 to 2008 in order to synthesize previous research findings relating to the outcomes of health policies in rural areas. A systematic literature review is defined as a study focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to the research question.
An advantage of this research approach is that it presents various views and findings regarding the research topic that can be critiqued using a selected criteria. In addition, the author(s) can add their own views into the study by using real life and up-to-date examples to support their choice of a particular set(s) of finding(s). The method is also fast and comparatively less costs.
One weakness of this research approach is that if common standards and guidelines are not adopted for comparing the methodologies and findings of all papers used, then the report could become biased and unreliable.
A manual check confirms that the authors consolidated information from numerous papers and adopted a universal standard for comparing the different findings.
The methodology used in this paper (systematic literature review) is appropriate for this paper as the research topic is broad and generalizable conclusions may not be easily arrived at in a single research, i.e. findings on the outcome of rural health policy in one rural area may not be applicable to all rural areas.
Besides, the precise objectives of the policies may differ, making comparison a challenge. Although the fundamental outcome of rural health policies should be good health at affordable cost, there might be additional objectives that are either acknowledged by, or important to, policy-makers, evaluators and communities. These additional objectives may differ from policy to policy and eventually reduce the capacity to compare the different policies.
Again, there might be inherent ambiguities even within the same policy objective that may stem from the way the objective is stated, the various hypotheses tested within the same objective, resource (un)availability, or even the conditions required before certain subsequent smaller objectives are achieved.
Finally, Objectives might be intangible, making it difficult to define measurable outputs. They might have multiple dimensions that can only be considered using different types of output measurement. This might mean that aspects that can be expressed quantitatively are given more weight, even though they are not the most important.
Findings and Outcomes
The aim of the research was to evaluate outcomes of rural health policies. However, before undertaking such a broad mission, a metric for evaluating health policies must be formulated due to the many challenges outlined earlier, i.e. policies might address a mix of objectives while some may be ambiguous or intangible.
The authors have come up with two specific outcomes that are discussed in detail: summative and formative approaches, and theory-based approaches (Farmer and Currie, 2009).
The authors devote give a lot of weight to a discussion of the findings and outcomes of the research
Therefore, the weight given to this section is justifiable and reflects the evidence provided. In addition, it is relevant to the problem issues identified at the beginning of the paper.
The Conclusion
In conclusion, Farmer and Currie recollect the issues within the policy process that affect evaluation. These issues are adequately covered in the paper and include the challenges of evaluation mentioned earlier. Due to these challenges, the authors conclude that there is much worthy of discussion in rural health policies.
Ethical considerations
It is unethical to allow personal information to be made public which informants would want to be kept private
It is unethical to violate informants’ right to privacy by posing sensitive questions or by gaining access to records, which may contain personal data;
It is also unethical to fail to observe/respect certain cultural values, traditions or taboos valued by your informants, particularly in the rural areas.
Careless presentation and interpretation of data may put readers who want to use the study’s findings on the wrong track. This may have serious consequences, in terms of time and money spent on the research and it may even lead to wrong decisions affecting people’s health
If the recommendations from a study will be implemented in the entire study population, one has the ethical obligation to draw a sample from this population in a representative way
Care must be taken not to draw conclusions or make recommendations that are not justified.