2.2.2 Monitoring and evaluation
Monitoring is a process by which priority data and/or information is routinely collected, analysed, used and disseminated to see progress towards the achievement of planned targets. This helps the managers take timely corrective actions in order to improve performance. It includes monitoring of inputs, outputs, outcomes and impacts of health programmes, including family planning. The most common form of monitoring is often based on input and output indicators using routinely collected service data. Monitoring of outcomes and impacts, on the other hand, requires the collection of target population level data, and for this reason is done at a higher level and for fewer selected priority areas only.
Monitoring consists of these components:
Routine data collection and aggregation (combining data from different sources) is the means by which routine service data is collected, aggregated, analysed and made ready for further performance monitoring.
Performance monitoring is the continuous tracking of required information on conducted activities and its indicators of success, in order to identify achievement gaps and lessons learnt. At all levels, performance monitoring will be based on the developed annual plan. The routine data collection and aggregation process provides a summary of performance data. Based on agreed Health Management Information Systems (HMIS) performance indicators, the performance monitoring committee will review the adequacy of achievements against the annual targets on a regular basis.
At all levels, performance monitoring will be conducted regularly on a weekly, monthly, quarterly and annual basis, supplemented by semi-annual and annual review meetings. With regard to family planning, you need to know what has to be monitored and how — you can refer to national HMIS technical guidelines.
In Box 2.4 you will find generic performance indicators of family planning. These may be different in your locality, but you can compare these with your own.
Box 2.4 Common performance indicators for a family planning programme
Inputs (resources, activities)
- Total commodities (supplies, equipment, contraceptives) received.
- Training and technical assistance received by the staff.
- Supplies and contraceptives expended (subtract inventory from amount received).
- Number of educational materials received, by type.
Outputs (services, training, information, education and communication)
- Number of new clients, given by choice of contraceptive method.
- Number of providers trained.
- Number of households covered.
- Number of community meetings and number of people informed at meetings.
- Number of referrals for clinical methods.
- Number of contraceptives distributed, by contraceptive method.
Indicators of quality of care (Some of these indicators can only be measured through evaluation research, depending on the programme’s Management Information System.)
- Providers’ level of adherence to informed choice protocols.
- Method mix offered.
- Percentage of clients referred by other clients (an indicator of client satisfaction).
- Continuation rates in programme.
- Percentage of clients expressing satisfaction with the service.
Indicators of effectiveness
- Indicators of knowledge of, attitudes towards, and practice of family planning in programme area.
Indicators of impact
- Contraceptive prevalence rate (CPR) in area.
- Crude birth rate in area.
- Induced abortion rates in area (if available).
- Total Fertility Rates (TFR) in area.
- Infant mortality rate.
- Maternal mortality rate.
- Rate of high-risk births (women over 35 years with 5+ births).
Supportive supervision (SS) is a process of guiding, helping, training and encouraging staff to improve their performance in order to provide high-quality health services through the use of integrated SS tools. A supervision session will include review of programme implementation at kebele level.
Programme evaluation is the systematic process of data collection, analysis and interpretation of activities and the effects of a programme, or any of its components. Programme evaluations may be either process evaluation, which examines the appropriate execution of programme components, or outcome evaluation, which examines the benefits of implementing an intervention or any of its components.