With the passage of time, the aspect of the heath programs governing larger and larger masses of the population has become increasingly strained to be continued with the same degree of efficiency and efficacy, as is natural for every system under operation with time. Stetler et al., (2006) has defined formative evaluation as “a rigorous assessment process designed to identify potential and actual influences on the progress and effectiveness of implementation efforts” and there are 4 stages of formative evaluation. In addition, the context of the operation of the public health programs have deviated over time with new researches, laws , fiscal, demographic, interpersonal as well
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