MONITORING AND

EVALUATION OF HEALTH
PROJECT
What is Monitoring and Evaluation

• Monitoring and Evaluation is a process of continued gathering of

information and its analysis, in order to determine whether
progress is being made towards pre-specified goals and
objectives, and highlight whether there are any unintended
(positive or negative) effects from a project/programme and its
activities.
What is a Monitoring?

• Monitoring is a continuous process of collecting, analyzing,

documenting, and reporting information on progress to achieve set
project objectives. It helps identify trends and patterns, adapt
strategies and inform decisions for project or programme
management.
What is Evaluation
• Project evaluation is the process of objectively assessing
a project’s performance and outcomes against its goals
and objectives once it's completed. It involves reviewing
progress, results, and processes to determine if the
project was successful, identify areas for improvement,
and inform future projects.
• Evaluation is a periodic assessment, as systematic and objective as
possible, of an on-going or completed project, programme or policy,
its design, implementation and results.
• It involves gathering, analysing, interpreting and reporting
information based on credible data.
• The aim is to determine the relevance and fulfilment of objectives,
developmental efficiency, effectiveness, impact and sustainability.
Purpose/Importance of Monitoring and Evaluation

• Timely and reliable M&E provides information to:

Support project/programme implementation with accurate,
evidence-based reporting that informs management and decision-
making to guide and improve project/programme performance.
Contribute to organizational learning and knowledge sharing by
reflecting upon and sharing experiences and lessons.
Uphold accountability and compliance by demonstrating whether or
not our work has been carried out as agreed and in compliance with
established standards and with any other stakeholder requirements
Provide opportunities for stakeholder feedback,.
• Promote and celebrate project/program work by highlighting
accomplishments and achievements, building morale and contributing
to resource mobilization.
• Strategic management in provision of information to inform setting
and adjustment of objectives and strategies.
• Build the capacity, self-reliance and confidence stakeholders,
especially beneficiaries and implementing staff and partners to
effectively initiate and implement development initiatives.
 Characteristics of monitoring and evaluation

• Monitoring tracks changes in program performance or key outcomes

over time. It has the following characteristics:
•  Conducted continuously
•  Keeps track and maintains oversight
•  Documents and analyzes progress against planned program activities
•  Focuses on program inputs, activities and outputs
•  Looks at processes of program implementation
•  Considers program results at output level
•  Considers continued relevance of program activities to resolving the
health problem
•  Reports on program activities that have been implemented
•  Reports on immediate results that have been achieved
Evaluation is a systematic approach to attribute changes in specific
outcomes to program activities. It has the following characteristics:

•  Conducted at important program milestones

•  Provides in-depth analysis
•  Compares planned with actual achievements
•  Looks at processes used to achieve results
•  Considers results at outcome level and in relation to cost
•  Considers overall relevance of program activities for resolving
health problems
•  References implemented activities
•  Reports on how and why results were achieved
•  Contributes to building theories and models for change
•  Attributes program inputs and outputs to observed changes in
program outcomes and/or impact
Key benefits of Monitoring and Evaluation

• a. Provide regular feedback on project performance and show any

need for ‘mid-course’ corrections
• b. Identify problems early and propose solutions
• c. Monitor access to project services and outcomes by the target
population;
• d. Evaluate achievement of project objectives, enabling the
tracking of progress towards achievement of the desired goals
• e. Incorporate stakeholder views and promote participation,
ownership and accountability
• f. Improve project and programme design through
feedback provided from baseline, mid-term, terminal and
ex-post evaluations
• g. Inform and influence organizations through analysis of
the outcomes and impact of interventions, and the
strengths and weaknesses of their implementation,
enabling development of a knowledge base of the types
of interventions that are successful (i.e. what works,
what does not and why.
• h. Provide the evidence basis for building consensus
between stakeholders
Types of monitoring

• Common types of monitoring

•  Results monitoring: Tracks effects and impacts to determine
if the project/programme is on target towards its intended results
(inputs, activity, outputs, outcomes, impact, assumptions/risks
monitoring) and whether there may be any unintended impact
(positive or negative)
•  Process (activity) monitoring : Tracks the use of inputs and
resources, the progress of activities, how activities are delivered –
the efficiency in time and resources and the delivery of outputs
•  Compliance monitoring: Ensures compliance with, say, donor
regulations and expected results, grant and contract
requirements, local governmental regulations and laws, and
ethical standards.
• Context (situation) monitoring: Tracks the setting in which the
project/programme operates, especially as it affects identified risks and
assumptions, and any unexpected considerations that may arise, including the
larger political, institutional, funding, and policy context that affect the
project/programme.
• Beneficiary monitoring: Tracks beneficiary perceptions of a project/programme.
It includes beneficiary satisfaction or complaints with the project/programme,
including their participation, treatment, access to resources and their overall
experience of change.
• Financial monitoring: Accounts for costs by input and activity within predefined
categories of expenditure, to ensure implementation is according to the budget
and time frame.
• Organizational monitoring: Tracks the sustainability, institutional development
and capacity building in the project/programme and with its partners.
Types of Evaluation
• Formative evaluation is an ongoing process that
involves collecting feedback and data during the
development of a program, product, or service.
• The purpose of formative evaluation is to identify areas
for improvement and make changes as needed to
ensure that the final product or service meets the
intended goals and objectives.
• Formative evaluation is usually conducted during the
early stages of development and is often used to guide
decision-making and improve the quality of the final
product
• Summative evaluation is conducted at the end of a program, product,
or service to determine its effectiveness and success in achieving its
goals and objectives.
• Summative evaluation is usually conducted using predetermined
criteria and involves collecting data through surveys, tests, or other
methods to measure the outcomes of the program.
• The purpose of summative evaluation is to provide feedback on the
overall effectiveness of the program, product, or service and to inform
decisions about its future.
 M&E LOGICAL FRAMEWORKS
Logical Framework:
A logical framework, also known as a logframe, is a tool used to plan,
monitor, and evaluate programs and projects.
Logical frameworks are diagrams that identify and illustrate the
relationships between program Inputs, Processes, Outputs, and
Outcomes.
Purposes:
• Provides a linear interpretation of planned use of resources and
desired ends
• Clarifies project/program assumptions about linear relationships
between key factors relevant to desired ends
 Components of Logic Model
• The logic model has 5 essential components
Logic Model Description
Component
Inputs The resources we invest in an intervention
Processes The activities carried out in order to achieve the intervention’s
objectives
Outputs The immediate RESULTS achieved by the intervention at the
intervention level through the execution of activities

Outcomes The set of results at the (target) population level induced by the
interventions. People level effect
Impacts The long term effects or end results of the intervention eg.
changes in health status
•Inputs: Resources, contributions, and investments
that go into the program.
•Eg: Funding, staff, time, equipment, technology, and
partnerships.

•Activities/ process: What the program does with the

inputs to fulfill its mission. The tasks or actions
undertaken to deliver the outputs
•Eg: Training, workshops, service delivery, community
outreach, and educational campaigns.
•Outputs: The direct products of program activities; immediate
results.
•Eg: Number of people trained, number of workshops conducted,
materials produced, and services delivered.

•Outcomes: The specific changes in program participants' behavior,

knowledge, skills, status, and level of functioning.
•Eg: Increased knowledge about maternal health, improved health
practices, higher engagement in prenatal care, and better nutritional
habits among pregnant women.
Impact:
•Definition: The broader, long-term changes that
result from the program's outcomes; the ultimate
goal.
•Examples: Reduction in maternal and infant
mortality rates, improved overall community
health, and enhanced quality of life.
 M&E logical framework for TB programme

INPUT PROCESS OUTPUT OUTCOME IMPACT

Resources NTP – mgt Diagnostic Case detection TB infection
/communication services
Clinical and Case treatment TB morbidity
managerial Communication Treatment
Case holding TB mortality
Staff services
Advocacy
Drugs Knowledge
Training of staff
Laboratories Reduced
Surveillance
Stigma
system

CONTEXT
Political commitment Health system Socio-economic conditions Epi-context
Availability HIV prevalence
Access Malnutrition
Utilization Alcoholism
 Logic Framework example:
Directly Observed Therapy

INPUT PROCESS OUTPUT OUTCOME IMPACT

•Drugs • Training of • HCWs trained •Improved cure • Reduced
•Guidelines HCWs to provide and treatment morbidity/
• Distribution of DOT completion rates mortality due
for DOT
• Drugs •Decreased failure to TB
•Human drugs
available at and default rates • Prevention of
Resources • Supervision
facilities MDR-TB
• Patients
receiving DOT
• Treatment
outcomes
reported
 Logic Models: ITN Distribution

INPUT PROCESS OUTPUT OUTCOME IMPACT

Human and • Establish ITNs ITN use Malaria
financial distribution distributed prevalence
resources points for ITNs malaria
BCC
ITNs • BCC staff conducted
trained
BCC materials
 Logic Model: Malaria Control Programs

Inputs Process Outputs Outcomes Impact

•Strategies •Training •Services •IITN/IRS •Malaria
•Policies •Services delivered ownership Incidence/
•Guidelines •Education •Knowledge, •ITN use Prevalence
•Funding •Treatments skills, practice •Treatment •Mortality
•Materials •Interventions • ITNs distributed based on •Socio-
•Facilities • HH sprayed parasitological economic
•Commodities •IPTs delivered confirmation wellbeing
•Supplies •Antimalarials •Economic
•Staff delivered Impact
•RDTs/slides
delivered and reads
taken

Adapted from: RBM. 2008 Global Malaria Action Plan. Available at:
http://www.rollbackmalaria.org/gmap/gmap.pdf
V C T P rogram I mplementation Logic Model

INPUTS ACTIVITIES IMMEDIATE INTERMEDIATE IMPACTS

OUTPUTS
OUTCOMES OUTCOMES

Nurses & lab

Train nurses & Quality of VCT
Nurses techs trained
lab techs in VCT increased
Lab techs
Clients are
Provide pre-test Access to VCT
counseled for
counseling increased HIV transmission
Govt. funds HIV testing
Risk behaviors rates decreased
GAP funds
Other donor Conduct HIV test decreased
Clients are Knowledge of
funds tested HIV status
Provide post-test increased
HIV test kits counseling to all Clients receive HIV prevalence
clients tested results and post- decreased
Knowledge
test counseling
about & access
Counseling to prevention HIV treatment
protocol Refer pregnant increased
HIV+ women to Pregnant HIV+ resources
PMTCT svcs women referred increased
Referral to PMTCT svcs HIV morbidity &
system for Access to HIV mortality
prevention & Refer HIV+ HIV+ clients treatment decreased
Tx services clients to Tx referred to ARV, resources
services support & HBC increased

26
 Logic Framework

Input  Process  Output  Outcome  Impact

Program Level (cohort) Population level

Purpose of the Logic Model

• Planning: Helps in outlining the necessary resources, activities, and

expected results.
• Implementation: Guides the process and ensures that activities align
with the desired outcomes and impacts.
• Monitoring: Tracks progress by comparing actual outputs and
outcomes against the planned ones.
• Evaluation: Assesses the effectiveness and impact of the program,
providing data for decision-making and improvements.
• Communication: Clearly explains the program to stakeholders,
funders, and partners.
EVALUATION CRITERIA FOR
PROJECTS
• a) Five Part Evaluation Criteria

•  Relevance - Was/is the project a good idea given the situation to

improve? Was the logic of the project correct? Why or Why Not? -The
validity of the Overall Goal and Project Purpose at the evaluation
stage.
•  Effectiveness - Have the planned results been achieved? Why or
Why Not? -The degree to which the Project Purpose has been achieved
by the project Outputs.
•  Efficiency - Have resources been used in the best possible way?
Why or Why Not? -The productivity in project implementation. The
degree to which Inputs have been converted into Outputs.
•  Impact - To what extent has the project contributed
towards its longer term goals? Why or Why Not? Have
there been any unanticipated positive or negative
consequences of the project? Why did they arise? -
Positive and negative changes produced, directly or
indirectly, as a result of the Implementation of the
project.
•  Sustainability – Can the outcomes be sustained after
the project funding to ensure continued impacts? Why
or Why Not? -The durability of the benefits and
development effects produced by the project after its
completion.
What Is a Project?

• A project is a set of tasks that are executed by a team to

achieve a specific goal.
• A project is a temporary endeavor undertaken to create a unique
product, service, or result. It has a defined beginning and end, specific
objectives, and constraints such as time, cost, and resources.
• A "project" is a planned undertaking with a defined start
and end date, aimed at achieving a specific goal or
outcome by completing a series of related tasks within
set constraints like time, budget, and
resources; essentially, it's a temporary endeavor
designed to deliver a unique product, service, or result.
Key Characteristics of a Project

• Temporary: Defined start and end dates.

• Unique Deliverable: Produces a unique product, service,
or result.
• Defined Scope and Objectives: Driven by specific goals.
• Constraints: Operates within time, budget, and resource
limitations.
• Lifecycle: Follows a structured lifecycle (Initiation,
Planning, Execution, Monitoring and Controlling, Closure).
What Is a Program?

• A programme is a collection of related projects

managed in a coordinated way to achieve strategic
objectives and benefits that would not be available if
the projects were managed individually.
• Programmes are typically ongoing and adaptable to
changes in organizational goals and environments.
Key Characteristics of a Programme

• Ongoing Nature: May not have a fixed end date.

• Strategic Alignment: Aligns with broader organizational goals.
• Coordination of Projects: Manages multiple related projects
together.
• Benefits Management: Focuses on overall benefits and value.
• Adaptability: Can evolve with changes in organizational priorities.
Comparison: Project vs Programme

• Scope: Narrow (project) vs Broad (programme).

• Duration: Temporary vs Ongoing.
• Focus: Specific deliverables vs Strategic goals.
• Management: Project management vs Programme management.
• Adaptability: Fixed plan vs Flexible.
• Project Management
• Project management is the discipline of planning, organizing, and
managing resources to achieve specific goals and meet specific
success criteria. It ensures that projects are delivered on time, within
scope, and within budget, while meeting the desired quality
standards.
Key Components of Project Management

1.Project Initiation
1. Defining the Project: Clearly articulate the project's purpose, objectives, and
scope.
2. Feasibility Study: Assess the project's viability in terms of resources, time,
and budget.
3. Stakeholder Analysis: Identify all stakeholders and understand their needs
and expectations.
4. Project Charter: Create a document that formally authorizes the project,
outlining the objectives, scope, and stakeholders.
• Project Planning
• Developing a Project Plan: Detail the tasks, timeline, resources, and budget
required to achieve the project objectives.
• Scope Management: Define and document what is included and excluded
from the project.
• Work Breakdown Structure (WBS): Break down the project into smaller,
manageable tasks and deliverables.
• Schedule and Budget Planning: Develop a detailed schedule and budget,
including contingency plans.
• Risk Management: Identify potential risks and develop mitigation strategies.
• Project Execution
• Resource Allocation: Assign tasks to team members and allocate
resources.
• Team Management: Lead and manage the project team to ensure
tasks are completed on time and within budget.
• Communication: Ensure effective communication among stakeholders
and team members.
• Quality Assurance: Implement quality control measures to ensure
deliverables meet the required standards.
• Project Monitoring and Controlling
• Progress Tracking: Monitor the project's progress against the plan.
• Performance Measurement: Measure performance using Key
Performance Indicators (KPIs) and other metrics.
• Change Management: Manage changes to the project scope,
schedule, and budget as needed.
• Risk Management: Continuously identify and manage risks
throughout the project lifecycle.
• Reporting: Provide regular updates to stakeholders on project status.
• Project Closing
• Completion of Deliverables: Ensure all project deliverables are
completed and meet the required standards.
• Final Reporting: Prepare a final project report summarizing the
project's outcomes, lessons learned, and any remaining issues.
• Stakeholder Satisfaction: Ensure all stakeholders are satisfied with the
project outcomes.
• Project Evaluation: Conduct a post-project evaluation to assess the
project's success and identify areas for improvement.
• Documentation: Archive all project documents for future reference.
 COMMON PROJECT
TERMS
• Deliverables: Tangible ‘things’ that the project produces
• Milestones: Dates by which major activities are
performed.
• Tasks: Also called Actions. Activities undertaken during
the project
• Risks: Potential problems that may arise
• Issues: Risks that have happened
• Stakeholder: Any person or group of people who may be
affected by your project