case study for monitoring and evaluation

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‘ It is a question of determination’ : a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo

Helen baker.

1 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 30322, USA

Roger Rochat

2 Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA

Kenneth Hepburn

Monique hennink, macoumba thiam.

3 AgirPF, EngenderHealth, Lomé, Togo

Cyrille Guede

Andre koalaga, eloi amegan, koffi fombo, bolatito ogunbiyi.

4 EngenderHealth, Washington D.C., 20004, USA

Lynn Sibley

Associated data, underlying data.

Due to restrictions of access to data outlined in the research participant agreement approved by the Togolese national ethics committee (CBRS), the datasets generated and analyzed during the study are not publicly available. Readers can access data by contacting the Lillian Carter Center for Global Health and Social Responsibility at the Nell Hodgson Woodruff School of Nursing at Emory University ([email protected]). Data will only be shared with researchers for reanalysis and grant proposals.

Extended data

Figshare: Study Documents Agir03. https://doi.org/10.6084/m9.figshare.7823651.v1 21 .

This project contains the following extended data:

• - Study documents including the protocols, consent forms, health facility assessment forms, and semi-structured interview guides

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Peer Review Summary

Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth’s AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services.

Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors.

Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations.

Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.

Introduction

Interest in providing family planning integrated into other health services has increased in the last five years 1 – 3 . While it is well established that integrating services such as family planning into postabortion and postpartum care can increase contraceptive use and decrease maternal and child deaths 2 , 4 , little information exists on the monitoring and evaluation of such programs at country or regional levels 5 .

Two studies in Togo, the focus of this paper, on postabortion care (PAC) and record keeping at five participating health facility sites documented that in 2014 the monitoring systems for PAC were informal and non-standardized in four of the five facilities 6 . With further training and support, a follow up study in 2016 in the same sites found standardized PAC registers which were generally filled out at the patient level, but the information was not transferred to the district, regional, or national levels 7 .

In opposition to this lack of standardized monitoring, there is increasing interest in monitoring progress towards international benchmarks such as the Sustainable Development Goals, as well as indicators for health initiatives funded by international organizations. Some of the barriers to timely and accurate monitoring include a lack of funding and resource allocation to monitoring and evaluation 8 , a disconnect between expectations of high quality monitoring systems and the level of detail required in reporting 8 – 10 , poor linkages between monitoring systems and points of data generation 11 , a shortage of trained professionals working in monitoring and evaluation 12 – 15 , and the large quantities of required health indicators 8 , which often results in duplication of data collection, and frequent underutilization of existing data collection tools 16 , 17 .

The best methods for reporting integrated family planning programs in practice are still being developed, especially in areas where health care is highly fragmented by type of service delivery (such as vaccination, maternity care, HIV care) 18 – 20 . The published literature lacks information about the processes and strategies for reporting integrated family planning services when implemented 4 .

Project description and study aims

Agir pour la planification familial ( AgirPF ) was a 5-year USAID/West Africa project (2013–2018) implemented by EngenderHealth to build capacity in and increase access to family planning, with interest in the integration of family planning into PAC and postpartum services. AgirPF was implemented in the urban and peri-urban areas of five West African countries- Burkina Faso, Cote d’Ivoire, Mauritania, Niger, and Togo, in partnership with ministries of health, the private sector, and non-governmental organizations (NGOs).

In this paper, we describe the extent to which monitoring and evaluation systems of health services, which operated within the AgirPF project area in Togo, captured integrated family planning services. We then examine the influence of values, interests, and power dynamics between key stakeholders on quality of the monitoring and evaluation system and discuss the implications for policy, programming, and research. The paper is based on research that was conducted as part of a larger case study 21 completed by EngenderHealth’s AgirPF project in April-August 2016 with the goal of understanding the status of integrated family planning in urban areas of Togo.

Study design and setting

For this study we used mixed methods including health facility assessments, health service record review, and key-informant interviews. The study was situated in the three largest urban areas in Togo, Lomé (pop. 956,000), Sokodé (pop. 114,800), and Kara (pop. 110,900) 22 . Between February and June 2016, and prior to data collection for this study, AgirPF initiated training around the integration of family planning with other health services. They trained health care workers at 35 facilities in PAC/postabortion care-family planning (PAC-FP), and health care workers at 7 health facilities in postpartum intrauterine device (PPIUD) insertion.

Health facility assessment. We obtained a diverse, purposive sample of 25 health facilities affiliated with AgirPF including university hospitals (n=2), regional hospitals (n=3), district hospitals (n=5), large community health facilities (n=9), a health dispensary (n=1), and private clinics (n=5).

For the assessment, we adapted the Postabortion Care-Family Planning Service Availability and Readiness Assessment 23 and ISSU Enquête Finale au Niveau des Structures de Santé (Final Survey at the Health Facility Level) 2015 24 .The adapted guide contained 194 both open and closed-ended questions. For this part of the health facility assessment, we focused on 19 questions related to monitoring and evaluation of reproductive, sexual, and child health services, and reporting of integrated family planning services.

We trained a data collection team of two nurses and four midwives and pilot tested the guide in July 2016. During the pilot testing and first 3 health facility assessments, the research team discovered that health workers were adapting the government approved and widely used family planning health registers to capture additional aspects of health service integration. This included recording information about what other services the woman received (PAC, postpartum care, immunizations, child health) in addition to whether the woman came on her own or with her husband/male partner. The health facilities also were creating their own unofficial registers to capture information about PAC and general gynecological care.

With this discovery, the health facility assessment team was asked to photograph de-identified filled out health service registers, including family planning, during the health facility assessments. These registers illustrate the different ways in which the registers had been adapted when the official register did not provide a way to capture information needed for reporting to the Ministry of Health and other agencies, including international NGOs.

The team conducted the assessments in person at the selected health facilities. They spoke with a staff member who had been designated by the director of the health facility to participate in the assessment. Since taking photos of the health facilities was not in the original study plan, the data collectors took photographs of different types of available health registers (e.g. not in use or inaccessible), and if the team member had use of a digital camera or smart phone with a camera the day of the health facility assessment. On average the health facility assessments took about three hours to complete by one data collector.

We entered all the closed ended data from the health facility assessment questionnaire into SPSS 24 25 software for cleaning and analysis and compiled the responses from the open-ended questions in tables in MS Word 26 . We used univariate analysis to generate descriptive statistics related to information about reporting on integrated family planning and the services offered at the facility related to integrated family planning. The principal investigator (first author of this article) developed a simple guide to assist with the review and analysis of the photographs by record type.

In-depth interview. We purposively sampled 41 total respondents from diverse professional roles within the Ministry of Health, academic institutions, NGOs/international organizations, and health services. These included faculty at schools of medicine, nursing, and midwifery (n= 3); directors and health workers in health services (n=9 and n=14, respectively); individuals working at reproductive health NGOs/international organizations (n=9); and individuals who worked primarily in reproductive health policy and politics (these included individuals working in the Ministry of Health and NGO workers focused on reproductive health policy) (n=7). This diversity in the sample was intended to elicit a variety of perspectives on reproductive health care from individuals with varying degrees of contact with the AgirPF program activities and trainings related to integrated family planning services. Respondents were recruited by AgirPF through official collaborations with the Togolese Ministry of Health, other reproductive health NGOs, and health facilities.

We developed and pretested five semi-structured interview guides appropriate to the type of respondent. Each of the guides included questions for respondents about multiple different aspects of family planning and integrated family planning in Togo. This paper uses data from the key-informant interviews related to questions about monitoring and evaluation of family planning and integrated family planning.

Five Togolese social scientists and the principal investigator conducted the face-to-face audio-recorded interviews in French. The interviews took place at a time and location chosen by the respondents and took from 30 to 150 minutes to complete. Interview recordings were transcribed verbatim in French by the Togolese social scientists using Express Scribe software version 5.000 27 and then copied into MS Word 2013 26 .

We entered the interview transcripts into Nvivo 11 for analysis 28 and then developed initial codes as well as an initial codebook with the input of Togolese social scientists. The principal investigator then coded all transcripts using the codebook and applied thematic analysis, a rigorous, inductive set of procedures with the goal of identifying and examining themes from textual data in a way which is transparent 29 . Matrices were created in Nvivo to better understand the intricacies of the responses by participant type and location for codes related to monitoring and evaluation of reproductive and sexual health and emerging methods of recording family planning integrated into postabortion and postpartum care. Transcripts were then re-read for further understanding of themes identified, and quotes were chosen to further illustrate selected themes.

Ethical review and informed consent

The study was approved by the Institutional Review Board at Emory University (eIRB#88781), the EngenderHealth Knowledge Management, Monitoring and Evaluation, and Research unit, and the Togolese Ministry of Health Comité de Bioéthique pour la Recherche en Santé (CBRS) (AVIS N o 015/2016/CBRS du 30 juin 2016) . Data were collected only after written informed consent was taken from participants using standard disclosure procedures.

The results are presented beginning with the health facility assessment and health record review followed by the results from the key informant interviews.

Health facility assessment

Description of the facilities. There were 13 facilities in Lomé, four in Sokodé, and eight in Kara, a total of 25 sampled facilities. Eleven of the facilities provided PAC prior to the start of the AgirPF project in 2013. In 2016, 24 of the facilities had some of their health care workers trained by AgirPF in PAC and PAC-FP, 6 had health care workers trained in postpartum family planning (PPFP) and PPIUD insertion. All the health facilities were supported in some way by the AgirPF project. Table 1 shows the types of reproductive and child services available at each health facility with an associated official government issued register or with an unofficial register made by each health facility.

*Italic indicates an “unofficial” register

System of reporting reproductive and child health services

The expected system. The expected flow of information in the system is from the patient to the health facility to the district, regional, national, and international levels of the Ministry of Health ( Figure 1 ). At the patient level, the health care worker must enter and then re-enter information multiple times about a single patient. For information to flow from the patient to facility levels, the health worker must initially enter information into a patient booklet and, for family planning and vaccination, into a patient form for these services. Then the health worker must file the patient form(s) and enter the information in the patient health booklet and sometimes a patient health form into one or more official health register(s). The PPFP/PPIUD register was the only official register which included information about integrated family planning services. This register also had a corresponding book with carbon copy sheets for the monthly reports sent to the Ministry of Health and the partner organizations.

The expected data collection steps and tools used in the reporting process to monitor utilization of integrated family planning services in Togo.

The actual system: individual level reporting. If an official register did not exist for a given service, sometimes NGO workers involved in integration projects would tell health workers to create an unofficial register for the service using a notebook and pen, inserting columns for recording information. Unofficial registers were used most often for general gynecological care (which sometimes included PAC/PAC-FP) as well as PAC/PAC-FP registers. There was little consistency across sites – they were idiosyncratic and site-specific in the unofficial records across the sampled facilities with respect to titles and the information captured. Figure 2 shows the different examples of PAC registers in use and a list of commonly included information in the PAC register.

Common information collected by the Togolese Ministry of Health’s registers and images of the various registers utilized by family planning services reporting system.

Family planning registers were adapted to capture when a client received family planning as part of other health services to enable the health workers to include these data on integrated health services into the monthly service provision reports ( Figure 3 ).

How health workers adapted registers to capture necessary family planning services information necessary to report to the Togolese Ministry of Health and NGOs.

The actual system: facility-level reporting. Within the past two years, the Ministry of Health revised its monthly service provision reporting form, Maternal and Infant Health Report, to include integrated family planning services as outlined in Table 2 . However, the existing service registers were not changed accordingly. As a result, the registers did not always have the data needed to complete the new form at the facility level.

In addition to reporting at facility level for the Ministry of Health, the health care workers were also required to report monthly to the AgirPF project using AgirPF’s form. The respondents also prepared reports for other national and international organizations when asked.

The greatest discrepancy between the sampled facilities with respect to reporting up the chain ( Figure 1 ) was when and where the facility level reports were sent. All 21 of the health facilities which sent reports on integrated family planning sent them monthly. Figure 4 shows the recipients of reports sent by the health facilities. The most common responses included NGOs and the district level Ministry of Health; reports could be sent to more than one recipient.

Where sampled health facilities send monthly monitoring reports and discrepancies between these facilities with respect to reporting up the chain.

Key informant interviews

Table 3 gives information about the 41 key informants involved in the study. Two of the health faculty were trainers for PAC, PAC-FP, PPFP, and PPIUD for the AgirPF project. One health facility director was trained in PAC/PAC-FP and 3 were trained in PPFP/PPIUD. One of the health care workers was a trainer for PAC and 8 had been trained in PAC. Four of the health care workers had been trained in PPFP/PPIUD insertion.

*One key informant was interviewed as both a faculty and health facility assessment.

How family planning registers are being adapted to include integrated family planning data. The health workers interviewed conveyed a great interest in ensuring high quality reporting within the health care registers. What they noted as missing was appropriately formatted registers--both official and unofficial-- which captured all the information required in the facility-level monthly reports sent to the district level of the Ministry of Health and partner NGO projects. This most frequently occurred with the family planning register. One of the educators (02) who also worked as a clinician in a district hospital noted, “ Some indicators that we must track are not noted in some registers, which is worrisome and causes extra work. The registers we have do not conform to the reporting tools. I suggest we review all the registers in use for family planning service providers and make sure they are consistent with the reporting tools. Then reporting would be easy.”

Availability of support for integrated family planning reporting. Individuals involved in reproductive health politics, NGOs, and health facilities directors had varying responses in relation to available support and resources to help implement and record family planning integrated with other health services. All but two respondents to this question felt that further support was necessary and that currently the availability of resources for integrated reporting was lacking, in part because the formats were not as useful as they could be, as described above. A major theme across respondents was how health care workers were already overwhelmed with the amount of required documentation that they were expected to produce. Respondents indicated that future reporting needed to be simplified or it would be necessary to have individuals specifically tasked with reporting. Training of health providers was a prominent request in improved reporting methods.

International NGOs provided health workers with the support for documentation of integrated services. During the PPFP/PPIUD training conducted by Jhpiego and EngenderHealth, health care workers being trained were given hard cover, bound registers approved by the Ministry of Health to record PPFP/PPIUD insertion to use at their respective health facilities as discussed above. One individual involved in reproductive health politics (05) said, “ For PPIUD, Jhpiego provided a register for postpartum care! But postabortion care currently does not even have a proper collection tool. It is handmade and could be used at all levels but is not.”

Uses of family planning data that is reported. There was not consensus as to who used the collected family planning data from the informants. Informants named the Ministry of Health, the Division of Family Health/Division of Maternal and Infant Health/Family Planning, funding organizations, general government, their superior at the health facility, NGOs, United Nations agencies, and/or that it was used at all levels of the health system. Only 6 of 41 informants (three health care workers, three health facility directors) noted that they used the collected data from the health facilities themselves to inform their work and programming.

Challenges and possible solutions associated with reporting integrated family planning services

1. Too many different registers

Adding registers for integrated family planning was the most common way of recording these services. Two informants noted that there were numerous registers for all different types of health care areas and that there may be a point at which the number of registers was becoming excessive. One director (08) noted, “ There are too many registers to fill out, but to get all the integrated services information one is tempted to increase the number of registers. On the other hand, we must rationalize to avoid having too much data to fill in. […] Integrated family planning must also be part of the overall data collection plan that is being worked on at the Ministry of Health. ”

Possible solutions suggested for this problem included bringing in support staff to help the health care workers to complete the reporting or, as noted above, revision and streamlining of relevant health reporting tools. One individual involved in reproductive health policy (01) said, “ It could be helpful if there are specialized services for data collection as well. ”

2. Lack of a standardized reporting system

The need for standardized tools was noted by many of the informants. Without the proper tools to measure the integration of services it is impossible to know if the services are currently being integrated. An individual from a reproductive health NGO (05) said, “ In terms of integration, data collection needs to have integrated tools, […] which must be at all levels of [patient care] delivery.” Possible solutions for this were given by two informants (a health worker and a director) which included having the government officials learn more about reproductive health work needs and implementing electronic systems. One director wanted to make all the reporting in a computerized format, possibly using electronic tablets for providers to enter all data at the patient level.

3. Difficulty in getting access to the registers

More integration of registers took place in smaller health facilities compared to larger hospitals due to the geography of the hospitals and the separation of departments for PAC, labor and delivery, vaccination, and family planning. In the larger hospitals, the different gynecological services were offered in different areas by individuals trained specifically in that area, so the health care staff who oversee the family planning programs were not the ones who were running the PAC services. The hours of service availability also varied depending on the type of service. It was difficult to get the necessary access to these different areas within the larger health facilities to fill out the appropriate register. Often the person doing the PAC service had to go to the family planning service the following day to enter the information about the patient who had received family planning as part of PAC. This person was not necessarily identified specifically as having received family planning as part of PAC unless someone compared the family planning register with the PAC register and identified the woman by name.

In the smaller health facilities, one or two health care providers were responsible for all reproductive health services. This made it easier for them to record the integrated services since they were the ones providing all the services in one location. This way the registers were kept in one area and the health worker had the ability to choose how that register was used and how integrated services were noted.

According to informants, possible solutions to this included having the family planning register available in common locations which all health care workers have access to or change to electronic report (using computers or tablets) on services at the patient level in a platform such as DHIS2. The NGO workers wanted to have further exploration into how the problem of register location could be improved with greater knowledge of the work flow.

4. Too much to record and too little time to do it

Health care workers in Togo provide hundreds of services each month and are required to also chart these services, often in multiple charts and registers by hand. An individual involved in reproductive health politics (01) said, “[Data collection] is done by service providers and they have a lot of work. The providers have to be providers, and I do not know, computer scientist, logistician, as well - they do everything at the same time.” The informants mentioned the large number of tasks health care workers were responsible for throughout the interviews.

Possible solutions posed to this included having less information for the providers to fill out and adapt the reporting tools to streamline the process. One NGO worker (06) said, “We need to have well-designed reporting tools that are not overloaded because […] when there are too many registers to fill in that can cause fatigue. We must […] adapt reporting tools and train personnel in the use of these tools.”

Why family planning reporting matters. The informants agreed that recording family planning played an important role in influencing future service needs. The areas which were prominent included the necessity to be able to make decisions and predict future service use; the ability to monitor improvements or declines in service, and if established goals were met; a way to justify staffing and expenses; and a way to see if there were current unmet needs or new program needs. An informant who worked at a reproductive health NGO (01) noted that while not always used effectively, “ data allows us to know if we are moving towards the goals.”

While there are many challenges to the reporting system, one facility director (07) made a thought-provoking statement when he said, in relation to improving reporting systems in Togo, “ It seems like dreaming, but it is already done elsewhere, and it is a question of determination – we can do this if enough people think it is useful .”

Reducing maternal and newborn morbidity and mortality is a priority of the Togolese government 30 . Integration of family planning into other reproductive health services may help increase the modern contraceptive prevalence rate and decrease the unmet need for contraception which can contribute to reducing maternal and newborn mortality and morbidity. Quality data (e.g. timely, complete, precise and accurate) are key to being able to accurately measure the success of integrated services 31 .

The study findings highlight vulnerabilities with respect to data quality in each link of the reporting chain at the individual patient and facility levels. These findings are unfortunately common. Numerous studies have highlighted the many challenges to reliable and timely information related to health service and health status of the population including problems with completeness, accuracy, and timeliness in low resource settings 32 , 33 , duplicate or parallel reporting systems and lack of capacity for data analysis 34 making planning, monitoring, and evaluation of these programs difficult 35 . In the end, a health monitoring and evaluation system that is designed (unintentionally) to generate poor quality data provides a shaky foundation for health service decision-making, planning, and health policy.

Global discussions around challenges and improvements to reproductive health monitoring and evaluation

Recording information about different types of care in individual registers is not unique to Togo and has been noted in other sub-Saharan African countries 33 , 36 . This type of recording makes it difficult to assign individual identifiers and increases staff workload due to the duplication of material in each register and the frequent changes in data entry protocols 36 . Adapting health care registers to capture the needed information on various reporting forms is also found in other African countries and points to the need to improve and make the health reporting system more flexible to capture multiple service provision in one visit.

In addition, while the innovation shown by the individual health workers in adapting the standard family planning form is important to recognize, it is not a long-term solution to improve the quality, ease, or time requirement of reporting. As in many low-resource countries, some areas of health care provision are supported by donor agencies that fund specific programs which often require additional reporting and documentation. This data should ideally be taken from existing data collection systems but often requires the creation of additional, parallel documents 37 , 38 .

With all the challenges noted above, there is a need to streamline indicators related to maternal health and contraception. One example of this is the FP2020 initiative and the Track20 project, which monitors progress of achieving the FP2020 goals. These goals include increasing modern method users by an additional 120 million women between 2012 and 2020 in the world’s 69 poorest countries, which includes Togo 39 . The Track20 project aims to reduce the need for heavy reliance on large national household surveys and instead use estimates of data collected through the public and private sector on specified family planning indicators 39 . Track20 uses a set of core indicators which were selected through a systematic, consultative process to allow for data-driven decision making by countries and measurement of how well individual needs are met 39 .

Future research questions

Numerous areas require further research into assessing and improving the reporting systems of integrated family planning programs. Time allocation studies of health care providers could show the actual burden on health workers for each type of task and can demonstrate specific areas that may be appropriate for streamlining, including technologies and task shifting that could reduce time burdens. A study of task shifting was undertaken in Botswana involving the creation of a new cadre of health worker, the Monitoring and Evaluation District Officer. These individuals were trained on the job for their tasks 40 . After 3 years on the job, data quality had improved, there was increased use of data for disease surveillance, research, and planning, and nurses and other health professionals had more time to focus on the clinical components of their work 40 . If such task shifting were to be scaled up, health care worker efficiency could improve and burnout could decrease.

Further research is needed to investigate the most effective ways to improve monitoring and evaluation systems themselves, especially in relation to integrated reproductive health programs. A study in Mozambique of a Health Management Mentorship (HMM) program to strengthen health systems in 10 rural districts analyzed change in 4 capacity domains after one year of the program: accounting, human resources, monitoring and evaluation, and transportation management. All the domains except for monitoring and evaluation showed improvement over the one-year mentorship program. The authors of this study noted that challenges included constantly changing program targets and objectives, continually being in a “crisis mode” (constantly trying to catch up on reporting or needing reports in a short period of time) which did not allow time to set up efficient systems, and unavailability of key program staff due to the frequent out-of-office trainings 41 .

This finding shows that monitoring and evaluation systems are difficult to improve even with the deployment of additional resources specifically for this purpose due to the inherent constraints. Implementation research to improve the functionality and sustainability of monitoring and evaluation within the health system, perhaps using a collaborative quality improvement approach, should be considered.

Programming and policy recommendations

Recently, the World Health Organization published results from a five-country intervention to strengthen measurement of reproductive health indicators which aimed to improve national information systems for routine monitoring of reproductive health indicators 42 . Activities within this intervention included revising, standardizing, and making consistent the existing reproductive health indicators gathered through routine systems and building capacity in data collection methods through training and supervision in pilot sites. The country teams reorganized and updated existing monitoring and evaluation frameworks. Challenges encountered even in this focused effort included frequent changes in staffing, delays from administration such as slow response times to updating systems and competing priorities for staff time for implementing reporting improvements. Thus, even with focused intervention it is challenging to streamline and harmonize monitoring and evaluation systems related to reproductive health.

The main recommendations for policy and programming in the Togolese context include consolidating reproductive data for health indicators and reducing provider workload for reporting, especially reporting integrated reproductive health services. This could include adopting electronic data management systems at the health facility level. Currently the largest task of recording integrated family planning is placed on the health care workers, who have adapted health registers to capture the requested information in monthly reports, but this requires extra work, memory, and creativity on the part of the health care worker. When reporting forms are developed they must be standardized to correspond with the associated health register. The number of times the health provider must enter, and re-enter data needs to be reduced.

Limitations

One main limitation of the health facility assessment included that health facilities in the purposive sample were all affiliated with AgirPF and located in urban areas. Another challenge is that the data are cross-sectional and therefore only provide a snapshot of the current monitoring and evaluation system. Lastly, there were challenges associated with photographing registers; however photographs of available registers were only used to illustrate the kinds of adaptations undertaken by health care workers.

Limitations of the key informant interviews included potentially not understanding all the possible perspectives of the informants, differences in the interviewer’s methods for probing and what areas were focused on in each interview, and potential response bias as the study was conducted under the auspices of AgirPF .

Conclusions

Monitoring and evaluation systems are fraught with implementation challenges that affect the quality of data used in patient care, planning, and policy, especially in relation to recording integrated health services. This is a reality not only in Togo but also in other countries. There is a need for a concerted, collaborative effort on the parts of national governments and global partners to address challenges to improve monitoring of integrated health services.

Data availability

Acknowledgements.

We would like to thank the data collectors involved in this research from the URD in Lomé, the Togolese Ministry of Health, and our partner organizations. We also want to recognize the amazing work of Togolese health care providers who work tirelessly to improve access to health care in Togo.

[version 1; peer review: 2 approved]

Funding Statement

This publication was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of the cooperative agreement AID-624-A-13-00004.The contents are the responsibility of authors and do not necessarily reflect the views of USAID or the United States Government.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Reviewer response for version 1

Karen hardee.

1 What Work Association, Arlington, VA, USA

This is an important and well written paper about the complexities of service delivery reporting systems for monitoring integrated family planning services.  The paper uses data from the AgirPF project in three urban areas of Togo to trace the expected and actual system for recording family planning integrated with postabortion and postpartum services in 25 health facilities and through 41 key informant interviews. While the focus is integrated services, the findings are applicable to reporting systems for any services and provide a cautionary note for programming that does not pay adequate attention to or funding for M&E. For example, the finding that the relevant registers for PAC are not located in the same place is instructive for understanding the complexities of reporting. The finding that providers are overwhelmed with so much reporting for different purposes is unfortunately not new. The use of visuals to show the workarounds that service providers do in order to record needed indicators is useful for those working on improving reporting of service statistics. I was struck by Figure 4 showing that most monthly reports are sent to NGOs – are those implementing partners funded by donors?  Are they contributing to the complexity and work for providers by, as the authors say, “If an official register did not exist for a given services, sometimes NGO workers involved in integration projects would tell health workers to create an unofficial register for the service using a notebook and pen, inserting columns for recording information.” 

I did not find the paragraph about FP2020 and Track20 in its current version so relevant to this paper. Service statistics constitute a small component of the data that go into FP2020’s 18 core indicators – and few of the 69 countries have strong enough systems to produce data of sufficient quality to use in the reporting. With that said, I think Track20 is doing interesting work with countries on their routine health systems – particularly to rationalize indicators. Rather than include a summary paragraph about Track20, I suggest that the authors contact Track20 to find out what they are doing related to routine health information systems – so the paragraph can be better tailored to the paper. 

I was surprised to see no mention of the work of MEASURE Evaluation, which has for decades been working on improving M&E systems, including routine health information. As one example, through JSI, MEASURE Evaluation has worked on PRISM (Performance of Routine Information System Management), that would be useful to review. Another resource is RHINO, the Routine Health Information Network ( https://www.rhinonet.org/ ). And PEPFAR, with its focus on reporting indicators, has generated lessons learned for strengthening routine health information systems. I suggest that the authors check these resources to strengthen the section of the paper on how to make improvements in the reporting system. 

Also, it would be good for the authors to say something about the official process of revising the components of routine health information. For example, who has the authority to make changes to the system? How often are registers reviewed and revised? By who? The authors indicate that some respondents recommended computerized reporting with tablets. Who would have the authority to make this change to the M&E system? Any implementation research carried out to strengthen reporting of integrated family planning services will need to acknowledge the official process for making changes – otherwise, it might just be creating more workarounds.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Jane T. Bertrand

1 Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

This article addresses the challenge of monitoring and evaluating integrated family planning services in urban areas of Togo. Specifically, it focuses on the integration of services for family planning, post abortion care, and postpartum care. The findings are based on an assessment of 25 purposively selected health facilities, a review of health services records, and 41 in-depth interviews with different categories of health personnel.

The article is well written and clearly presented. The photos of the registers are useful in reminding readers of the very basic data collection tools available in these facilities. The photos also reflect the attempts by health providers to do the right thing, in the absence of having the appropriate tools to do so.

The paper merits publication because of its systematic examination of the issue of monitoring integrated family planning services. With a new interest in postpartum (and in some countries post-abortion) family planning, this methodological issue is very relevant to those working in family planning. It captures a reality found in many health systems in low-income countries, which often is “understood” but not documented.

The paper effectively communicates the tension between good service provision and timely data collection by low- to middle-level health workers, often poorly paid, who feel overwhelmed by the amount of documentation they are required and expected to produce.

Missing from the paper is a clear statement of what the authors would consider the short list of most valuable indicators to measure integrated family planning. The service providers developed ingenious “work-arounds” to provide information relevant to this question, as they improvised the use of the available forms. If the researchers had full reign over the data collection, what would they recommend? This is particularly relevant, given their citation of the FP 2020 indicators as an example of a standardized set of metrics that countries could then strive to obtain and report.  Table 2 provides a list of 13 indicators that includes integrated family planning services. However, the list is long, and the authors don’t attempt to identify or prioritize those of greatest relevance to the question. For readers looking to better understand best practices in the area of measuring integrated family planning services, it’s important to learn what this handful of indicators most important in measuring integrated family planning services would be.

In a related vein, there is lack of a clear path toward a better system. The authors do provide recommendations for improving the quality of service statistics by capturing the data at all levels and reducing the reporting burden on service providers. Yet the very circumstances that created the problems in the current data collection system are fairly ingrained in weak health systems (in Togo and elsewhere). Can the authors provide concrete examples of where their recommendations have actually paid off in other countries?

The following edits would improve the flow and content of the paper:

• Paragraph 3 under the introduction: replace “in opposition to…” with “in contrast to…”
• Under procedures/health facility assessment: The authors clearly explain the purpose of the sample of 25 health facilities. It would be useful to have an approximate estimate of the universe of facilities from which the 25 were selected.
• Under results/health facility assessment: it is not intuitively clear why the researchers took half as many facilities from Sodoké as from Kara, when in the previous section they explain that the population of Sodoké is slightly larger than that of Kara.
• Figure 4. The idea behind this graph and the explanation underneath it do not clearly communicate what it is intended to show. For instance, what the expected/preferred route of transmission?
• On page 10, under “uses of family planning data reported,” the authors make the very salient point that “only six of 41 informants… noted that they use collected data from the health facilities themselves to inform their work and programming.” The author should further develop this issue in the discussion.

With these minor edits, I recommend indexing.

The Monitoring and Evaluation Toolkit

This section asks:

What is a case study?

• What are the different types of case study ?
• What are the advantages and disadvantages of a case study ?
• How to Use Case Studies as part of your Monitoring & Evaluation?

There are many different text books and websites explaining the use of case studies and this section draws heavily on those of Lamar University and the NCBI (worked examples), as well as on the author’s own extensive research experience.

If you are monitoring/ evaluating a project, you may already have obtained general information about your target school, village, hospital or farming community. But the information you have is broad and imprecise. It may contain a lot of statistics but may not give you a feel for what is really going on in that village, school, hospital or farming community.

Case studies can provide this depth. They focus on a particular person, patient, village, group within a community or other sub-set of a wider group. They can be used to illustrate wider trends or to show that the case you are examining is broadly similar to other cases or really quite different.

In other words, a case study examines a person, place, event, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity.

A case study paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or among more than two subjects. The methods used to study a case can rest within a quantitative, qualitative, or a mixture of the two.

Different types of case study

There are many types of case study. Drawing on the work of Lamar University and the NCBI , some of the best-known types are set out below.

It is best not to worry too much about the nuances that differentiate types of case study. The key is to recognise that the case study is a detailed illustration of how your project or programme has worked or failed to work on an individual, hospital, school, target community or other group/ economic sector.

• Explanatory case studies aim to answer ‘how’ or ’why’ questions with little control on behalf of researcher over occurrence of events. This type of case studies focus on phenomena within the contexts of real-life situations. Example: “An investigation into the reasons of the global financial and economic crisis of 2008 – 2010.”
• Descriptive case studies aim to analyze the sequence of interpersonal events after a certain amount of time has passed. Studies in business research belonging to this category usually describe culture or sub-culture, and they attempt to discover the key phenomena. Example: Impact of increasing levels of funding for prosthetic limbs on the employment opportunities of amputees. A case study of the West Point community of Monrovia (Liberia).
• Exploratory case studies aim to find answers to the questions of ‘what’ or ‘who’. Exploratory case study data collection method is often accompanied by additional data collection method(s) such as interviews, questionnaires, experiments etc. Example: “A study into differences of local community governance practices between a town in francophone Cameroon and a similar-sized town in anglophone Cameroon.”
• Critical instance : This examines a single instance of unique interest, or serves as a critical test of an assertion about a programme, problem or strategy. The focus might be on the economic or human cost of a tsunami or volcanic eruption in a particular area.
• Representative : This relates to case which is typical in nature and representative of other cases that you might examine. An example might be a mother, with a part-time job and four children, living in a community where this is the norm
• Deviant : This refers to a case which is out of line with others. Deviant cases can be particularly interesting and often attract greater attention from analysts. A patient with immunity to a particular virus is worth studying as that study might provide clues to a possible cure to that virus
• Prototypical : This involves a case which is ahead of the curve in some way and has the capacity to set a trend. A particular African town or city may be a free bicyle loan scheme and the experiences of that town might suggest a future path to be followed by other towns and regions.
• Most similar cases : Here you are looking at more than one case and you have selected two cases which have a preponderance of features in common. You might for example be looking at two schools, each of which teaches boys aged from 11-15 and each of which charges similar fees. They are located in the same country but are in different regions where the local authorities devote different levels of resource to secondary school education. You may have a project in each of these areas and you may wish to explain why your project has been more successful in one than the other.
• Most dissimilar cases : these are cases which are, in most key respects, very different and where you might expect to find different outcomes. You might for example select a class of top-ranking pupils and compare it with a class of bottom-ranking puils. This could help to bring out the factors that contribute to or detract from academic success.

Advantages and Disadvantages of Case Study Method

• It helps explain how and why a phenomenon has occurred, thereby going beyond numerical data
• It allows the integration of qualitative and quantitative data collection and analysis methods
• It provides rich (or ‘thick) detail and is well suited to capturing complexities of real-life situations and the challenges facing real people
• Case studies (sometimes illustrated with quotations from beneficiairies/ stakeholder and with photographs) are often included as boxes in project reports and evaluations, thereby adding adding a human dimension to an otherwise dry description and data.
• Case studies may offer you an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously.

Disadvantages

• Case studies may be marked by a lack of rigour (e.g. a study may not be sufficiently in-depth or a single case study may not be sufficient)
• Single case studies may offer very little basis for generalisations of findings and conclusions.
• Case studies often tend to be success stories (so they may involve a degree of bias).

Where to next?

Click here to return to the top of the page, here to return to step 3 (Data checking) and here to see a short worked example of a metrics-based evaluation.

• MONITORING AND EVALUATION APPROACHES
• Protected: Learning Center

Monitoring and evaluation (M&E) are two essential components of project management that help organizations assess the progress and effectiveness of their programs. Monitoring and evaluation approaches are essential for any organization for measuring the progress and success of any project or program. Evaluation approaches have often been developed to address specific evaluation questions or challenges and they refer to an integrated package of methods and processes.

Table of contents

Results-based monitoring and evaluation approach

Participatory monitoring and evaluation approach, theory-based evaluation approach.

• Utilization-focused evaluation approach

M&E for learning

• Gender-responsive evaluation

Case study evaluation approach

Process monitoring and evaluation approach, impact evaluation approach.

• Evaluation approaches versus evaluation methods

Conclusion on monitoring and evaluation approaches

This approach involves setting specific, measurable, achievable, relevant, and time-bound (SMART) indicators for a project and tracking progress against these indicators. It emphasizes the importance of measuring outcomes and impact rather than just activities. Results-based monitoring and evaluation (M&E) approaches can provide the insight needed to evaluate performance and strategy. Results-based M&E involves collecting and analyzing data to assess the impact of programs and identify areas for improvement. It helps organizations understand where they need to focus their resources, and allows them to ensure that projects are meeting established goals. Results-based M&E is an invaluable tool for ensuring efficiency, effectiveness and accountability in any organization’s operations. Read more .

This approach involves involving stakeholders, including beneficiaries, in the monitoring and evaluation process. It can help ensure that the evaluation is sensitive to the needs of those who are intended to benefit from the project. It provides an insight into the progress of the program or project and helps to identify problems that need immediate attention. Participatory monitoring and evaluation approaches help to ensure that all stakeholders are engaged in the evaluation process, bringing a wider perspective and enabling more effective feedback. Through this method, progress and impact can be better understood, allowing for better decisions in order to reach desired outcomes. Participatory approaches are therefore an important part of monitoring and evaluation for any project or program. Read more .

This approach involves examining the underlying theory of change that a project is based on to determine whether the assumptions about how the project will work are valid. It can help identify what changes are likely to occur and how they can be measured. The Theory-based Evaluation approach is a powerful monitoring and evaluation tool that can help organizations make informed decisions about their programs and services. This approach focuses on the underlying theories of change that drive program implementation and outcomes, and helps to identify and address gaps in the program’s effectiveness. It also serves as a way to measure the progress of a program and its impact on the target population. Theory-based evaluation is a comprehensive approach that considers both qualitative and quantitative data, and is useful for understanding the complex relationships between program activities and outcomes. It is an important tool for organizations to ensure that their programs are achieving their intended goals and objectives. Read more.

Utilisation-focused evaluation approach

The Utilisation-focused Evaluation approach is an effective tool for monitoring and evaluation users. It is a user-oriented approach that focuses on the utilisation of evaluation results by intended users and stakeholders. This approach encourages users to be actively involved in the evaluation process, from planning to implementation to reporting. It enables users to assess the impact of the evaluation results on their decision-making and practice. The Utilisation-focused Evaluation approach also encourages users to use the results for further improvement and refinement of their strategies and practices. This approach helps users to identify areas for improvement and to develop strategies to address them. In addition, it helps users to determine the most effective ways to use the evaluation results in order to achieve their desired outcomes. Read more.

Monitoring and Evaluation (M&E) for learning is an approach that prioritizes learning and program improvement, as opposed to solely focusing on accountability and reporting to external stakeholders. It is an iterative process that involves continuous monitoring, feedback, and reflection to enable learning and adaptation. By engaging stakeholders in the evaluation process, M&E for learning can identify strengths, weaknesses, and areas for improvement, and use this information to guide program design and implementation. Ultimately, the goal of M&E for learning is to create a culture of continuous learning within organizations, where learning and adaptation are integrated into every aspect of program design and implementation. Read more .

Gender Responsive Evaluation

A gender-responsive evaluation is an approach to understanding the impacts of a project, policy, or program on women, men and gender diverse populations. It is a valuable tool to assess how different gender groups are affected by a particular project, as well as how to ensure that the project meets its objectives in a way that is equitable and beneficial to all genders. Gender-responsive evaluations also provide useful information on how different gender groups interact and participate in projects or policies, which can help identify any potential inequities in access or outcomes.  Read more .

The case study evaluation approach is a powerful tool for monitoring and evaluating the success of a program or initiative. It allows researchers to look at the impact of a program from multiple perspectives, including the behavior of participants and the effectiveness of interventions. By using a case study evaluation approach, researchers can develop a comprehensive picture of the program’s strengths and weaknesses, identify areas for improvement, and make recommendations for future action. This approach is particularly useful for programs that involve multiple stakeholders, as it allows for the examination of both individual and collective outcomes. Furthermore, it is a valuable tool for assessing the program’s effectiveness over time, as it enables researchers to compare the results of different interventions and track changes in program outcomes. Read more.

This approach focuses on how a project is implemented, rather than the outcomes. It can help identify problems in project implementation, such as delays or budget overruns, and make recommendations for improvement. The process monitoring and evaluation approach is a systematic way of tracking and assessing the progress of a project or program. It involves regularly collecting, analyzing, and interpreting data to determine the effectiveness of a program and to identify areas for improvement. Monitoring and evaluation are two distinct but related functions. Monitoring is the continuous collection of information to track the progress of a program or project over time. Evaluation, on the other hand, is the periodic assessment of a program or project to determine its effectiveness and impact. The process monitoring and evaluation approach provides a comprehensive understanding of the program’s strengths and weaknesses, enabling decision-makers to make informed decisions about how to improve the program and ensure its success. Read more.

This approach involves assessing the causal impact of a project on its beneficiaries or the wider community. It can help determine whether a project has achieved its intended outcomes and whether the benefits outweigh the costs. The impact evaluation approach is a monitoring and evaluation technique used to assess the outcomes of a program or intervention. This approach helps to identify the changes that have occurred due to the program or intervention and measure the effectiveness of the program. It is used to evaluate the impact of the program on the target population, such as whether the program has achieved its desired objectives. The impact evaluation approach helps to identify areas of improvement and assess the cost-effectiveness of the program. It also helps to determine whether the program has met its goals and objectives, and if not, what changes should be made in order to achieve the desired results. This approach is a valuable tool for organizations to assess the success of their programs and interventions. Read more.

Evaluation Approaches versus Evaluation Methods

Evaluation approaches and evaluation methods are both used to assess the effectiveness and impact of programs, policies, or interventions. However, they refer to different aspects of the evaluation process.

Evaluation approaches refer to the overall framework or perspective that guides the evaluation. They define the philosophical, theoretical, and methodological principles that underpin the evaluation.

Evaluation methods, on the other hand, are the specific techniques and tools used to collect and analyze data to evaluate the program. Methods can be quantitative (e.g., surveys, experiments, statistical analysis) or qualitative (e.g., interviews, focus groups, content analysis), and may vary depending on the evaluation approach used.

In summary, evaluation approaches define the overall framework and principles that guide the evaluation, while evaluation methods are the specific techniques and tools used to collect and analyze data to evaluate the program.

An effective monitoring and evaluation approach can help to identify whether an organization’s goals are being achieved in a timely manner.

Overall, organizations can use one or more of these approaches to monitoring and evaluation, depending on the needs of their project and the resources available to them. Although there are many different types of monitoring and evaluation approaches available, they all share the same goal – to understand the impact of an organization’s programs and projects on its stakeholders.

This is so detailed and simple to understand. Thanks EvalCommunity for your contribution towards monitoring and evaluation. I always love your resources, thank you!

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Perspectives are different frameworks from which to explore the knowledge around sustainable sanitation and water management. Perspectives are like filters: they compile and structure the information that relate to a given focus theme, region or context. This allows you to quickly navigate to the content of your particular interest while promoting the holistic understanding of sustainable sanitation and water management.

Monitoring and evaluation - TARA (case study)

Executive Summary

This case study supports and illustrates the theoretic factsheet "Monitoring and evaluation (safe water business)" with practical insights.

TARA going from informal, to paper to a mobile app - M&E evolution in India

Informal infrequent M&E

TARAlife produces and sells liquid chlorine to purify drinking water, produced with Antenna Foundation ’s WATA™ technology converting salt and water with a simple electrolysis process into sodium hypochlorite (chlorine). When TARA started producing and selling chlorine branded Aqua+ (see picture) via its social enterprise TARAlife Pvt. Ltd. in 2012, TARA did not have a systematic M&E system in place to monitor sales and business activities. The head of TARAlife simply contacted each local partner by phone on an irregular basis to collect sales figures.

Paper-based

Recognising the importance of collecting customer and sales data in a more systematic way, TARA designed its first M&E system in 2013. This was a sales record booklet which included sections for customer data, sales data, and marketing materials. This system was not functioning properly, because each franchisee filled out the booklet slightly differently and the data were also not reported back to TARA headquarters consistently. This made the data from different regions and last mile agents difficult to compare. At the same time, TARA’s channel partners were having difficulties in managing their Aqua+ stocks, which was causing delayed orders and expired stocks.

To address both the issues of sales management as well as stock management, TARA started developing a mobile application, with support from a consultant. The app aims to make the sales reporting more user-friendly, more consistent and quicker. When developing the app, TARA realized that it could also be used to collect customer and impact-related data to assess the social, health and financial impacts of TARA's interventions.  Together with IRC, the framework for the app (see figure below) was developed based on the following four objectives:

• Retain & increase database of Aqua+ customers
• Track and record impact of intervention on health/overall quality of life
• Decrease or minimise sales lost and inventory costs
• Extend the application of the system to other products than Aqua+ over the long run

The key functions of the application are the following:

• Data collected through the app by micro franchisees: details about customers, micro franchisees, customer purchasing behaviour, baseline survey of potential new customers (i.e. current water disinfection practices, existing health status, medical expenses, etc.), and product feedback from customers.
• Analysis of the data captured with the application: real-time tracking of sales and micro franchisee performance in terms of meeting sales targets.
• Implementation of the data used: send reminders to customers about purchasing TARA products and send periodic messages about safe water awareness.
• Conduct an impact assessment survey (post intervention survey after 6 months of purchase).

The development of the mobile application is completed and it is about to enter the pilot test phase with micro franchisees at TARA Akshar locations in the state of Eastern Uttar Pradesh, India. The results from the pilot test are expected by 2018.

Lessons learnt from digitalising M&E

• Paper-based M&E has the advantage that surveys do not need to have access to a source of electricity, which can be advantageous in non-electrified rural areas.
• Paper-based M&E is more time-consuming as to get a clear overview and statistics data has to be fed into computers. During such process mistakes can occur and falsify data.
• The launch of the app-based M&E brings different advantages along: Data is now homogenously compiled and can soundly be tracked back to microfranchisees. It easily allows to make comparisons between regions, products and salespeople on a daily basis.
• App-based M&E allows to be adapted to a variety of products and can be duplicated when necessary.
• App-based M&E improve attractiveness of a safe water initiative or safe water enterprise for investments as impact is soundly collected and can be easily presented and accessed externally also.

Recommendations for implementing an app-based M&E system

• Developing and integrating app-based M&E is time-consuming and has its costs that have to be taken into account when reflecting on starting such project in your safe water initiative.
• In a long-term perspective is the use of app-based M&E inevitable as tendencies are in place of donors and impact investors to have sound track access to data and this if possible on a daily basis.

Safe Water and Jobs - Creating Access to Safe Water in India through Women-Led Service Delivery Models

Taralife sustainability solutions pvt. ltd, alternative versions to, perspective structure.

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African Monitoring and Evaluation Systems: Exploratory Case Studies

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PRI Awards 2019 case study: Portfolio-wide Monitoring and Evaluation Platform

2019-09-10T08:52:00+01:00

Company: Old Mutual Alternative Investments

HQ: South Africa

Category: Real World Impact Initiative of the Year (shortlisted)

In the spirit of showcasing leadership and raising standards of responsible investment among all our signatories, we are pleased to publish case studies of all the winning and shortlisted entries for the PRI Awards 2019.

See the full list

Project overview, objectives, and reasons for undertaking it

African Infrastructure Investment Managers (AIIM) is a wholly owned subsidiary of Old Mutual Alternative Investments. It has shareholdings in 26 renewables assets in South Africa under the Renewable Energy Independent Power Producer Procurement Programme (REIPPP). Each is obligated to spend a percentage of profit on socioeconomic development and enterprise development projects within a 50km radius.

AIIM’s investment philosophy is to provide superior returns to investors while making a tangible contribution to local communities. In line with this objective, in 2016 it commissioned the development of a Social Outcome Measurement Methodology to measure social outcomes arising from socioeconomic development, enterprise development and corporate social investment initiatives – all underpinned by the Theory of Change methodology.

The platform was borne out of the need to assess the degree to which assets are achieving their intended socioeconomic development and enterprise development goals, and to evaluate the positive impact of projects. Mainstream Renewable Power was a key collaborator in helping drive the launch of the platform, across their managed renewables plants. The objectives of the project were to:

• track performance of socioeconomic projects;
• track outcome indicators effectively;
• improve communication with stakeholders;
• align and improve reporting processes;
• and support investment decision-making.

Successful implementation of the project across the portfolio will enable AIIM to understand the scale of its impact, effectively report this to its stakeholders, magnify positive impacts through good decision-making, and transfer lessons learned to improve performance or inform course correction.

Financial scale of the project and impact

The pilot phase of the project involves a monitoring and evaluation initiative for eight renewable energy projects, namely: Cookhouse, Umoya, Khobab, Loeriesfontein2, Noupoort and Kangas Wind Farms and the REISA Solar Farm. The plan is to take on the remaining 26 assets and eventually scale this project to the wider REIPPP program via a secure cloud-based platform. The results of the monitoring and evaluation are mapped to the United Nations Sustainable Development Goals and South Africa specific goals. The scope of work included:

• a desktop review of existing development programmes;
• creation of social outcomes maps for the investments;
• identification of appropriate indicators;
• data collection;
• analysis and reporting.

AIIM hired a leading African sustainability consultancy, IBIS Consulting, to undertake the project. It is currently concluding the development of social outcomes maps and appropriate indicators. Data collection will take place in June 2019 with reporting in July or August 2019. A key indicator of success will be the representation of the data. AIIM envisages a concise impact measurement report per community investment project that focuses on numerical and graphical representations of the data and conclusions.

Project delivery challenges overcome

The project was piloted with the REISA Solar Farm in Q1 of 2017. Through 2017 and 2018 the social impact methodology was implemented in three assets: REISA, Cookhouse and Umoya. The flagship socioeconomic development and enterprise development projects were evaluated using the methodology, with reporting provided to the companies’ social and ethics committees.

Implementation for this early stage was through community operations teams, including community liaison officers, who undertook monitoring and evaluation.

Critical challenges included:

• It took time to understand the Theory of Change methodology, creating a time lag and incorrect indicator selection;
• The heavy administrative burden put on management teams;
• Difficulty in scaling, with assets spread across South Africa;
• Conflict of interest having teams assess and report on their own impacts;
• Reporting did not always meet the expectations of the regulatory authorities.

A new model was initiated in the latter half of 2018 to address these challenges and create an external platform of specialist advisers to undertake the scoping, data collection, analysis and reporting across a portfolio of renewables companies. In addition to this, a leading technical social impact and Theory of Change specialist was appointed to act on behalf of AIIM to continuously review the advisers’ approach and work.

Measuring success and lessons learned

AIIM’s goal is to make the platform available not only to all 26 of its own portfolio of renewables companies, but also to the whole REIPPP. In terms of broadly applied lessons learnt, the following are evident from this platform:

• A similar outsourced monitoring and evaluation platform could be applied across different geographies and sectors to achieve the same levels of quality and efficiency.
• There is a need to balance the qualitative versus quantitative data collected and used. In order to become more efficient and cost effective, experience shows that a greater use of quantitative data is required, while not losing the value of qualitative data in providing nuanced information about the actual change happening in the community.
• The cumulative spend of the assets in AIIM’s portfolio was in excess of ZAR350m (US$24m) at the end of 2018. Currently 95 renewable assets are part of REIPPP.
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A Case Study from Ethiopia: Supportive Supervision in Monitoring and Evaluation with Community-Based Health Staff in HIV Programs

Author(s): Marshall A, Fehringer J

Background – Supportive supervision is a facilitative approach that promotes mentorship, joint problem-solving, and communication between supervisors and supervisees. In Ethiopia, MEASURE Evaluation trained government managers on supportive supervision as part of a project to scale-up the country’s health management information system (HMIS). This report presents a case study of the project that can serve as an example for other programs wishing to use supportive supervision in monitoring and evaluation (M&E).

Methods – A single case study design was used. Data were collected through 12 key informant interviews, four observations of supervision visits, and document review. Participants were sampled purposively from three strata: MEASURE Evaluation staff, government supervisors, and community-level staff. Interview transcripts were coded in NVIVO 10 and compared with direct observation notes and documents using thematic content analysis.

Results – Findings suggest that the project was successful in promoting program ownership, standardizing supervision, and improving data quality. Participants attributed these successes to collaboration among government offices, supervision tools, and feedback and training provided to staff by supervisors. The project was less successful at promoting data use for decision making. While participants had theoretical knowledge, there was little actual use of information at health facilities.

Conclusion – Supportive supervision is a promising approach to improve routine data collection for M&E of community-based programs. Programs that wish to use this approach can adapt best practices and lessons learned from this and other projects. Specifically, programs should work in teams of supervisors, address staff motivation and confidence during visits, promote data demand and use, and create a training plan for M&E staff.

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Monitoring and Evaluation: An Urban Project Case Study in Kenya

1982, Planning processes in …

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International Journal of Scientific and Research Publications (IJSRP)

Serah Muchai

Moses Otieno

Fredrick Okuta

International Journal of Academics & Research, IJARKE Journals

The new devolved structures of county governments and devolution with respect to development policies, programs and projects in Kenya has brought to light the need for a comprehensive monitoring and evaluation framework. However, most devolved systems have been found not to have the M&E systems in place. Due to this high number of stalled projects, experiences of cost overruns and extended construction periods beyond the initial completion dates may cease and save the country from unnecessary loss and wastage of resource which in scarce supply. The study sought to examine the effects of monitoring and evaluation on the performance of county government projects in Kenya, a case of Kisii County. The study was guided by the following objective; to establish the effect of baseline survey, on project performance in Kisii County and To establish the effect of monitoring and evaluation planning on performance of county government projects in Kisii County. The study was grounded on theory of change, program theory and agency theory. The target population for this study composed the county representatives, contractors and project management committee members. A sample size of 157 for the study with the population of 265 was obtained using Morgan and Krejcie (1970) model. Primary data was obtained using selfadministered questionnaires. The drop and pick method were used. Data was analyzed using Statistical Package for Social Sciences (SPSS Version 25.0). All the questionnaires received were referenced and items in the questionnaire were coded to facilitate data entry. After data cleaning which entails checking for errors in entry, descriptive statistics such as frequencies, percentages, mean score and standard deviation was estimated for all the quantitative variables and information presented inform of tables. Inferential data analysis was done using multiple regression analysis. The study found that the performance of county government projects is determined and affected by baseline survey, monitoring and evaluation findings.

saba harethi

This paper sets out to examine the efficacy of monitoring and evaluation in achieving project success in Kenya. The victory of project management is usually gauged by the project success. Project success is achieved as a result of various contributing factors. One of the major factors leading to project success is monitoring and evaluation. This study therefore examined the efficiency of monitoring and evaluation function and its effect in achieving project success. This was done by assessing whether various attributes monitoring and evaluation such as; strength of monitoring, monitoring approach adopted, political influence and project lifecycle stage affects project success. Each of these attributes was regressed against the project success. The study found out that all the monitoring and evaluation attributes assessed had some impact in achieving the Project success. This study concluded that a number of projects that fail were as a result of weak a monitoring and evaluation function which was partly contributed by lack of management support. The study contributed new knowledge in that it established that projects may be unsuccessful despite having monitoring and evaluation function due to the weakness of M&E, lack of management support on the project functions, and political interference especially in Africa and developing countries.

Jacob Tombo

ABSTRACT The study explored impact of monitoring and evaluation on performance of community development projects in Kisumu district. M&E of development projects are increasingly recognized as indispensable management functions. M&E has over the years experienced various problems and constrains not only in Kenya but in world as a whole, some of the constrains include weak culture of sharing out, weak interest and commitment to M&E functions by both donors and government among other stakeholders. M&E is an integral part of Community Development Projects (CDPs) in Kenya thus it has enhanced prudent planning, timely feedback and constant review of projects constrains leading to improved performance in terms of efficiency, accountability and project effectiveness The general objective of the study was to establish the impact of monitoring and evaluation on performance of Pandipieri community development projects. The study adopted survey design; stratified random and convenience sampling was used to sample the beneficiaries and stakeholders of Pandipieri Community Development Projects. The study population comprised of 1500 beneficiaries, staffs and stakeholders who are distributed in the sub estates of Nyalenda, Nanga and Manyatta. A questionnaire was used as the main tool of data collection where data was analyzed using descriptive statistics and presented in tables and graphs. The study came up with various factors, which were seen as the elements of monitoring and evaluation. Specifically, elements included feedback, planning, and continuous review. The The study recommends that the government, donors and other stakeholders should enact laws, guidelines to ensure that all projects are monitored and evaluated to provide better means for learning from past experience, improving service delivery, planning and allocation of resources hence demonstrating results as part of accountability to key stakeholders, the study also recommends that project managers should involve target population to incalculate a sense of expectation trust and ownership of the project hence sustainability of the initiative in subsequent phases.

International Journal of Scientific and Research Publications

naomi njoroge

Benard Muronga

i the research that formed the basis of this report, we studied factors that influence the : healion o f participators monitoring and evaluation approach of managing development cels in Kenya, with a focus on the Local Links Project (LLP) in Kibera. Kibera is a low-class using estate that is located about 7 kilometers to the west of Nairobi city. I lie objectives of this study were to explore the influence of participatory' monitoring and 0 .iluation (PM&E) model that was used, on the PM&E of the L.LP: to examine the effect of the wel of education of project stakeholders on PM&E of the LLP: to establish the influence of ethnical expertise of project stakeholders in M&E on PM&E of the LLP, and to examine the effect of planning for PM&E on PM&E of the LLP. This project is significant because its ' filings are critical not only to development projects in Kenya, but also to those in Africa as a whole. By identifying the factors that influence the management of development projec...

Beryl Mutekhele

Monitoring and evaluation as a subject faces diverse understanding from different people and has been evolving progressively over the last quarter. One of the early definitions for monitoring and evaluation was contained in the guiding principles for the design and use of M&E in rural development programs. At that time, M&E were seen primarily as projectrelated activities. Monitoring was defined as a continuous assessment of both the project activities and of the use of Abstract: Monitoring and evaluation (M&E) are at the center of sound governance arrangements globally, regionally, nationally and locally as well. They are necessary for the achievement of evidence-based policy making, budget decisions, management, and accountability. However, there is limited focus on utilization of M&E systems and performance of educational building infrastructural projects in Bungoma County. The purpose of this study was to examine utilization of monitoring and evaluation systems and performance o...

Jeanne Mogusu

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Creating a Corporate Social Responsibility Program with Real Impact

• Emilio Marti,
• David Risi,
• Eva Schlindwein,
• Andromachi Athanasopoulou

Lessons from multinational companies that adapted their CSR practices based on local feedback and knowledge.

Exploring the critical role of experimentation in Corporate Social Responsibility (CSR), research on four multinational companies reveals a stark difference in CSR effectiveness. Successful companies integrate an experimental approach, constantly adapting their CSR practices based on local feedback and knowledge. This strategy fosters genuine community engagement and responsive initiatives, as seen in a mining company’s impactful HIV/AIDS program. Conversely, companies that rely on standardized, inflexible CSR methods often fail to achieve their goals, demonstrated by a failed partnership due to local corruption in another mining company. The study recommends encouraging broad employee participation in CSR and fostering a culture that values CSR’s long-term business benefits. It also suggests that sustainable investors and ESG rating agencies should focus on assessing companies’ experimental approaches to CSR, going beyond current practices to examine the involvement of diverse employees in both developing and adapting CSR initiatives. Overall, embracing a dynamic, data-driven approach to CSR is essential for meaningful social and environmental impact.

By now, almost all large companies are engaged in corporate social responsibility (CSR): they have CSR policies, employ CSR staff, engage in activities that aim to have a positive impact on the environment and society, and write CSR reports. However, the evolution of CSR has brought forth new challenges. A stark contrast to two decades ago, when the primary concern was the sheer neglect of CSR, the current issue lies in the ineffective execution of these practices. Why do some companies implement CSR in ways that create a positive impact on the environment and society, while others fail to do so? Our research reveals that experimentation is critical for impactful CSR, which has implications for both companies that implement CSR and companies that externally monitor these CSR activities, such as sustainable investors and ESG rating agencies.

• EM Emilio Marti is an associate professor at the Rotterdam School of Management, Erasmus University. His research focuses on corporate sustainability with a specific focus on sustainable investing.
• DR David Risi is a professor at the Bern University of Applied Sciences and a habilitated lecturer at the University of St. Gallen. His research focuses on how companies organize CSR and sustainability.
• ES Eva Schlindwein is a professor at the Bern University of Applied Sciences and a postdoctoral fellow at the University of Oxford. Her research focuses on how organizations navigate tensions between business and society.
• AA Andromachi Athanasopoulou is an associate professor at Queen Mary University of London and an associate fellow at the University of Oxford. Her research focuses on how individuals manage their leadership careers and make ethically charged decisions.

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African monitoring and evaluation systems: Exploratory case studies

Resource link.

• African monitoring and evaluation systems: Exploratory case studies (PDF, 3.8MB)

This publication is an analysis of six monitoring and evaluation (M&E) case studies from Benin, Ghana, Kenya, Senegal, South Africa, and Uganda.

Written in either French or English, the case studies presented are used as a tool for reflection on the rapidly changing terrain of African governance systems and their ability to respond effectively to the increased demand for results and accountability from citizens. The paper proposes that M&E systems are capable of generating information that can be used by civil society, the executive, and the legislature, and that substantive case studies such as these are useful in providing a strong evidence base for learning for future development.

The case studies compiled in this document formed the basis of discussion at an African M&E Systems Workshop held in March 2012, in Pretoria, South Africa. The workshops were hosted in partnership with the Centre for Learning on Evaluation and Results (CLEAR) housed at the Graduate School of Public and Development Management at the University of the Witwatersrand, Johannesburg .While by no means claiming to offer an exhaustive diagnosis of the M&E in the African continent these case studies and the resulting workshop are viewed as steps in building an evidence-based approach to M&E across the continent.

The focus of analysis of the six studies is on the capacity of the relative governments to demand results-orientated monitoring and commission evaluation appropriate to the policy context. The discussion at the beginning of the paper in English unpacks the concept of demand; then the six cases are examined in relation to trends emerging in institutional design, monitoring, and evaluation systems; finally, an overall conclusion is presented.

• Acknowledgements  p.4
• Foreword  p.5
• The growing demand for monitoring and evaluation in Africa p.7
• Republic of Benin  p.20
• Executive summary (resume en anglais)  p.21
• Etat des lieux du systeme national de suivi et d’evaluation du Benin p.24
• Republic of Ghana  p.48
• Resume (executive summary in French)  p.49
• The monitoring and evaluation system of Ghana with a focus on the link between planning and budgeting p.51
• Republic of Kenya  p.68
• Executive summary (resume en Anglais)  p.69
• Monitoring and evaluation in the government of Kenya: Challenges and Prospects p.71
• Republic of Senegal  p.94
• Executive summary (resume en Anglais)  p.101
• Le systeme de suivi evaluation au Senegal p.103
• Republic of South Africa  p.140
• Resume (executive summary in French)  p.141
• Monitoring and evaluation in the republic of South Africa and the application of the ‘outcomes approach’ p.144
• Republic of Uganda  p.170
• Resume (executive summary in French)  p.171
• Monitoring and evaluation in Uganda with a focus on community Participation 176

Centre for Learning And Evaluation Results (CLEAR). (2012) . African Monitoring and Evaluation Systems, Graduate School of Public and Development Management, University of the Witwatersrand, Johannesburg.

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Experienced consultant in climate adaptation for mission east's "inclusive climate solutions" study.

• Mission East

Do you have a strong track record in evaluation of international cooperation programs? Can you demonstrate experience in carrying out research involving with people with disabilities with focus on climate adaptation projects in fragile contexts? And are you able to provide advocacy and programmatic recommendations to a variety of stakeholders?

You may be the consultant we are looking for!

Mission East (MEED) and our partners are currently searching for a consultant for the project “Inclusive Climate Solutions: Lessons for Disability-Inclusive Climate Programming and Advocacy in Fragile States”. This project is undertaken in collaboration with DPOD and our partners, with MEED being the lead organisation.

As consultant, your objectives will be:

• To understand the impact of the climate crisis on people with disabilities in fragile & volatile contexts in 3-4 countries in Africa and Asia (including Afghanistan and Nepal, security permitting)
• To evaluate and gather lessons learned and best practices of programming addressing the effects of the climate crisis on people with disabilities, with all their intersecting identities (e.g. poverty, gender, caste/ethnicity/social grouping, age, and other relevant factors)
• To evaluate and gather lessons learned and best practices of policies addressing the effects of the climate crisis on people with disabilities, with all their intersecting identities (e.g. poverty, gender, caste/ethnicity/social grouping, age, and other relevant factors)
• To provide recommendations on how to improve the inclusion of people with disabilities in climate adaptation programming, especially in the areas of FSL, WASH, and water resource management
• To inform evidence-based programming in order to prevent and reduce the negative impacts of the climate crisis on individuals with disabilities
• To identify and understand the advocacy opportunities at local and global levels, with a particular emphasis on how people with disabilities, and their representative organisations, can influence policymakers’ decisions on climate action

The assignment has been scoped for approx. 30 days of work with the following provisional schedule:

• Preparation phase: 3 days. Includes preparation of inception report.
• Field phase: Approx. 22 days, provisionally to be split between 3 countries in Africa and Asia, with the possibility of extending to a fourth country. Includes completion workshop with local participants.
• Finalisation phase: 5 days. Includes final report and presentation of findings to MEED and participating organisations.
• It is envisaged that the consultancy will start around end of April 2024.
• The consultant should be ready to travel in May/June.
• The draft report should be submitted for feedback by participating organisations by 11th August.
• The final report should be submitted by 28th August.

How to apply

You should read the full Terms of Reference here .

If you have any questions about the position, please, contact Fie Ostergaard på [email protected].

You apply from the Terms of Reference page and upload following documents:

• your CV including 3 references
• a Cover letter
• A track record of conducted studies, research, publication
• Your technical proposal for the project, including proposed methodology and work plan
• Your financial Proposal (please, note that per-diems are not issued as part of consultancies with Mission East. Please take this into consideration in the financial proposal)
• Eligibility Statement (our form to be downloaded here and signed)
• A sample of recent work, relevant to these terms of reference

Mission East wants to promote equality and diversity, and we therefore encourage all qualified people to apply for the assignment - regardless of ethnic background, gender, age, sexual orientation, disability or religion.

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• International
• Foreign affairs

British International Investment (BII) longitudinal mobilisation study evaluation reports: renewable energy investments and BII-backed funds

These 2 evaluation reports outline findings from a series of case studies on how British International Investment (BII) has mobilised capital directly and indirectly.

Synthesis report: analysis of mobilisation in 3 BII renewable energy investments, March 2024

https://assets.bii.co.uk/wp-content/uploads/2024/03/19095126/Analysis-of-mobiliation-in-BII-renewable-energy-investments.pdf

Synthesis report: analysis of mobilisation in 4 BII-backed funds, March 2024

https://assets.bii.co.uk/wp-content/uploads/2024/03/19095026/Analysis-of-mobilisation-in-four-BII-backed-funds.pdf

The Foreign, Commonwealth & Development Office (FCDO) contracted Itad to undertake a 10-year study, starting in 2018. The longitudinal mobilisation study ( LMS ) aims to understand:

• when and how British International Investment ( BII ) mobilises investment
• the drivers of this mobilisation
• the influence of country and sector contexts

The study distinguishes between direct mobilisation and demonstration effects:

• direct mobilisation refers to co-investment in BII deals
• demonstration effects refer to investment (‘indirect mobilisation’) or other changes in business practice that BII has influenced but is not a co-investor

These 2 reports summarise findings from 7 case studies on BII ’s role in mobilising finance. They cover renewable energy investments and equity funds. These sectors were chosen by evaluators as the main areas for learning about BII ’s mobilisation efforts.

Both reports include lessons learnt, which help to refine our understanding of when and how BII can most effectively mobilise capital.

1. Renewable energy investments

Synthesis report: analysis of mobilisation in 3 BII renewable energy investments presents case studies on 3 of BII ’s renewable energy investments: 

• Ayana Renewable Power  independent solar and wind generation company in India, which  BII launched in 2018  to address decarbonising India’s energy mix away from coal and support job creation
• the Benban solar power park in Egypt, which includes Alcazar Energy Egypt
• an investment in the  Redstone Concentrated Solar Power project in South Africa

The case studies showed that BII , individually or as part of a consortium, mobilised other public investors and private capital by providing the confidence needed to invest. The report explains that these investments also have the potential to create demonstration effects.

2. BII -backed funds

Synthesis report: analysis of mobilisation into 4 BII -backed funds presents case studies of equity funds between 2005 and 2019 in:

• Bangladesh: Frontier Funds I and II
• India: Lok I to III  and  India Value Funds I to III
• Nigeria: Capital Alliance Private Equity I to IV

The report describes how BII brought other investors and created the conditions that make investment opportunities more attractive to these investors. In all cases, BII supported the credibility of the funds and reassured potential investors about high standards in business integrity and environmental, social and governance.

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