FACTORS AFFECTING THE UTILISATION OF MONITORING AND EVALUATION FINDINGS IN PUBLIC HEALTH FACILITIES IN IBANDA DISTRICT, UGANDA
ABSTRACT
This study investigated the factors affecting the utilisation of monitoring and evaluation (M&E) findings in public health facilities in Ibanda District, Uganda. The research was guided by three specific objectives: first, to establish the relationship between technical capacity and the utilisation of M&E findings in public Level III and IV health facilities in Ibanda District; second, to assess the relationship between financial capacity and the utilisation of M&E findings in these facilities; and third, to examine the relationship between the quality of M&E systems and the utilisation of M&E findings.
The Pearson correlation analysis coefficient was 0.831**, indicating a strong correlation between financial capacity and utilisation of M&E findings. The p-value of 0.000 (<0.005) led to rejection of the null hypothesis and acceptance of the alternative hypothesis. These findings further demonstrate a relationship between financial capacity and M&E findings. The results also show that a one percent change in financial capacity leads to a 0.682 change in the utilisation of M&E findings, indicating a positive relationship between the two variables.
Regression analysis was conducted to examine the effect of financial capacity on utilisation of M&E findings. The R-squared value of 0.691 indicates that 69.1% of the factors affecting utilisation of M&E findings are explained by the financial capacity of the organisation.
Regarding the availability of adequate financial resources to execute key activities in Ibanda District, the findings indicate that financial resources were inadequate, as none of the responses exceeded even half of the adequacy threshold. On the question of whether funds are made available to support decisions once made, the majority of respondents were uncertain. Similar results were obtained regarding whether funds are availed at an appropriate time to execute key decisions.
To examine the relationship between the quality of M&E systems and the utilisation of M&E findings, Pearson correlation analysis was performed. The correlation coefficient was 0.833**, indicating a strong positive relationship between the quality of M&E systems and the utilisation of M&E findings. The R-squared value of 0.694 indicates that 69.4% of the variation in utilisation of M&E findings is explained by the quality of M&E systems.
Based on the finding that adequate financial resources to execute key activities in Ibanda District were lacking, this study recommends that sufficient financial resources be allocated to M&E to enhance the utilisation of M&E systems. Regarding the finding that the majority of respondents were uncertain, with a considerable number disagreeing, that funds are made available to support decisions once made, this study recommends that funds be provided to support the utilisation of M&E findings. Furthermore, the study recommends that health facilities in Ibanda District provide funding capable of supporting organisational M&E activities, as financial resources are not always sufficient.
CHAPTER ONE: INTRODUCTION
1.1 Introduction
This study examines the determinants of utilisation of monitoring and evaluation (M&E) findings within public health facilities at Levels III and IV in Ibanda District. Technical capacity, financial capacity, and quality of M&E systems serve as the independent variables, while utilisation of M&E findings is the dependent variable. This chapter focuses on the background of the study, statement of the problem, purpose of the study, specific objectives, research questions, research hypotheses, conceptual framework, scope of the study, significance, justification, and operational definitions of key terms.
1.2 Background to the Study
1.2.1 Historical Background
Evaluation is as old as civilisation itself and has evolved alongside human progress (Basheka, 2016). Evaluation practices can be traced back to biblical times, notably in the creation story extensively addressed in Genesis (1:31), where the biblical account reports that on the fifth day, God saw everything He had created and it was good. From the philosophical works of Socrates, Plato, and Aristotle to the mathematical methodologies of Pythagoras and Euclid, the ideas of the ancient Greeks shaped many institutions and contributed to numerous fields, including evaluation (Zanakis, Theofanides, Kontaratos, & Tassios, 2003). Existing scholarly accounts indicate that the Delphic oracle of the ninth to third centuries BC served as the first central intelligence database of the ancient world—an interdisciplinary think tank of approximately ninety priests, regarded as the best-educated experts of antiquity (Theofanides et al., 2003). They collected and evaluated information and advised ordinary people and leaders, including Alexander the Great. Major project management existed in the fourth century BC, with evaluation and monitoring as key components. Griffin (2005) notes that management practice can be traced back thousands of years. The great pyramids, built around 2900 BC, exemplify management and coordination, demonstrating that the Egyptians used the management functions of planning, organising, and controlling in their construction.
In the contemporary world, the international status of M&E research remains theoretically and methodologically influenced by the American tradition. The United States is regarded as the birthplace of the field in terms of its trends, number of authors and their academic and professional influence, degree of professionalisation, focus of academic programmes, legislation and institutionalisation of evaluation, development of evaluation models and approaches, evaluation capacity-building initiatives, evaluation standards and guiding principles, number and attendance of evaluation conferences and workshops, publications and their impact factor, and evaluation guides and handbooks (Basheka, 2016:4). The American Evaluation Association (AEA), for example, remains the most dominant evaluation society globally, with membership growing from just over 3,000 in 2001 to approximately 7,000 by mid-2015 (Basheka & Byamugisha, 2015:76). Other countries, however, have also achieved notable developments in evaluation. In Europe, professionalisation of evaluation has progressed to varying levels across countries, with Sweden, the Netherlands, Great Britain, Germany, Denmark, Norway, France, and Finland currently leading. Recent rankings further highlight impressive developments in Switzerland, Japan, Spain, Italy, Israel, and Africa. In 2011, the International Organization for Cooperation in Evaluation (IOCE) identified 117 evaluation associations, 96 of which were national organisations located in 78 different countries. By 2013, the number had increased to 145 (IOCE, 2013:2; BaTall, 2009:7).
In Africa, the oldest evaluation association was established in 1997 in Ghana, while the African Evaluation Association was established in 1999, with the peak period of intense professional association development reported between 2000 and 2004 (Basheka & Byamugisha, 2015). Both domestic and global forces contributed to this growth. Globally, Mertens and Russon (2000:275) state that the emergence of many new regional and national evaluation organisations illustrated the growing worldwide recognition of the importance of evaluation. Before 1995, only five regional or national evaluation organisations existed worldwide, but by 2000 there were more than thirty—a 500% increase over five years. Much of this growth occurred in developing countries, particularly in Africa (p. 275). Malefetsane, Lungepi, and Tembile (2014:5) observe that evaluation has been increasing in Africa, a trend predicted to continue, especially given political recognition of evaluation’s utility for good governance. De Kool and Van Buuren (2004:173) conceded that the rise of New Public Management (NPM), constructed around key philosophies emphasising outputs, outcomes, transparency, and accountability, created demand for M&E in Africa.
In Uganda, over the past two decades, considerable efforts have been made to establish a robust basis for assessing both private and public spending. To achieve this, M&E was considered a means for the government and NGOs to measure their development interventions. Consequently, M&E was enshrined in the National Development Plan and institutionalised in governance systems and processes (National Development Plan, 2010/11–2014/15). The Office of the Prime Minister (OPM) was given the constitutional mandate to oversee reforms and service delivery in all government ministries, departments, and agencies and established an M&E function to support this role (National M&E Policy, 2013).
A National Integrated Monitoring and Evaluation Strategy for government programmes was developed to enhance M&E capacity and ensure that sound, evidence-based data and information are available to inform decision-making (NIMES, 2006). Significant effort was directed toward introducing planning, results-based budgets, and monitoring systems, as well as developing institutional capacity to design ministry strategies and plans to implement M&E arrangements. These efforts aim to monitor results and provide a basis for performance improvement as provided for in the National Development Plan (Annual Performance Assessment Report, 2013/2014).
1.2.2 Theoretical Background
This study is based on General Systems Theory, developed by Bertalanffy (1934), as cited in Tama (1987). The theory provides an analytical framework for explaining the factors affecting the utilisation of evaluation data. According to Bertalanffy (1968), a system is an assemblage of things connected or interrelated so as to form a complex unity: a whole composed of parts and sub-parts in orderly arrangement according to some scheme or plan. Key features of a system include: a combination of parts, sub-parts, and sub-systems (each part may have various sub-parts); mutually dependent parts, each of which may include many sub-systems; parts and sub-parts are mutually related, some more than others, some directly, some indirectly, with the relationship existing within the context of the whole; any change in one part may affect other parts; and a system is an interdependent framework in which various parts are arranged (Tamas, 1987).
A system transforms inputs into outputs, a transformation essential for the system’s survival. Three aspects are involved in this transformation process: inputs, mediator, and outputs. Inputs are taken from the environment, transformed into outputs, and returned to the environment. Inputs may take the form of information, money, materials, human resources, etc., while outputs may be goods and services. The total relationship is called the input–output process, and a system functions as a mediator in this process (Bertalanffy, 1968). In this study, it is assumed that inputs such as technical capacity, financial capacity, and the quality of M&E systems constitute the inputs, while utilisation of M&E data is the output.
1.2.3 Conceptual Background
Technical capacity refers to the extent to which an organisation’s human resources are able to manage evaluations (Byamugisha, 2016). For this study, technical capacity will be measured by whether staff are qualified, experienced, and knowledgeable about using M&E systems.
Financial capacity refers to the extent to which funds are available to finance and facilitate the M&E function within an organisation (USAID, 2015). In this study, financial capacity will be measured by the adequacy of financial resources, the timeliness of fund release, and whether funds are accounted for.
Quality of M&E systems refers to the extent to which M&E systems and activities meet specified requirements and standards (Mulandi, 2013:12). For this study, quality of M&E systems will be measured as the extent to which M&E systems meet methodological and quality standards.
Utilisation of M&E information refers to putting monitoring and evaluation results to use, including using M&E findings for decision-making and project control to establish baselines against which new measurements can be undertaken (Mulandi, 2013). For this study, utilisation of M&E data will be measured by the extent to which the data is used to inform decisions, improve organisational processes, and facilitate learning.
1.2.4 Contextual Background
Poor utilisation of M&E findings has been characterised by weak performance of health facilities in Uganda. As a result, the health sector faces numerous challenges despite high budget funding. In the 2018/2019 fiscal year, out of total government funding of US144.61percapita,fundingtothehealthsector(includingexternalfinancing)wasanestimatedUS 10.40 per capita, approximately UGX 2,310 billion (Duchoslav & Cecchi, 2019). Uganda continues to face substantial challenges, including high deaths from preventable causes such as malaria. As of 2013, Uganda had the sixth highest number of annual malaria deaths in Africa and some of the highest reported malaria transmission rates worldwide, with approximately 16 million cases reported in 2013 and over 10,500 deaths annually. By 2019, there was a 40% surge in malaria cases. Beyond malaria, the leading causes of death in Uganda include communicable diseases such as HIV/AIDS, respiratory tract infections, and diarrhoeal disease (Anywar et al., 2020).
According to the Annual Performance Assessment Report (2013/2014), significant efforts toward the utilisation of M&E findings have been observed, characterised by the introduction of planning, results-based budgets, monitoring systems, and the development of institutional capacity to design and implement M&E arrangements. These efforts aim to mitigate challenges in Uganda’s health sector, such as drug shortages in most health facilities.
National efforts have been directed toward providing a basis for performance improvement as provided for in the National Development Plan (2010/11–2014/15), indicating that utilisation of M&E findings is valued for improving health sector performance. These efforts are also characterised by the establishment of an M&E function, a role enshrined in the National M&E Policy (2013). Unfortunately, although national efforts have focused on enhancing M&E capacity and ensuring that sound, evidence-based data and information are available to inform decision-making (Republic of Uganda, National Integrated Monitoring and Evaluation Strategy, 2006), the use of M&E results remains questionable. According to a 2009 published report, there is one doctor for every 7,272 Ugandans. The related statistic for nurse and midwifery professionals is 1:36,810. Shortages are worse in rural areas, where 80% of the population resides, as 70% of all doctors practice in urban areas. Although there are sixty-one institutions that train health workers—five medical colleges, twenty-seven allied health training schools, and twenty-nine nursing schools—this indicates that Uganda’s health sector is at risk of total collapse (Ogwal et al., 2020). This study will therefore attempt to examine the factors affecting utilisation of M&E findings in Uganda’s health sector using Ibanda District as a case study.
1.3 Statement of the Problem
Findings from the M&E function ought to be used to inform decision-making, planning, and organisational learning (Basheka, 2016). However, at public health facilities at Level III and above in Ibanda District, health information is not adequately used (Ibanda District, 2017). To increase the use of health information, the Ministry of Health has devoted significant human, technical, and financial resources to the M&E function. Despite this significant investment in M&E, there is widespread concern that utilisation of evaluation findings in public health facilities in the district remains low. According to the Annual Health Sector Performance Report (AHSPR) 2018/2019, Ibanda District ranked 18th nationally out of 128 districts; in the AHSPR 2019/2020, it ranked 76th. The AHSPR tracks performance of public health facilities in terms of coverage of health services, quality of health services, human resources for health services, and reporting for health services.
The current study thus sought to determine the factors affecting utilisation of M&E findings within public health facilities in Ibanda District. Without this information, utilisation of evaluation findings may deteriorate further and adversely affect the performance of public health facilities.
1.4 Main Objective
The study sought to establish the factors affecting the utilisation of M&E findings in public health facilities at Levels III and IV in Ibanda District.
1.5 Specific Objectives
i. To establish the relationship between technical capacity and the utilisation of M&E findings in public health facilities at Levels III and IV in Ibanda District.
ii. To assess the relationship between financial capacity and the utilisation of M&E findings in public health facilities at Levels III and IV in Ibanda District.
iii. To examine the relationship between the quality of M&E systems and the utilisation of M&E findings in public health facilities at Levels III and IV in Ibanda District.
1.6 Study Hypotheses
H₁: There is no relationship between technical capacity and the utilisation of M&E findings in public health facilities.
H₂: There is no relationship between financial capacity and the utilisation of M&E findings in public health facilities.
H₃: There is no significant effect of the quality of M&E systems on the utilisation of M&E findings in public health facilities.
