Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

Abstract

BackgroundThe use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda.MethodThe data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis.ResultsAt the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns.ConclusionDiverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-017-0274-9) contains supplementary material, which is available to authorized users.

Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries

“…However, the authors emphasized the important role of facilitation in meetings between community members and health providers to balance their respective demands. 39 A similar finding was observed by Kananura et al, 41 who found improved engagement from the community and health services management staff in response to participatory monitoring processes designed to monitor implementation of an antenatal care project. Yet the process was only maintained in the presence of the project team, suggesting challenges exist in ensuring long-term sustainability.…”

“…Leadership and the role of active engagement from senior management was highlighted across multiple included studies as a feature associated with strengthened M&E capacity and facilitating uptake at the local level. 33 , 34 , 38 , 40 , 41 The concept of leadership is itself nuanced and difficult to measure and is represented slightly differently in each of the studies. In the study by Holvoet and Inberg, 38 which compared Rwandan and Ugandan health systems, there was evidence demonstrating the role of leadership in both countries.…”

“…Other studies explored the concept of community or participatory monitoring to varying degrees. 36 , 37 , 39 , 41 , 43 A community monitoring intervention formed the cornerstone of Björkman and Svensson’s study 37 based in Uganda. They found that community monitoring, through dissemination of a report card followed by a series of meetings and joint action planning between the community and health facilities, led to improvements in service utilization and health outcomes.…”

“…Qualitative data played a role in supporting quantitative findings in 2 of the included studies. 32 , 41 A study by Chukwuani et al 32 in Nigeria assessed primary health care operations, using a mix of data collection methods. Qualitative audits of primary health care facilities were found to be valuable in uncovering operational problems because respondents were more pragmatic than in the questionnaire about their needs.…”

District Governance and Improved Maternal, Neonatal and Child Health in South Africa: Pathways of Change

“…1 In recent years, the district has also become the unit of intervention and strengthening for improving the quality and outcomes of maternal, neonatal and child health (MNCH) care. District-based methodologies addressing MNCH include data-driven "bottleneck analyses," developed and popularized by UNICEF; 2,3 formal district planning; 4,5 quality improvement cycles; 6 participatory action research; 7 mentoring and coaching; 8 citizen score cards and other forms of social accountability; 9 or some combination of these. 3,10,11 Initiatives to strengthen the district health system using these methodologies vary in their entry points and the extent of additional resources they mobilize, but all are fundamentally concerned with how to galvanize existing district players and improve the efficiency of resource use.…”