Evaluation of a community-level health policy intervention.

In this article an evaluation approach towards an innovative community-level health policy intervention in Germany is presented. The aim of the intervention was basically to establish new structures of health planning and co-ordination at the community level in order to improve health monitoring and health care as well as health promotion. To realise this aim Round Tables, Working Groups and Project Offices were implemented in the communities. Based on the theory of change and using a developmental perspective the evaluation was focussed on the links between contexts, activities and outputs of the initiative. A mixed-method design with triangulation of quantitative and qualitative methods was applied. Results show that most of the communities succeeded in convening all major organisations and institutions of the local health care system within the Round Tables. Working climate was rated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for action programmes, and about 40% of these programmes were implemented during the observation period of the project. Probability of programme implementation was high if measures remained within the scope of the communities' range of decision authority. Potential effects on population health produced by the action programmes could not be assessed both for logistic reasons and due to the short observation period. Finally, some major characteristics of health policy evaluation at the community level are discussed briefly.