M&E >> Methodology #1
As defined in the previous section of this document, M&E has to take into cognizance the practicalities and realities of data collection, analysis and reporting in today's environment in the MoH.
We have already noted that the HMIS has oversight for collection of health data from facilities. Therefore, the M&E unit will not engage in data collection but will work closely with the HMIS to continue streamlining data collection by ensuring that data collected meets the information needs of the various constituencies within the health sector. The actual conduct of monitoring, then, takes on a unique hue.

Since the distinct element of regular data collection within the M in M&E has been apportioned to HMIS, therefore the actual conduct of monitoring will revolve around three aspects – data mining/reporting, validation, and critical reflection.

  • Data Mining/Reporting, which entails analyzing data from different perspectives and summarizing it into useful information; information that can be used to improve service delivery or quality of services offered, cuts costs or both.
  • Validation, which entails checking or verifying whether or not the reported progress is accurate;
  • Participation/Critical Reflection, which entails obtaining feedback from various constituencies within the health facility, non-health facilities and beneficiaries on progress and proposed actions.
Data Mining/Reporting
M&E officers are expected to use the HMIS and at least any one of the reports in their selection of activities under data mining and reporting.

The HMIS Database: This is a core monitoring tool. The HMIS unit, on a quarterly basis, will announce the release of health data in various file formats (SPSS, Stata, Access, etc) to be used by M&E officers at various levels to undertake their planned analyses. At the end of the first quarter of each year, the HMIS will release annual data sets for the previous year. These data sets will allow M&E officers to conduct rudimentary or complex statistical analyses.

Reports: All types of reports listed in this section contain both data and information about health programmes. Regular analysis of reports, culling them for insights or actually establishing insights from these reports should be a normal part of each M&E officer in the SID. At a minimum, individuals conducting M&E are expected to make references to these documents as a demonstration of having considered other information sources apart from the HMIS database.
While the HMIS unit is largely responsible for data quality through its unique Data Quality Improvement (DQI) strategy, M&E officers are expected to communicate data quality issues to the DQI team. They are also expected to participate in RDQAs.

Routine Data Quality Assessments: Each M&E officer, at a minimum, should participate in one RDQA per year. This affords the individual an appreciation of their role in maintaining data quality through first hand observation of the causes and solutions of data quality problems and helps reinforce the importance of correct interpretation of data analyses. When developing work plans, ensure to indicate a section on data quality. The DQI team will announce their schedule at least three months in advance to allow adjustment of work plans to ensure M&E officers participate in these events.

Data Quality Profiling Reports: These will be released on a semi-annual basis. They contain an overview of data quality issues for health facility data. They are basically a 'barometer' of quality for health data. These are to be reviewed and analysed for possible feedback to the DQI team. However, there will be monthly reports that will be released to all regions to enable them develop awareness of the data quality challenges.

External Assessments: Every two years, the SID will conduct an assessment of the M&E system using external facilitation. This is done to assure that assessments of program results have been systematic, credible, and objective.
Critical Reflection
M&E is not for the benefit of the individual conducting it. The practice of M&E ultimately should help management teams at various levels to make sense of the data that is collected in M&E processes. Critical reflection, as a third component of the practice of M&E, helps to bring into focus efficiencies, quantity and quality of results or the lack thereof. Critical reflection events need to planned in detail from the onset otherwise they will not be accorded the importance they hold and will therefore not happen. The steps below have been provided for you as a guide to review when you develop your critical reflection events.

Annual Review Sessions: While many strategies to conduct critical reflection exist, M&E officers are expected to schedule and provide oversight for an annual review session. The following is the core structure of an annual review session:

Pre-Annual Review Period: This should be at least two months before the planned event. During this time, the M&E officer prepares an announcement for the review session to be circulated to the supervising management team. The announcement is a document that provides the background and rationale, objectives, duration, facilitation methodology and facilitators, expected outputs and an abridged programme. This will enable recipients to develop an anticipation of the event. During this time, the M&E officer will also constitute the facilitation team, gather necessary documents to be used in the review session, arrange for keynote speakers where necessary and secure venue and other logistics.

Annual Review Sessions: An annual review session should not last less than a day or run for more than three days. This is an event that is focussed in nature, aimed at reviewing information over the past year, reviewing trends, discussing implications of the same trends, juxtaposing these against findings in similar contexts from other places but ultimately, generating new insights, learning and knowledge. Therefore, any annual review session, should comprise the following components, not necessarily limited to these or in the order they have been presented ...

  • A section on an overview of trends in health data. This section will largely be covered through presentations
  • A section for debating and discussing the trends, exploring their implications on current strategies for service delivery.
  • A section for establishing new insights, learning's and knowledge generated. This is a section that affords participants to make resolutions that can be adopted for implementation geared towards improving performance, regardless of the level i.e. facility, region or HQ level.

Post-Annual Review Session: Within a month of conducting an annual review session, each M&E officer is expected to produce a report of the event that will be circulated to stakeholders and interested parties. The highlight of this report is a one page summary of the resolutions containing new insights, learning's and knowledge generated to impact future service delivery.
Although Evaluation is listed as a tool under validation in the choice of M&E tools, it is addressed in its own section due to the importance of tool and also because it has often been swamped by the demands of setting up project monitoring mechanisms alone. Often, organisations spend considerable amounts of time setting up monitoring systems with little attention paid to evaluation. In the MoH, evaluation will be accorded equal emphasis if not more than monitoring. The MoH is interested in what works, why and in what context . However, due to the technical nature of evaluation and the challenges of establishing evaluative capacity, the SID will employ a two pronged strategy; a short-term approach to conducting evaluations i.e. plan for and engage external consultants to conduct priority evaluations, and a long-term approach i.e. building the capacity of the staff cadre within SID to conduct evaluations and evaluative assessments. These circumstances have rendered the discussion of evaluation to be beyond the scope of this document. However, in the next version of the M&E framework, it is anticipated that a full chapter will be devoted to evaluation in 2013.
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