Logic model of the Franche-Comté Regional Health Project: advantages and limitations for the evaluation process

The French "Hospitals, patients, health and territories" law of July 2009 created the Regional Health Project (PRS) to support regional health policy, and requires evaluation of these projects. The construction of these projects, which includes prevention planning, care planning, and medical and social welfare planning, presents an unprecedented complexity in France, where evaluation programmes are still in their infancy. To support future evaluations, the Franche-Comté Regional Health Agency (ARS FC), assisted by the expertise of EFECT Consultants, decided to reconstruct the PRS logic model. This article analyzes the advantages and limitations of this approach. The resulting logic model allows visualization of the strategy adopted to achieve the Franche-Comté PRS ambitions and expected results. The model highlights four main aspects of structural change to the health system, often poorly visible in PRS presentation documents. This model also establishes links with the usual public policy evaluation issues and facilitates their prioritization. This approach also provides a better understanding of the importance of analysis of the programme construction in order to be effective rather than direct analysis of the effects, which constitutes the natural tendency of current practice. The main controversial limit concerns the retrospective design of the PRS framework, both in terms of the reliability of interpretation and adoption by actors not directly involved in this initiative.