M&E >> Methodology
What is to be monitored and evaluated?
Traditionally monitoring and evaluation focussed on tracking meticulously project inputs and implementation process – counting the number of condoms purchased and how many have been distributed. It is now generally agreed that more focus is required on tracking outputs (their quantities and quality) and how these contribute or shape development outcomes such as sexual behaviours, HIV infection rates, treatment, etc.

With a generally accepted shift in M&E from traditional i.e. implementation-focussed M&E (i.e. M&E that counted the inputs and the concomitant processes and much less-so the outputs) to results-based M&E (i.e. focussing on outputs, outcomes and impact), the SID has taken into consideration the influence of the proposed approach to M&E and how this ultimately shapes the focus of the growth of M&E in the sector. Secondly, as the MoH rolls out the decentralisation strategy, changes will have to be internalised in the focus, approach and implementation of monitoring and evaluation at the three levels; the facility, the regions, programmes and at HQ level.

The diagram below is the new results chain that puts into context the focus on results-based M&E. Fig.1 shows that the focus of M&E is on results . In Fig.1, this shift is articulated as follows:

At the facility level, this shift will result in the focus of M&E being applied towards tracking the generation of outputs according to three overarching categories of functional outputs, service outputs and service utilisation as depicted in the diagram. This shift will facilitate clearly the documentation of attainment of regional targets and at an aggregate basis, national-level targets. Does this mean the tracking of inputs and process will cease?

On the contrary, these will continue but not under the dispensation of M&E! For example, in the HTC programme, tracking of test kits procured will not be a focus of M&E as it is already captured and reported on by the programme implementation recording systems such as inventory logs. Using the same example of HTC, the focus will now be:

Functional Outputs
  • Number of counsellors trained in HTC counselling.
Service Output
  • Quality of counselling offered at health facilities
Service Utilisation
  • Number of individuals counselled and tested
A more focussed discussion of M&E at the facility, regional and HQ level follows that explains how this results chain will facilitate the conduct of M&E.
At Facility Level
The planned approach to monitoring at the facility level will focus on tracking the generation of outputs, i.e. according to three overarching categories of functional, service outputs and service utilisation. By focussing monitoring on capturing output data, at this level, helps address issues of operational efficiencies/ineffectiveness in that failure to achieve output targets is symptomatic of implementation challenges. Evaluation activities will be aimed at generating knowledge and learning on achievement of optimal efficiencies. Evaluation will facilitate the scanning of the environment in which the facility operates to obtain a complete picture of factors that impinge or facilitate the efficient achievement of outputs.
Regional Level
The regions present an opportunity to aggregate facility data to paint a regional perspective. Regions will conduct monitoring focussing on obtaining a picture of regional coverage i.e. the outputs generated by each facility will be aggregated (accounting for quality and quantity). Regions will also factor in non-health facility data to offer a broader and richer picture of health outputs in the region. Evaluation will help regions better understand the contribution of facility and non-health facility data, including exogenous factors to the attainment of health outcomes at the regional level.
HQ Level– Programmes, Policy, Planning& Budgeting
The HQ level in the sector drives the development and growth of strategies in response to the sectors policy directives. This in turn will entail M&E will focus more on generating evaluative knowledge which is necessary for strategy analysis and review. Monitoring, specifically, will be limited to tracking the implementation of strategies, collecting information that depicts the growth of a strategy over time, presenting enough information to warrant evaluative studies that will help develop a better understanding of why strategies work or fail. Due to the scale of perspective, M&E at the national-level will be focussing on collating the regional picture to provide a national perspective. Therefore, "monitoring" at the national level will not be as frequent as it will be at the facility level but instead will be periodic quarterly/annual to capture evidence of the sectors performance. Of urgent importance is the need for evaluative knowledge that responds to sector policy review and development, planning and reporting.
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