Evaluation of program utilization and cost effectiveness.

In order to improve understanding of the dynamics cost and effectiveness of the interventions used to influence mortality morbidity and child growth and development in India systematic measurement of health inputs service outputs and outcomes in terms of changes in health and nutrition status was undertaken. Functional analysis methods to quantify interventions in the nutrition project yielded several useful results. It became possible to plan practical adaptation of the Narangwal service patterns to other situations by using quantitative estimates of required inputs; information wzas revealed about the cost of each service component so that administrators and health planners designing new nutrition and child health programs could use the Narangwal experience as a guide in estimating relative costs of different services; a more rational basis for recommendations about service packages was formed. Data were collected in all project villages by a separate evaluation team producing detailed information on the time spent by project staff providing services and on all costs related to the provision of services for each year of the project. A sample household survey was conducted in all study villages during the final year of the project. In terms of the total economy of the Punjab the types of healthh programs introduced by the Narangwal project are probably within a realistic expansion of expenditures if government and community resources could be combined. Combined services for only slightly more expenditure of time and money than for either 1 of the single intervention packages alone achieved effects nearly equal or superior to the single interventions on all parameters of physical growth psychomotor development mortality and morbidity. All possible impacts and costs must be considered rather than a single outcome measurement.