I am cutting
rocks
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I am building a
temple
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Some principles of
monitoring and evaluating
health programmes
Questions
 What is monitoring?
 How is this different from evaluation?
 As DCSTs, what monitoring are you
involved in?
 What evaluation activities are you involved
in?
Learning Objectives
 Understand basic concepts of M&E
 Be able to critique M&E systems more
rigorously (especially your own role in this)
 Think critically about how you are
monitoring and evaluating your own work
Monitoring
• Monitoring is an on-going systematic review
of the implementation of a program/project
What, when, how many, where, at what cost, how well?
• Where is the project at any given time – relative to
objectives?
• Is implementation is taking place as planned?
• Does implementation vary from site to site?
• How well has the project been implemented?
Why do we monitor?
• Measures whether programme is on track
• Ensures the most effective and efficient use of resources
• Assist in making informed decisions about what to
change
• Provides the opportunity to spot difficulties
implementation early enough to take remedial action
in
• Help distinguish between theory and implementation
failure
What are you monitoring?
The implementation of your work plans
Are you performing activities as planned?
Are you reaching the intended target population?
Are you reaching the intended number of
participants?
Is it leading to the products (outputs) you expected?
How do the participants perceive these services and
activities?
Problem statement
Goals
Objective
Outcomes
Inputs
Activities
Outputs
Rationales and assumptions
Problem statement
The district has high stillbirth and perinatal asphyxia rates
Goals
To increase the quality of intrapartum care in order to
reduce the number of stillbirths and asphyxiations
Objective
To increase the knowledge, skills and confidence of
midwives and doctors in labour ward to use and interpret
the partogram effectively and manage obstetric
emergencies appropriately
Inputs
•Trainers – O&G, ADM, FP
•Printed training aids
•Projector
•Transport
•Master trainers
•Fire drill dummy
•Printed training aids
•Projector
•Transport
•Excel and data presentation skills
Activities
1. Regular partogram
audits
2. Train managers in
partogram use and
assessment
3. ESMOE training
and EOST and onsite mentorship
4. Set up/strengthen
MMR processes
Activities
1. Regular
partogram
audits
2. Train
managers in
partogram use
and
assessment
3. ESMOE
training and
EOST and onsite mentorship
4. Set
up/strengthen
MMR
processes
Outputs
# facilities with quarterly
partogram spot
checks by DCSTs
% partograms filled in
correctly
# managers/staff trained
in partogram use and
assessment
# doctors, midwives,
EMS personnel who
received ESMOE training
Outcomes
What is evaluation?
 Evaluation is the systematic collection of
information about a program that enables
stakeholders to better understand the program,
improve its effectiveness, and/or make
decisions about future programming.
 Focuses on the impact of the activities
Did the activities achieve the planned
objectives and targets?
Evaluation is about outcomes
 Outcomes are the changes that occur or the
difference that is made for individuals, groups,
families, organizations, systems, or communities
during or after the program.
 Outcomes fall along a continuum from immediate
(initial; short-term) to intermediate (medium-term)
to final outcomes (long-term), often synonymous
with impact.
Activities
1. Regular
partogram
audits
2. Train
managers in
partogram use
and
assessment
3. ESMOE
training and
EOST and onsite mentorship
4. Set
up/strengthen
MMR
processes
Outputs
# facilities with quarterly
partogram spot
checks by DCSTs
% partograms filled in
correctly
# managers/staff trained
in partogram use and
assessment
# doctors, midwives,
EMS personnel who
received ESMOE training
Outcomes
Relevant managers skilled in
assessment of partogram
and able to address
weaknesses with
ST
feedback and training
Midwives and doctors
knowledgeable and
skilled in use and
ST
interpretation of
partogram
Partogram used effectively to
identify problems
timeously and take
MT
effective, appropriate
action
Fresh stillbirth rate in facilities
LT
decreases
ESMOE training of midwives
Short term
Medium term
Long term
LEARNING:
BEHAVIOUR:
CONDITION:
The knowledge the
midwives gain from
training.
The actions midwives
take as a result of that
knowledge.
The conditions that
change as a result of
those actions.
Midwives
knowledgeable and
skilled in the use and
interpretation of
partograms
Improved
management of labour
through correct use
and interpretation of
partograms
Reduction in stillbirths
and early neonatal
deaths
Evaluation of DCST work
 What difference did you make?
 What will you evaluate?
 Changes in knowledge, skill, attitudes, behaviour,
motivation, decisions, policies and conditions
 How will you know these changes have
happened?
 How will you know these changes happened
as a result of your activities?
WBOT – household visits to pregnant
women to educate family about
danger signs in pregnancy
Short term
Medium term
Long term
LEARNING:
BEHAVIOR:
CONDITION:
The knowledge
families gain from the
health messages.
The actions families
take as a result of that
knowledge.
The conditions that
change as a result of
those actions.
Families are equipped
with appropriate
health care messages
on danger signs
during pregnancy.
An increase in families
of pregnant women
recognising danger
signs of pregnancy
and seeking timely
health care.
Decrease in Maternal
Mortality Ratio
Setting up a Kangaroo Mother Care
Unit
Short term
Change that
occurred:
Increase in the
number of prem
babies and mother
pairs admitted to the
KMC unit
Medium term
Difference that was
made:
Long term
Impact caused by
difference:
Homework
 Develop a monitoring and evaluation plan for one of your
flagship projects/activities
 Carry this through – document your monitoring indicators
and your outcomes (short term, medium term and long
term)
 Write this up
Guidelines
 Choose your project/activity
 What do you want to monitor about the:
 Inputs
 Outputs
 What are the short term, medium term and
long term outcomes you wish to see?
 How will you measure these? What will your
indicators be?