Health policy design analysis: foundations for monitoring and evaluation

Abstract

Objective: To analyze health policies based on policy design theory, identifying elements that enable their monitoring and evaluation. Methodology: A descriptive and exploratory study with a quali-quantitative approach examining health policy design regarding monitoring and evaluation elements. The research universe is Consolidation Ordinance No. 2, dated September 28, 2017, and updates until August 2024. Simple frequency analyses and content analysis were performed. The evaluative axis combined elements of competencies, guidelines, objectives, strategic actions, and specific chapters for monitoring and evaluation. Results: Of the 50 analyzed policies, 40 (80%) originated from ministerial ordinances; 36% lack explicit monitoring and evaluation elements; in the others, their incorporation predominates as objectives (62%). Responsibility is mainly shared among federal entities (60%). Four main monitoring and evaluation constructs were identified: activity standardization and regulatory focus, present in 48% of policies; systematic monitoring and data quality (54%); evidence-based evaluation (62%); and ex-post evaluation (68%). In 90% of disease-specific policies, all constructs are present. Only 28% of policies incorporate all four constructs simultaneously. Recent policies emphasize ex-post evaluation and evidence-based decision-making. Conclusion: The analysis of health policies points to the need for improvement of continuous processes in monitoring and evaluation mechanisms. The importance of periodic review of older policies for incorporating evaluative elements and developing specific monitoring and evaluation methodologies is highlighted, considering the particularities of each policy.

Submitted: 19/12/24| Revision: 06/02/24| Approved: 07/02/25