Monitoring And Evaluation In Health System Pdf

monitoring and evaluation in health system pdf

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Its goal is to improve current and future management of outputs, outcomes and impact. Monitoring is a continuous assessment of programmes based on early detailed information on the progress or delay of the ongoing assessed activities. The credibility and objectivity of monitoring and evaluation reports depend very much on the independence of the evaluators.

Monitoring and evaluation

Sector-wide approaches SWAps were introduced in the health sectors of low-income countries during the s, in response to a growing acknowledgement of the limitations of project support. Health SWAps are characterized by policy frameworks that focus on priorities in the health sector, by expenditure frameworks that define budgets for these priorities, by the use and improvement of national management systems and by partnerships between governments and donors Peters and Chao SWAps are expected to contribute to better co-ordination, harmonization and alignment, and to enhance national ownership and domestic accountability.

These principles were also adopted more generally in the Paris Declaration Walford , which sets out a reform agenda for both donors and recipients with the aim of increasing aid effectiveness.

Moreover, it is also essential for improving the quality of joint sector reviews. Rwanda and Uganda are both low-income countries in central Africa with low human development: they rank th human development index value of 0.

While Uganda outperformed Rwanda on many of the Paris Declaration indicators 2 in , the selective overview of indicators shown in Table 1 demonstrates the remarkable progress made by Rwanda in the period — Only on the indicator that measures progress in results orientation was no change in status recorded. Uganda, being one of only two countries to have a largely developed results-oriented framework B score in , received a lower score C in Several of our interviewees in Uganda, however, do not agree with this relegation and stress that the quality of the performance assessment framework has actually improved over the past few years because of stronger sector performance indicators.

Sources : Kaufmann et al. Table 1 also highlights —10 progress on the six Kaufmann et al. No significant improvement was made by Uganda in the governance indicators between and Donors provide their support through a health SWAp, which has been in place since in Rwanda and since in Uganda. Table 2 shows the progress made by Rwanda and Uganda on some of the indicators related to the health MDGs.

The progress made by Rwanda, in particular, is remarkable. Sources : World Health Organisation , , , Case selection was also influenced by the fact that our research aims to feed into the policy and practice of the Belgium aid agency that provides health sector budget support to both countries.

The assessments have been endorsed by the ministries of health, and terms of references and results of the assessment exercises have been discussed in the Joint Health Sector Working Group in Rwanda and the Health Policy Advisory Committee in Uganda. The HMN framework is supposed to function as a kind of benchmark for the collection, reporting and use of health information Health Metrics Network and describes six components of a health information system, subdivided into inputs, processes and outputs.

Based on the argument that health management information systems, through which facility-based data are collected, are generally weaker than other data sources including household and facility surveys, Aqil et al. This framework takes into account technical, organizational and behavioural factors Aqil et al. Our own assessment tool is most similar to this tool, as we do not focus on specific diseases while we also provide a more comprehensive overview than the HMN and PRISM frameworks, which focus on the health management information system.

These criteria are further subdivided into 34 topics see Table 3. Such combinations of tools might be particularly useful in cases where the assessment on the basis of our tool points at specific weaknesses in the system, for instance, at the level of the health management information system. Our assessment is based upon a combination of primary and secondary data.

Moreover, valuable feedback on preliminary research findings was provided during debriefing workshops. To trigger the use of our findings and comply with Paris Declaration principles of harmonization and alignment, we have embedded our exercise from the start within the framework of the existing Joint Health Sector Working Groups and Committees. In Uganda, however, accountability is undermined by a lack of data control at the various levels of the health management information system, resulting in unreliable data.

This is in sharp contrast with the situation in Rwanda, where local health data are controlled in a context of performance-based financing Ireland et al. While there is a continuous tendency of donors and especially vertical health programmes to push for additional indicators, efforts are being made to prioritize and harmonize better among various indicator sets and data collection sources.

Important data sources include census and population-based surveys and health management information systems. In both countries, the health information systems have been assessed on the basis of the HMN framework.

The HMN assessments, which include assessments of various data sources, conclude among others that the quality of data collected through census and population-based surveys is generally higher than that of facility-based data collected through the health management information systems Health Metrics Network ; Republic of Rwanda Interestingly, various interviewees in both countries emphasized that little cross-reading has so far been carried out among survey and facility-based data.

The lack of cross-reading among data sources, insufficient disaggregation according to relevant categories, a lack of qualitative facility-based data and deficient integration of indicators into causal chains all contribute to a lack of evaluative analysis. As many actors are involved in data collection, analyses and feedback, an appropriate institutional structure for co-ordination, support, overview and feedback is crucial.

Various interviewees hinted at the fact that the power of the Quality Assurance Department is curtailed by the limited number of staff members and its positioning under the Directorate of Planning and Development.

In Uganda, supervision is provided during quarterly area team visits, but several interviewees remarked that these visits are very expensive, time consuming and of limited use.

Joint health sector reviews are organized in both countries, twice a year in Rwanda one retrospective and one forward looking , and once a year in Uganda. While joint health sector reviews in Rwanda have been criticized for their poor preparation, for example, performance reports not being made available prior to the review, recent reviews hint at a number of improvements in this respect BTC In Rwanda, field visits in the context of the joint sector review have only recently been introduced.

While some of the interviewees were rather sceptical and referred to a lack of independence, in principle field visits offer opportunities to confront the aggregated data provided by the ministry with reality checks on the ground. Field visits spread over different regions and across different layers of inequality might be particularly valuable in the Rwandan context, where concerns have been voiced over increasing levels of inequality and potentially exclusionary poverty reduction policy and outcomes see Evans et al.

They include reality checks and structured interviews at the levels of health districts, hospitals and health centres on the basis of a pre-determined and standardized checklist.

Somewhat surprisingly, this checklist does not include topics related to data collection, use of data or feedback on data quality, despite the fact that the MoH itself identified poor data collection as a major weakness Republic of Uganda Field visits clearly focus on monitoring and local level reality checks, and do not investigate the underlying reasons for local non-performance.

As a result, potential weaknesses or obstacles at other levels of the health system, which may nevertheless have a strong influence on local-level performance, are not disclosed. Donors and civil society organizations in Rwanda and Uganda participate in the technical dialogue through technical working groups, and in the policy dialogue through joint sector reviews and sector working groups. Holvoet and Rombouts might also explain why participating civil society organizations do not adopt a critical stance.

Several Ugandan civil society organizations, however, are active in community-based monitoring. The Uganda Debt Network, for example, has been involved in community-based monitoring since Together with 15 community-based organizations, they have trained more than community monitors in 22 districts to monitor service delivery at village level not only in relation to health but also to education, rural roads, agriculture and water and sanitation Uganda Debt Network On the basis of information provided by the community monitors, the Uganda Debt Network facilitates dialogue meetings which focus both on accountability and learning.

To date, however, the information they provide is scarcely used by the MoH, donors or parliament. This is in contrast to the Ugandan Parliament, which adopts a more active stance. Here, for instance, the parliamentary Social Service Committee has visited 16 districts to document health performance, on the basis of which the committee underlined, for example, the need for increased community involvement in decision-making Wild and Domingo However, various interviewees also point out that parliamentarians are particularly active only when it comes to issues that directly affect their own districts, and fail to show sustained interest in issues that affect the country or the system as a whole.

While these reports produce a lot of data and information, their analytical quality remains weak, notwithstanding considerable improvement over time. In the Rwandan case, however, ad hoc instances of learning, and rapid changes in programmes made on the basis of evidence, are not unknown.

An example of this can be seen in the field of maternal and under-five mortality, where Rwanda had previously failed to reach Sub-Saharan African averages, and where several measures were subsequently taken to successfully redress the situation Basinga et al. However, when it comes to the more sensitive issues including, among others, issues of inequality in the health sector , analysis and learning appears to be less straightforward.

In Uganda, ad hoc instances have also arisen in which data have been used for planning, but the level of usage remains relatively low due to poor data quality, among other things. However, interest in data quality and use is on the increase in the context of the recent adoption of a system of half-yearly high-level retreats with the president, ministers and permanent secretaries, during which sector performance is discussed.

Use of data at local level has increased in Rwanda since the introduction of performance-based financing in the health sector, and district hospitals and health centres have also begun to use their data analyses for their own planning.

However, analytical depth is still lacking, and the analyses are mainly limited to tabular overviews and the use of graphs. In Uganda, health facilities do not currently use data systematically, and this limited usage of data does not motivate staff to control and improve data quality, which in turn affects data usage.

With regard to the broader policy issues, the strong linkages between the local and central levels, and between the health sector and finance ministry, are particularly striking in Rwanda.

They are also indicative of the generally strong intra-governmental accountability. The extent to which this plan will actually be put into practice, however, remains unclear. Rwanda has also been widely applauded for its successful implementation of performance-based financing in the health sector see e. Basinga et al. In Uganda, the introduction of performance-based financing has recently been proposed in the context of the October joint sector review Quality Assurance Department However, as discussed in Ireland et al.

While Rwanda, in particular, has made remarkable progress on several health indicators in recent years, it is highly probable that the need for qualitative in-depth analysis and disaggregation will become more pronounced in the future as achievements in the health sector slow down, and as measures need to be taken to reach the less accessible segments of the population.

A lack of evaluative analysis also affects the quality of the joint sector reviews. Williamson and Dom consider both the Rwandan and Ugandan parliaments weak. In particular, they point out the lack of effective pluralism, which is also evident in the fact that the political opposition, while formally permitted, is weak in comparison with the ruling party. Hedger et al. So far, however, parliament and donors have made little use of findings from community-based monitoring.

This is consistent with the idea that small incremental changes to existing systems might be more feasible and workable than radical and abrupt changes that seek to impose blueprints from the outside.

We are grateful to the Ministries of Health, the Belgian Embassies and the offices of the Belgian Technical Co-operation in Rwanda and Uganda for their support during our field mission. We would also like to thank the interviewees we met in various settings for their invaluable contribution to this study.

The findings, interpretations and conclusions presented in this report are entirely those of the authors and do not represent the views of the Rwandan or Ugandan Ministries of Health, the Belgian Development Co-operation or the Belgian Technical Co-operation. The research has been conducted within the framework of the O-platform aid effectiveness. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Skip Nav Destination Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. General background: Rwanda and Uganda. Article Navigation.

Activities: What is actually done

NCBI Bookshelf. Assessment, monitoring and evaluation are used at different stages during a humanitarian response and are closely linked to public-health decision-making and the implementation of RH programme activities. The results of assessment, monitoring and evaluation inform planning for comprehensive RH programmes because they help to:. RH officers and programme managers often find decisions regarding the transition from implementing MISP activities see Chapter 2 to initiating comprehensive RH service components challenging. Timely dissemination of accurate assessment, monitoring and evaluation results will enable them to make evidence-based decisions about the steps in the transition to comprehensive RH programme implementation and service delivery. Appropriate use of the results will also ensure that activities are carried out in a sustainable manner, appropriate for the context and adapted to the needs of the population.

Monitoring and Evaluation

Monitoring and evaluation of Primary Health Care attributes at the national level: new challenges. This essay discusses these elements in light of a new evaluation model that also guides a new process of financing the Brazilian Primary Health Care PHC. It builds on the correction of distributive distortions, and also seeks to guide greater effectiveness and efficiency in public investment and quality of service provided to the population.

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Metrics details. This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. The term monitoring is commonly used to describe the process of systematically collecting data to inform policymakers, managers and other stakeholders whether a new policy or programme is being implemented in accordance with their expectations.

Monitoring and evaluation

Sector-wide approaches SWAps were introduced in the health sectors of low-income countries during the s, in response to a growing acknowledgement of the limitations of project support. Health SWAps are characterized by policy frameworks that focus on priorities in the health sector, by expenditure frameworks that define budgets for these priorities, by the use and improvement of national management systems and by partnerships between governments and donors Peters and Chao SWAps are expected to contribute to better co-ordination, harmonization and alignment, and to enhance national ownership and domestic accountability. These principles were also adopted more generally in the Paris Declaration Walford , which sets out a reform agenda for both donors and recipients with the aim of increasing aid effectiveness. Moreover, it is also essential for improving the quality of joint sector reviews. Rwanda and Uganda are both low-income countries in central Africa with low human development: they rank th human development index value of 0. While Uganda outperformed Rwanda on many of the Paris Declaration indicators 2 in , the selective overview of indicators shown in Table 1 demonstrates the remarkable progress made by Rwanda in the period —

Metrics details. The demand for quality data and the interest in health information systems has increased due to the need for country-level progress reporting towards attainment of the United Nations Millennium Development Goals and global health initiatives. Three years after establishment of the cadre, an assessment was conducted to document achievements and lessons learnt. Reported achievements of the cadre included improved health worker capacity to monitor and evaluate programs within the districts; improved data quality, management, and reporting; increased use of health data for disease surveillance, operational research, and planning purposes; and increased availability of time for nurses and other health workers to concentrate on core clinical duties.

Monitoring and evaluation of HIV occurrence and responses allow countries to track the epidemic and their prevention and control efforts. Scientists use standardized indicators to assess progress and challenges over time and make cross-national comparisons. These massive inputs and the colossal and urgent needs at hand make systematic monitoring and evaluation of control and prevention of HIV infection and AIDS patient care programs critical to maximizing their cost effectiveness, particularly in resource-poor countries World Bank Unable to display preview. Download preview PDF. Skip to main content.

This is a very important step, so you should try to involve as many people as possible to get different perspectives. You need to choose indicators for each level of your program — outputs, outcomes and goal for more information on these levels see our articles on how to design a program and logical frameworks. There can be more than one indicator for each level, although you should try to keep the total number of indicators manageable. Some organisations have very strict rules about how the indicators must be written for example, it must always start with a number, or must always contain an adjective. My advice is just to make sure the indicators are written in a way where everyone involved in the project including the donor can understand them.

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