Monitoring is a systematic and continuous collection and analysis of data about the progress of a project or program over time. It involves a continuous process of data gathering and analysis that allows adjustments to be made in the objectives. On the other hand, Evaluation is a systematic periodic collection and analysis of data about the progress of a project or program. An evaluation provides credible and useful information enabling the incorporation of lessons learned into the decision-making process of both recipients and financiers (donors).
Monitoring and evaluation (M&E) systems have played a critical role in advancing the field of health through applying quantitative and qualitative methods in collecting and using health data, to inform decision making, applying rigorous evaluations in assessing program effectiveness, and designing and conducting operational research that address implementation challenges.
M&E systems have globally contributed to the improvement of health through tracking and evaluating the various diseases that mostly affect the low developed countries (LDCs). By establishing strong M&E systems to track and assess performance, strengthening Health Management Information Systems (HMIS) at facility, community, national and international levels to manage health data, and tracking progress towards achievement of health targets, the field of M&E has contributed in the achievement of health outcomes, improving health service delivery and saving lives.
The broad continuum of program/project evaluation stresses the fact that evaluation results are used for making decisions to improve on the overall program performance. This notion attracts no substantial objection until one plugs in the time element and the summative form in the conceptual elucidation of evaluation and the particular intervention being assessed. If an intervention is undergoing a terminal evaluation exercise or impact evaluation, how best will that intervention still benefit from the results? Considering this observation and from the practitioners’ point of view, monitoring outputs are used for coming up with corrective actions on a program under implementation while evaluation outputs are used for generating lessons.
These lessons can depict positive or best practices that can be replicated in future interventions.
According to Uganda in Figures 2013, a publication by Uganda Bureau of Statistics, the infant mortality rate (2010/11) is 54 and expected to reduce to 31 by 2015 in a bid to reduce child mortality. Maternal mortality ratio (per 100,000 live births) (2010/11) is 438 and expected to reduce to 131 by 2015 in order to achieve the millennium goal of improving maternal health. In order to achieve these targets, a strong, effective and efficient Monitoring and Evaluation system needs to be in place so that the deliverables can be tracked against the set targets, which are in line with the objectives to be attained.
Despite different advances, there are still major challenges to address for which Monitoring and Evaluation can significantly help. As 2015 is knocking and with a significant number of countries expected to not achieve health-related Millennium Development Goals (MDGs), Monitoring and Evaluation is poised to continue playing a prominent role for monitoring performance, accountability, and most importantly for understanding and tracking deliverables in the health sector through answering what, when, how and who questions.
In addition, by means of corruption, embezzlement and misuse of donor resources/funds by states, for example, Uganda hinders the country from attaining more development in the health sector. This has caused many donor agencies, including the UNDP, UNICEF, ADB, World Bank, UKAID, Civil Society Fund, and USAID, to mention but a few, to adjust their monitoring and evaluation policies, focusing on performance, evidence of effectiveness, and impact of the different programs they are funding in order to increase efforts and resources for monitoring, evaluation, and implementation research to bring about sustainable solutions to address global health problems mostly in developing countries more so the Sub Saharan Africa.
In conclusion, since most of the program implementation frameworks are results-oriented and go hand in hand with effective and efficient utilization of resources, governments and donor agencies need to ensure that the Monitoring and Evaluation systems are strengthened because the M&E results are useful in providing authentic best practices to learn from. The performance indicators to measure the impact, outcome, output and input must be SMART in nature.
This in turn motivates implementers once the set performance targets are achieved. Likewise, the results can inform implementers on areas they have not performed well, thereby providing an early warning that trigger administrative decisions/corrective actions for the purposes of improving performance all of which will help in improving service delivery in the health sector hence promoting and improving global health and attaining health equity.