The final step within the HIA is monitoring and evaluation. There are three different types of evaluations within an HIA that all serve a different purpose.
The first type of evaluation is the process evaluation of the HIA itself; did it go well, was the original plan followed, what problems were encountered and how were they solved? This process evaluation can provide lessons for future HIAs.
The second type of evaluation is the impact evaluation. The aim of this evaluation is to monitor and evaluate how the recommendations of the HIA were adopted and implemented by the decision makers. This impact evaluation provides information on the utility and or acceptance of the HIA within the decision making process.
A third type of evaluation is the outcome evaluation. The aim of this evaluation is to assess the actual impact of the proposed policy or intervention on health outcomes or health determinants after it has been implemented. This outcome evaluation provides information on the effectiveness of the proposed intervention or policy itself.
The success of the HIA or the action can be evaluated by monitoring indicators of the process (e.g. adherence to guidelines), the impact (e.g. the number of recommendations that are successfully adopted) or the outcome (e.g. the reduction in smoking prevalence and associated mortality).
Potential equity focused questions (Gunther, 2011) that can be asked in this step are “Have the stakeholders (including target groups) been asked what the health impact of the policy has been on them?” (process evaluation), “Did the health equity focus of the policy change in relation to the HIA and if so, how?” (impact evaluation), or “Did the policy impact health inequity (in real life) similar to the estimated impact (in the HIA)?” (Download here).