Monitoring and evaluation

of RH services
 Learning objectives

By the end of the session you are expected to

• Understand basic concepts of monitoring and evaluation
• Discuss difference between monitoring and evaluation
• Identify types of evaluation
monitoring ?

evaluation?

indicators?
Basic concepts
Categories of indicators
• Input: resources expended in undertaking activities
• Process: things needs to be done to achieve outputs
• Outputs: major results needed to achieve outcome
• Outcome: long term benefits
• Impact: the result of specific outcome
 Cont..
impact –related to goal- malnutrition rates reduced amongst
young children

Outcome –related to objective- % of young children getting

appropriate complementary food

Output-immediate result-number of mothers who know about good

complementary food & how to prepare

Input –related to resources

 Good indicators
Specific : in terms of quantity ,quality ,time ,location ,target group,
Measurable: is it reliable and clear measure of result?
will the indicator show desirable change?
is it sensitive to changes?
Achievable :are the results realistic?
Relevant: is it relevant to the intended result ?
Time bounded:
What is monitoring

Monitoring is the systematic measurement of progress toward

desired objectives of a project, program or policy.
• It involves measuring Inputs
• Activities
• Outputs, and assessing whether these are indeed contributing
to achieving the project/program/policy’s stated objectives
(outcomes and impacts).
• It helps ensure that the project, program or policy achieves its
defined objectives within a prescribed time frame and budget.
 Purpose of monitoring
• To document progress and results of projects according to the
designed plan
• To provide the necessary information to management for timely
decision taking and corrective action (if necessary)
• To provide/ promote accountability to all stakeholders of a
project (to beneficiaries, donors, etc)
• Trigger timely adaptation of response, particularly in crises or
unstable contexts;
• Generate critical information that can be used for the evaluation
 What is evaluation?
• A systematic process of data collection and analysis about
activities and/or effects of a program, looking to answer an
evaluation question
• Determines the merit or the value of programs and explains
the relationship between a program and its effects.
• Evaluation may be done periodically by internal managers or
by external stakeholders
• Evaluation focuses on outcomes and impacts and assesses
whether they are contributing to achieving program goals and
Purpose of evaluation

• Supports decision-making process

• Improve programme performance

• Enhances learning by doing

• Provide accountability for programme results

 Evaluation answers
• Whether we are Doing the Right Things
– Rationale/justification
–Client satisfaction
• Whether we are Doing it Right
–Effectiveness/coherence
–Efficiency: optimizing resources
• Whether there are Better Ways of Doing it
–Alternatives
–Good practices
–Lessons learned
 Types of evaluation

• Formative

• Summative

• Normative
 Formative evaluation
• performed during the entire planning process and program execution to
answer evaluation questions important to modify an intervention.

• Provide solutions for program improvement

• Answers questions such as:

How can the intervention be modified to achieve its outputs and
outcomes?
Are there better solutions compared to those proposed by the program
How do the components of this program relate amongst themselves
 Summative evaluation
• Usually performed to provide judgment about a program’s worth.

• Answers questions such as:

• Is the program effective?

• Should the program be continued

 Normative Evaluation:
• Usually performed to provide managers or users judgment about
a program’s compliance to best practices.

• Answers questions such as:

• Is the program following recommended guidelines?

• Does the program follow national guidelines?

• Does the program comply with prescribed norms?

 Focus of evaluation
• Projects
• Normally consist of a set of activities undertaken to achieve specific
objectives within a given budget and time period.
• Programs
• Are organized sets of projects or services concerned with a particular
sector or geographic region
• Services
• Are based on a permanent structure, and, have the goal of becoming,
national in coverage, e.g. Health services, whereas programmes are
usually limited in time or area.
• Processes
• Are organizational operations of a continuous and supporting nature
(e.g. personnel procedures, administrative support for projects, etc
Evaluation designs
• The following are evaluation designs:
–Ongoing service/program evaluation
–End of program evaluation
–Impact evaluation
–Spot check evaluation ( quick progress report)
–Desk evaluation ( scanning literature & analysing secondary
data)
 Monitoring and Evaluation
Monitoring Evaluation
A planned, systematic process of • A process that assesses an
observation that closely follows achievement against pre-set
a course of activities, and criteria.
compares what is happening • Has a variety of purposes, and
with what is expected to happen follow distinct methodologies
• Identifies shortcomings before • Attempts to measure service’s
it is too late. relevance, efficiency and
• Provides elements of analysis effectiveness. It measures
as to why progress fell short of whether and to what extent the
expectations programme’s inputs and
services are improving the
quality of people’s lives
 Indicators in RH
• Indicators are clues, signs, and markers as to how close we are to our
path and how much things are changing

• Indicators are used to:

• Monitor changes overtime

• To monitor achievement towards targets…

• Monitor differences between population subgroups (sex, age…)

• Measure policy environment

• To evaluate effectiveness and impact of a program

Cont..

• Suggestive of problems or issues needing action

• But do not serve as a specific diagnostic tool

• Eg. Decreasing trend in postnatal care coverage does not show

why this has happened.

• Indicators are stimulus for other activities

• Why is the trend decreasing?

Definitions of commonly used terms in RH

• Fertility: the actual production of live offspring (excluding

stillbirths, foetal deaths and abortions)

• Fecundity: the ability to produce live offspring (theoretical ability

of a woman to conceive and to carry a foetus to term)
 Definitions of commonly……
• Gravidity: the number of pregnancies (completed or incomplete) experienced
by a woman
• Parity: the number of full-term children previously borne by a woman
(excluding miscarriages or abortions in early pregnancy, but including
stillbirths)
• Gestational age :the elapsed time since conception (The first day of the last
menstrual period taken)
–Preterm < 37 completed weeks; -Term 37 - < 42 completed weeks:
–Post term: > 42 weeks;
Definitions of commonly……

• Puerperium the period from delivery of the placenta until

involution of the uterus is complete - approximately 6 weeks.

• Perinatal the period from the end of the 28 week of pregnancy

to the end of the 7 day of life of the new-born.
Reproductive Health Indicators for
Global Monitoring

1. Total fertility rate: Total number of children

a woman would have by the end of
her reproductive period,
2. Contraceptive prevalence (any method):
Percentage of women of reproductive age
who are using (or whose partner is
using) a contraceptive method at a
particular point in time.(41% Medhs 2019)
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 Cont.…..
3. Maternal mortality ratio: The number of maternal
deaths per 100 000 live births from causes associated
with pregnancy and child birth.
4. Antenatal care coverage: Percentage of women
attended, at least once during pregnancy, by
skilled health personnel for reasons relating to
pregnancy.

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5. Births attended by skilled health personnel:
Percentage of births attended by skilled health
personnel. This doesn’t include births attended by
traditional birth attendants.
[Link] basic essential obstetric care: Number
of facilities with functioning basic essential
obstetric care per 500 000 population
Reproductive Health Indicators for
Global Monitoring
 Cont.…..

Essential obstetric care includes,

• Parenteral antibiotics,
• Parenteral oxytocic drugs,
• Parenteral sedatives for eclampsia,
• Manual removal of placenta,
• Manual removal of retained products,
• Assisted vaginal delivery.
• Immediate new born care
These services can be given at a health center level.
 Cont.……
• 7. Availability of comprehensive essential obstetric
care: Number of facilities with functioning
comprehensive essential obstetric care per 500 000
population. It incorporates
• obstetric surgery,
• anesthesia and
• blood transfusion facilities

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 Cont.….
8. Perinatal mortality rate: Number of perinatal deaths
(deaths occurring during late pregnancy, during childbirth
and up to seven completed days of life) per 1000 total
births. Deaths which occur starting from the stage of
viability till completion of the first week after birth (22
weeks of gestation up to end of first week after birth, WHO).
 9. Low birth weightCont.….
prevalence: Percentage
of live births that weigh less than 2500 g.
10. Positive syphilis serology prevalence in
pregnant women: Percentage of pregnant
women (15–24) attending antenatal clinics,
whose blood has been screened for syphilis,
with positive serology for syphilis.

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 Cont.….
11. Prevalence of anemia in women:
Percentage of women of reproductive age
(15–49) screened for hemoglobin levels with
levels below 110 g/l for pregnant women and
below 120 g/l for non- pregnant women.

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 Cont.…
12. Percentage of obstetric and gynecological admissions
owing to abortion: Percentage of all cases admitted to service
delivery points providing in-patient obstetric and gynecological
services, which are due to abortion (spontaneous and induced,
but excluding planned termination of pregnancy)
 Cont.…
13. Reported prevalence of women with FGM: Percentage of
women interviewed in a community survey, reporting to have
undergone FGM.

14. Prevalence of infertility in women:

• Percentage of women of reproductive age (15–49) at risk of
pregnancy (not pregnant, sexually active, non- contraception and
non-lactating) who report trying for a pregnancy for two years or
more.
 Cont.…..
15. Reported incidence of urethritis in men: Percentage of men
(15–49) interviewed in a community survey, reporting at least one
episode of urethritis in the last 12 months.
16. HIV prevalence in pregnant women: Percentage of
pregnant women (15–24) attending antenatal clinics, whose
blood has been screened for HIV, who are sero-positive for HIV.
 Cont.…..
17. Knowledge of HIV-related prevention practices: The percentage of all
respondents who correctly identify all three major ways of preventing the
sexual transmission of HIV and who reject three major misconceptions about
HIV transmission or prevention.

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