M&E >> Methodology #2
Roles and Responsibilities for M&E
The Strategic Information Department (SID) provides overall technical direction and guidance on all matters on M&E in the sector. The placement of 'Strategic Information' (SI) officers at the regional and facility level ensures that this mandate is fully implemented. Broadly speaking, the SID has the mandate to ensure that there is technical capacity and infrastructure to generate and supply information required for the purposes of ensuring the strategic objectives of the health sector are achieved. Within this lies an important function of implementing a knowledge management strategy for the ministry.

The department has three units (M&E, Research and HMIS). Within the three, M&E provides the overarching framework for the conduct of both Monitoring and Evaluation. HMIS has been and will continue to function as the ministry's health information management structure . This includes collecting both in and out patient data. A key function of HMIS that is traditionally in the domain M&E is data quality. The HMIS unit is the key unit implementing data quality management in the MoH. This responsibility is facilitated by the fact that the unit manages the ministry's health database for out/in-patient, Human Resources and HIV/AIDS data. The research unit has been introduced to play a critical coordination role for all health related research in the country. Over and above this function, the research unit provides technical guidance in the implementation of the national health research agenda . The implementation of the national agenda helps meet selected M&E information requirements, particularly at the regional and HQ levels.

How are responsibilities outlined at the various strata of M&E responsibility as outlined earlier in the document? The following applies:

The National Office , headed by the M&E manager, is responsible for planning, coordination and supportive supervision functions of all M&E activities. The office is custodian of the M&E framework and its related work plan. It has oversight for implementing the M&E work plan, a document that outlines, broadly, the core activities and resources required to support the conduct of M&E in the MOH. The office is responsible for establishing and improving benchmarks in the practice of M&E as outlined in this document. This office also houses M&E officers supporting programmes, policy, planning and budgeting at the HQ level. A detailed description of these functions is beyond the scope of this document. The national M&E office is responsible for meeting reporting requirements for the ministry of health at the national level i.e. producing the annual health review of the MoH, reporting on international commitments such as UNGASS, MDGs, etc.

HQ – I: Policy, Planning and Budgeting will be supported by Si officers based at the HQ offices of the M&E unit in the SID. SI officers assigned to support these areas of health management will be guided by the minimum health indicator list. These programme areas are represented, often, by senior health officials with management and administrative oversight responsibilities.

HQ – II: Disease Specific Programme Divisions play an important role of steering strategies. To effectively and successfully steer health strategies (such as the TB, Malaria, SRH, etc), programme divisions should have a good grasp of the following:
  • the programme design (objectives, procedure, resources)
  • the programme organisation
  • the relationships between the programme and the target groups
  • the relationships between the programme and its environment

The bullets are above can be called "steering" devices in the sense that they should be used as mechanisms for understanding how health services are delivered and bring about the desired impact on the target group. During programme implementation these "steering devices" are the vital "observation fields" for monitoring. Monitoring observes developments in these fields, it requires and supplies the information we need to assess them, and organises appropriate communication and consultation processes. The results are fed back into programme implementation in the form of steering decisions.

Therefore, at the programmes and HQ level, to assist programme managers and directors in ensuring programme growth and improvement, including ensuring policy has the desired effect, the SID will provide M&E support functions. Programme managers and directors on the other need to demand M&E information. Programme managers will work closely with the national M&E office to seek analytical programme information that helps them in strategic decision making functions.

What about existing M&E support to some of the programmes in place, e.g. Malaria, TB and Nutrition?

These will remain as they are and they will be recognised as a vital part of the M&E infrastructure. The SID recognises the significant resources that have been invested into these programmes to ensure service delivery is quality and effective. M&E systems were established to provide much needed information to make inferences about performance of these programmes. They will be part of a harmonisation framework that is yet to be finalised that allows these M&E officers to tap into the broader M&E unit in terms of technical assistance and other resources. The main thrust of harmonisation is to recognise that systems are working and there is no need to dismantle them in the name of a newly created entity but rather to allow the new entity's system to be able to relate to the existing systems elsewhere.

Regional Health Management Teams , in fulfilling their mandate and in line with the decentralisation approach, monitor health service delivery, clearly articulating desired health outcomes for the region, assuring equitable management of limited resources. RHMTs provide an overall picture of health in their respective regions. RHMTs are the primary audience for M&E in the region. In fulfilling this function, RHMTs are assisted by Regional SI officers. Specifically, SI officers work closely with the RHMT to produce analytical regional reports on health outcomes, specially commissioned health reports and service availability mapping.

Health Facility Management. As a place where service delivery meets with the target population, health facilities are the point where it all begins in terms of M&E. Health facilities are responsible for delivering the outputs of the health services, their actual implementation, input management and sound administrative management. By ensuring effective operations, health facilities lay the ground work of good M&E. Health facilities are assisted in this function by the presence of Strategic Information officers. Health facilities monitor the delivery of outputs, paying attention to the quality of services through existing quality assurance mechanisms, maintaining technical competence/skills of staff through ongoing in-service strategies and ensuring service delivery meets planned service coverage targets.
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