ABSTRACT
AIM: Tackling health inequalities is a top priority for public health services in England. Third sector organisations, or non-governmental organisations (NGOs), are seen as having a key role in providing these services, particularly to the socially excluded, often dubbed 'hard to reach', for whom services must be provided if health inequalities are to be reduced. The plethora of evaluation frameworks available to NGOs have a variety of value bases, ranging from those which unambiguously support commissioners and providers to address health inequalities and work with the 'hard to reach', through to those which could offer such support if suitably adapted, to those that would struggle to address these issues in practice. In this context, the aim of this article is to answer the question, 'to what extent can evaluation frameworks help NGOs to address health inequalities caused by social exclusion?' METHOD: The literature on health inequalities, evaluation frameworks, and the policy context within which NGOs deliver public health services, is briefly reviewed. We then draw on the concepts of 'comparative advantage' and the 'space of access' to explore the extent to which evaluation frameworks can help NGOs to address health inequalities caused by social exclusion. RESULTS: We identify contradictions between recent government policies around public service delivery in England which can make it difficult for service providers and commissioners to know which value(s) to focus on. This confusion is likely to at least perpetuate, perhaps even exacerbate, the marginalisation of socially excluded people, particularly in the current climate of austerity. The evaluation frameworks NGOs choose to use, and how they decide to use them, can have a real impact on health inequalities. We argue that, wherever possible, NGOs should place social value at the centre of the evaluation process, or at least make sure they capture as much as they can of the social value they create, in line with their own value base. CONCLUSION: Commissioners and providers do not always have a free choice about which evaluation framework to use, for example, due to resource constraints. Nevertheless, commissioners or providers can still influence evaluators to address health inequalities and involve the 'hard to reach'.
