Rosy Goals, Reactive Practice: Interpreting Programme Failure

Much evaluation research has focussed on the impact of innovative health programmes, yet there have been few attempts to identify the reasons underlying reported programme successes or failures. This shortcoming has reduced the generalisability of research findings, and hence their policy relevance. This paper explores the reported failure of two Queensland community health centres to improve the health status of the communities served. The data indicate a lack of fit between pro gramme goals and practice. Strong support for the specified goals at all levels of implementation, however, negates the hypothesis that the evaluation was based on “unreal” goals. Four alternative explanations are developed — “grandiose goals”, “bureaucratic red tape”, “staff fallibility” and the “exigencies of the job”. The paper concludes with an assessment of the relevance of this analysis to other innovative health programmes.