MONITORING AND EVALUATION SYSTEMS AND PERFORMANCE OF

CERVICAL CANCER UNITS IN UGANDA: A CASE STUDY OF

SELECTED UNITS IN WAKISO DISTRICT.

ABBREVIATIONS AND ACRONYMS

AIDS: Acquired Immune Deficiency Syndrome

CDC: Centre for Disease Control

CIN : Cervical Intraepithelial Neoplasia

CPD: Continuous Professional Development

DHO: District Health Officer

DHT: District Health Team

HIV:  Human Immune Virus

HPV: Human Papilloma Virus

HW: Health worker

NGO: Non-Government Organization

STI: Sexually Transmitted Infections

VIA: Visual Inspection with Acetic acid

VHT: Village Health Team

WHO: World health Organization

Operational definitions

1. Cervical cancer screening is used to identify any changes within the cervical cells that could result in cancer. Cervical cancer screening is offered to all women living with HIV who seek medical care from public health facilities.
2. Monitoring and Evaluation system is the process that involves the definition, selection, collection, analysis and use of information during and after a project life.

• Performance is the action or process of carrying out a task.

1. Availability is the physical presence to carry out an action
2. Responsiveness is the ability to react quickly and in a positive manner.
3. Productivity is the measure of output against the input of performance.

• Competence is the ability to perform a task effectively.

CHAPTER ONE: INTRODUCTION

1.1  Introduction

This chapter covers the thematic area of the study such as the background description, the statement of the problem, the objectives of the study, the research questions and hypothesis of the study. Furthermore, the chapter also describes the conceptual framework, study significance, justification as well as operational definitions and selected terms and concepts.

Overall, the study is organized into five chapters: the first chapter is introduction and background to the study, the second chapter is the literature review which reviews other findings from studies and other settings in relation to this study, chapter three describes the methodology that shall be used to answer to collect and analysed data so as the answer the research question.

1.2 Background of the study

This subsection discusses back ground under historical, theoretical, conceptual and contextual perception of the study.

1.2.1 Historical Perspective

Cervical cancer, a malignancy affecting the cervix, the lower segment of the uterus connecting to the vagina, has a history marked by extensive medical exploration, preventive efforts, and therapeutic advancements, while cervical cancer likely afflicted human populations for centuries, ancient civilizations lacked the medical comprehension and tools needed for its diagnosis and treatment (Escobar, & Plugge, 2020).

In the 19th century, medical science progressed, leading to the gradual development of knowledge about cervical cancer as a distinct medical condition. This period saw physicians beginning to differentiate and acknowledge cervical cancer (Lin et al., 2021).  By the 1920s, scientists tentatively proposed a link between cervical cancer and human papillomavirus (HPV). However, comprehending this connection fully took several decades. In the 1940s and 1950s, Dr. George Papanicolaou’s ground-breaking creation, the Pap smear, emerged as a cervical cancer screening method. This affordable and straightforward test enabled early detection of precancerous and cancerous cervical cells, substantially reducing cervical cancer mortality rates (Bouvard et al., 2021).

In the 1970s, HPV’s role as a prominent cause of cervical cancer was definitively confirmed, with specific HPV strains identified as culprits. This discovery spurred heightened research into HPV vaccines and preventive strategies (Lin et al., 2021), By the 1980s and 1990s, the introduction of HPV vaccines like Gardasil and Cervarix represented a significant stride in cervical cancer prevention, these vaccines targeted HPV strains known to be linked to cervical cancer (Vu et al., 2018).

Advancements in medical technology and surgical techniques, including the development of procedures such as loop electrosurgical excision (LEEP) and laser therapy, greatly enhanced cervical cancer treatment outcomes, however worldwide efforts encompassed screening programs and educational campaigns aimed at raising awareness and promoting routine Pap smears and HPV vaccinations. These endeavors contributed to a decline in cervical cancer incidence and mortality rates across many nations (Ciapponi et al., 2021).

Ongoing research remains dedicated to uncovering new treatments, early detection methodologies, and addressing HPV-related cancers. This ongoing pursuit aims to further mitigate the impact of cervical cancer (Bhatla et al., 2021), It’s essential to underscore that, despite notable progress in cervical cancer prevention and treatment, it still poses a global health challenge, especially in regions with limited access to healthcare and vaccination initiatives. Consistent screening, HPV vaccination, and robust public health endeavors remain critical in the ongoing battle against cervical cancer (Schulte-Frohlinde, Georges, Clifford, & Baussano, 2022).

Globally, it was estimated that there were over 311,000 deaths from cervical cancer in 2018, however by 2020 cervical cancer was the fourth most frequent cancer in women with an estimated 604 000 new cases in 2020 (Hagiya, et al., 2022), Of the estimated 342 000 deaths from cervical cancer in 2020, about 90% of these occur in low- and middle-income countries (Bouvard et al., 2021), Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV, and an estimated 5% of all cervical cancer cases are attributable to HIV (2). Moreover, in all world regions the contribution of HIV to cervical cancer falls disproportionately on younger women (Wilailak, Kengsakul, & Kehoe, 2021).

Sub-Saharan Africa, parts of South Asia, and some areas in Central and South America have some of the highest mortality rates, often due to limited access to healthcare and screening services. The onset of the HIV/AIDS epidemic has exacerbated the incidence of cervical cancer among HIV-positive women due to compromised immunity. In May 2018, the World Health Organization (WHO) called for a global initiative to eliminate cervical cancer as a public health problem (Kjaer, Dehlendorff, Belmonte, & Baandrup, 2021), to achieve this goal, global scale-up of effective vaccination against the human papillomavirus (HPV) as well as screening for and treatment of cervical cancer were launched, (Jalil et al., 2021).

In the modern global landscape, the standing of Monitoring and Evaluation (M&E) research is shaped both theoretically and methodologically by the American tradition. The United States (US) is widely recognized as the birthplace of this field, characterized by its prevailing trends, numerous influential authors, academic and professional impact, level of professionalization, emphasis in academic programs, legislative support, institutionalization of evaluation practices, development of evaluation models and methodologies, efforts to enhance evaluation capabilities, establishment of evaluation standards and guiding principles, the size and attendance at evaluation conferences and workshops, the impact and reach of publications, as well as the availability of guides and handbooks on evaluation (Basheka, 2016).

In Uganda, cervical cancer is the leading cause of death among women. According to the World Cancer Research Fund international, in 2020 Uganda was ranked in 7^th position having registered 6,569 new cases and 6^th position with 4,607 deaths globally. The ICO/IARC information centre on HPV and cancer indicated that currently 6959 women are diagnosed with cervical cancer every year and 4607 die from the disease (Obol, Lin, Obwolo, Harrison, & Richmond, 2021).

Uganda has one of the highest cervical cancer incidence rates in the world. This is partly due to limited access to preventive measures like HPV vaccination and widespread infection with high-risk strains of the human papillomavirus (HPV), which is the primary cause of cervical cancer. Limited Screening and Early Detection (Rawat et al., 2021), Access to cervical cancer screening services, such as Pap smears and HPV testing, is limited in many parts of Uganda. As a result, a significant number of cases are diagnosed at advanced stages, making treatment less effective (Namuli et al., 2021).

The World Health Organization estimated a total of 3915 Ugandan women had been diagnosed with cervical cancer and that 2160 died from the disease (WHO, 2021). Cervical cancer screening guidelines in Uganda are based on a “See and Treat” algorithm (Ministry of Health & Strategic Plan for Cervical Cancer Prevention and Control in Uganda 2010–2014, 2010).

The target age group are women 25 to 49 years old. Women in Uganda are screened using VIA and those with positive findings and eligible precancerous lesions are treated using cryotherapy. Screening occurs every 3 years for both HIV-negative women and HIV-positive women. Midwives and nurses are the primary providers of cervical cancer screening as well as treatment. Unfortunately, screening in Uganda is erratic, opportunistic, and in some places absent due to a lack of resources or lack of financial commitment. This translates to a staggeringly low screening uptake of about 4.8% in rural Uganda (Nakisige et al., 2017). Consequently, the Ministry of Health with support from its development partners have trained and deployed health workers to provide cervical cancer screening to all HIV-positive women seeking health care services. The performance of health workers in regard to this screening is believed to play an important role in the early detection of cancerous cells. However, inspite of this, many women are still reporting to Uganda Cancer institute with advanced stage of cervical cancer. It is for this reason that the study seeks to study intends to study the monitoring and evaluation systems and performance of cervical cancer units in Uganda within of selected units in Wakiso district as a case study.

1.2.2 Theoretical Perspective

The study is grounded in General Systems Theory, originally formulated by Bertalanffy in 1934 and referenced in Tama (Chatterjee, 2021). This theory furnishes an analytical framework for elucidating the factors that presently influence the utilization of evaluation data. As per Lom, & Pribyl, (2021), a system presently constitutes an assemblage of interconnected or interrelated elements, shaping a complex unity: a whole presently composed of parts and sub-parts presently arranged in an orderly manner as per some scheme or plan. The following presently delineates the features of a system. A system now basically embodies a combination of parts, sub-parts, and sub-systems. Each part may presently encompass various sub-parts. A system currently entails mutually dependent parts, each of which may presently include many sub-systems. Parts and sub-parts of a system presently maintain mutual relationships with each other, with some being more direct and others more indirect. The relationship now exists in the context of the whole. Any alteration in one part can presently have an impact on other parts as well. A system currently represents an interdependent framework in which diverse parts are currently organized (Clark, 2014).

A system presently undergoes the transformation of inputs into outputs, an essential process for its ongoing survival. This transformation currently encompasses three fundamental aspects: inputs, a mediator, and outputs. Inputs are presently derived from the environment, currently transformed into outputs, and then presently returned to the environment. The various inputs can now take the form of information, finances, materials, human resources, and so on. Outputs now manifest as goods and services. The overall relationship can presently be denoted as the input-output process, and a system currently functions as a mediator in this process (Pihal, Debora, & Singh, 2022).

1.2.3 Conceptual Perspective

Monitoring and evaluation (M&E) are two essential components of assessing and improving the effectiveness and efficiency of programs, projects, policies, or initiatives in various fields, including business, healthcare, education, and development (Burke,et al., 2020).

Monitoring refers to the systematic and ongoing process of collecting, recording, and analysing data and information about a project, program, or process as it unfolds. The primary purpose of monitoring is to track progress, performance, and implementation in real-time or at regular intervals (Forti, Balde, Kuehr, & Bel, 2020).

Evaluation is a systematic and objective examination of an ongoing or completed policy, program, or project, as well as its conception, implementation, and results (World Health Organization, 2019). The objective is to give timely assessments of the intervention’s relevance, efficiency, effectiveness, impact, and sustainability, as well as overall progress toward the intervention’s original objectives. Ballard (2013) defines monitoring and evaluation as a process that uses objective evidence to assist program implementers in making educated decisions about program operations, service delivery, and program effectiveness;

Gathering relevant data and information through various methods, such as surveys, interviews, observations, or document reviews, examining collected data to assess whether activities are being carried out as planned, identifying issues or challenges, and making timely adjustments if necessary (Zall Kusek, & Rist, 2014).

Evaluation is a systematic and comprehensive process that assesses the performance, outcomes, and impact of a program, project, or policy (Ishizaka, & Resce, 2021), It involves the use of various research methods and data collection techniques to determine the extent to which objectives have been met and to understand the effectiveness and efficiency of the intervention (Aung, Fischer, & Azmi, 2021).

Evaluating the relevance, efficiency, effectiveness, impact, and sustainability of the program or project. Gathering data and evidence to assess the program’s outcomes and impact on its target audience or beneficiaries.

Human capacity for monitoring and evaluation (M&E) refers to the knowledge, skills, expertise, and capabilities of individuals or teams responsible for conducting M&E activities within an organization, project, or program (Markus, Kors, & Rijnbeek, 2021), Effective M&E is crucial for assessing the performance, impact, and outcomes of initiatives and for making informed decisions based on data and evidence (Gray et al., 2021). Human capacity in M&E encompasses various key elements, Individuals involved in M&E should have a deep understanding of M&E principles, methodologies, and best practices. This includes knowledge of data collection and analysis techniques, research methods, and relevant subject matter expertise related to the program or project being evaluated (Ravaghi et al., 2021).

Capacity in data management involves the ability to collect, store, clean, and manage data efficiently and securely. This includes knowledge of data management tools and software and Skilled evaluators are essential for designing and conducting evaluations that are rigorous, unbiased, and provide meaningful insights. This includes skills in designing evaluation frameworks, selecting appropriate research methods, and conducting data analysis (Ravaghi,  et al., 2021).

Depending on the nature of the program or project, individuals involved in M&E may require technical proficiency in specific areas, such as healthcare, education, agriculture, or economic development, to understand the nuances and context of the work being evaluated and Effective communication skills are essential for conveying M&E findings to stakeholders, including program managers, policymakers, funders, and beneficiaries. This includes the ability to present data and results in a clear and understandable manner (Clemente, 2020).

Data dissemination refers to the systematic and organized process of making data, information, or research findings available and accessible to a wide and relevant audience. It involves the distribution and communication of data in various formats, such as reports, publications, digital media, or presentations, with the goal of informing and engaging stakeholders, policymakers, researchers, and the general public (Aaltio, 2022).

Routine program monitoring is an ongoing and systematic process of collecting, analysing, and interpreting data and information related to the implementation of a program or project. The primary purpose of routine monitoring is to assess whether the program is progressing as planned and to identify any deviations or issues that may require corrective action (Boswell, & Cannon, 2022). This process helps program managers and stakeholders keep track of program activities, outputs, and outcomes to ensure that objectives are being met efficiently and effectively (McKenzie, Neiger, & Thackeray, 2022).

1.2.4 Contextual Perspective

Cervical cancer is a slow growing malignancy following infection with the human papillomavirus (HPV) in the cervical cells resulting in growth of abnormal cells. In Uganda the persistent infection with oncogenic HPV type 16 and 18 has contributed to 6959 women being diagnosed with cervical cancer every year and 4607 succumbing to the disease. The morbidity and mortality due to cervical cancer can be attributed to the high prevalence of 33.6% of human papillomavirus (HPV) among women in Uganda coupled with low screening utilization. This low utilization has resulted in the country having one of the highest cervical cancer incidence rates in the world of 47.5 per 100,000 per year (ICO Information Centre on HPV and Cancer (HPV Information Centre), 2016). Relatedly, the Uganda Cancer Institute (UCI), receives 80% of the women with cervical cancer in advanced stage disease. In order to prevent deaths due to cervical cancer in Uganda, a multidisciplinary approach must be taken to deliberately improve on the uptake of cervical cancer screening services. One of these approaches is ensuring the health workers have the required job satisfaction and motivation at the cervical cancer units so as to performance to the best of their abilities.

Health workers’ performance have since remain poor even after the health sector reforms in the early 90s. The poor performance of health workers is believed to be attributed to inadequate support supervision from both the districts and from the Ministry. Additionally, limited facilitation of medicines, equipment, working environment have all contributed to the decimal performance. Several factors such as absenteeism, inadequate skills, poor remuneration and low staffing levels have all been blamed for the poor performance. Whatever the case, the inadequate performance of individual health workers leads to poor health sector performance. It is therefore, imperative that monitoring and evaluation and performance of cervical units be examined to identify gaps that be filled to improve the cervical screening at health facilities.

1.3 Problem statement

In any organization monitoring and evaluation activities are carried out not just only for collecting data; they are about using that data to make informed decisions, improve activities, and ensure accountability and transparency in the use of resources, in the case of cervical cancer, performance of these units is imperative as it is essential in the provision of life saving treatment to the patients.

In Uganda, cervical cancer remains a significant public health concern, with high incidence and mortality rates among women, in Uganda there has been efforts to improve healthcare services by reducing the challenges that the country faces specifically in cervical cancer units by adopting monitoring and evaluation of different cervical cancer units.

Despite the growing prevalence of cervical cancer in Uganda, there is a critical gap in the effectiveness of monitoring and evaluation systems within the country’s cervical cancer units. The existing systems lack comprehensive strategies to assess the performance of these units, hindering the timely detection, treatment, and prevention efforts necessary to combat this deadly disease. As a result, there is a pressing need to evaluate and enhance the monitoring and evaluation systems associated with cervical cancer units in Uganda. This problem impedes the overall quality of healthcare services, delays vital medical interventions, and jeopardizes the lives of countless women in the country. Addressing this issue is paramount to improve the efficiency and effectiveness of cervical cancer care, ultimately reducing the morbidity and mortality rates associated with this devastating disease. It is against this Background that this study intends to investigate into examining the monitoring and evaluation systems and performance of cervical cancer units in Uganda.

1.4 General objective

To examine the monitoring and evaluation systems and performance of cervical cancer units in Uganda.

1.4.1 Specific objectives

1. To examine the relationship between Human Capacity for M&E and performance of cervical cancer units in Uganda.
2. To determine the relationship between routine program monitoring and performance of cervical cancer units in Uganda.

• To examine the influence of Data Dissemination and performance of cervical cancer units in Uganda.

1.5 Research questions

1. What is the relationship between Human Capacity for M&E and performance of cervical cancer units in Uganda?
2. What is the relationship between routine program monitoring and performance of cervical cancer units in Uganda?

• What is the influence of Data Dissemination and performance of cervical cancer units in Uganda?

1.6 Hypothesis of the study

H0₁ There is no relationship between Human Capacity for M&E and performance of cervical cancer units in Uganda.

H0₂There is no relationship between routine program monitoring and performance of cervical cancer units in Uganda?

H0₃ There is no influence of Data Dissemination on performance of cervical cancer units in Uganda?

1.7 Conceptual frame work

Monitoring and Evaluation system (IV)         Performance of cervical cancer units (DV)

In the study the key the Human capacity for M&E of monitoring and evaluation is influenced  by ; knowledge & skills, technical skill, soft skills, cognitive skills and Emotional intelligence, while ; Routine program monitoring is determined by;  Workplan and indicators indicators and Data dissemination and use is measured by Data collection, Data source, Data accuracy and Data analysis .

1.8 Scope of the study

This section includes; the geographical scope, time scope and content scope.

1. 8.1 Geographical scope

The study will be conducted in a total of 42 facilities within Wakiso district

1.8.2 Time scope

The study will be conducted between June and October 2023.This because the cervical cancer project which began in 2021 will be closing off.

1.8.3 Content scope

In regard to content, the study will specifically examine of performance of cancer units in relation to functional M&E structures, Human Capacity for M&E, Routine program monitoring and Data dissemination and Use.

1.9 Significance of the study

Reports from Uganda Cancer Institute (UCI) indicate that 80% of women who are admitted present with advanced-stage cervical cancer are also infected with HIV. As such, these patients can only benefit from palliative care until they succumb to the disease  . It is therefore importance to determine the performance of health workers in conducting effective cervical cancer screening at health facilities. Performance of health workers in regard to cervical cancer screening is critical for early detection of precancerous lesions. Early detection of precancerous lesion means appropriate treatment can be provided to curtail the development of fully blown cancer. Therefore, this study is important in determining any gaps related to cervical cancer screening by health workers. If not conducted, many women who have precancerous cells shall go undetected and thus appropriate intervention shall not be given. This then leads to the high burden of the disease and high economic not to the

1.10 Justification of the Study

This study intends to evaluate the performance of health workers on cervical cancer screening of HIV positive women at health facilities supported by Mildmay Uganda. The finding from this study is expected to inform Wakiso district, and Mildmay Uganda to provide the necessary training of health workers to address any gaps that may be identified. The findings is also expected to help policy makers to develop policies and design appropriate strategy to incorporate routine cervical cancer screening and treatment of pre-cancer lesions into primary health care services at all levels of health facilities.

CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction

The study examines the performance of Monitoring and Evaluation systems in cervical cancer units with M&E Functions, Human Capacity for M&E, Routine program monitoring and Data dissemination and use.

The dependent variable is performance of cervical cancer units in selected facilities in Wakiso district while the independent variables are the components of the monitoring and evaluation system. Performance of the cervical units shall be measured by the effectiveness, timeliness, accuracy, competence, productivity, knowledge, efficiency, responsiveness, and target management of the health workers.

This chapter presents a review of literature on the topic under investigation. The chapter presents a review of the relevant theories. It also presents empirical literature on the monitoring and evaluation systems and performance of cervical cancer units.

2.2 Theoretical Review

This study is grounded in the General Systems Theory (GST). GST, originally formulated by Bertalanffy in 1934 as cited in Tama (1987), serves as a foundational framework for examining the impact of planning on performance.

General Systems Theory (GST) is a conceptual framework that was developed to understand and describe the fundamental principles of systems, regardless of their specific type or nature. It provides a way to analyse and comprehend the complex interactions and interdependencies that exist within various systems, whether they are natural, social, or artificial (Chatterjee, 2021).

Some of the Key concepts and principles of General Systems Theory include; Holism indicating that one of the central tenets of GST is holism, which emphasizes that a system should be studied as a whole rather than as a sum of its individual parts. It recognizes that the interactions and relationships among components are essential for understanding the system’s behaviour, it further analyses Systems, a system is defined as an organized assembly of components or elements that interact with one another to achieve a common goal or function. These components can include people, processes, materials, information, or any other relevant entities (Klein, Solinger, & Duflot, 2022).

Interdependence further indicating that GST emphasizes the idea that the components within a system are interconnected and interdependent. Changes in one part of the system can have ripple effects on other parts, and these interactions can be both direct and indirect, the Hierarchy, this also further states that the Systems can often be structured hierarchically, with subsystems nested within larger systems. This hierarchical organization allows for the examination of systems at different levels, from small-scale subsystems to larger, more complex systems. Boundaries; Systems are defined by boundaries that separate them from their environment. These boundaries serve to delineate what is included within the system and what is external to it. Information and energy can flow across these boundaries, influencing the system’s behaviour (Rottleuthner,2022).

As articulated by Bertalanffy in 1968, a system is a complex unity composed of interconnected components, subcomponents, and subsystems, all organized according to a predetermined scheme or plan. The key attributes of a system include: Comprising various parts, subparts, and sub-systems, with each part potentially housing multiple subparts. Exhibiting interdependence among its constituent parts, both directly and indirectly, within the context of the whole. Allowing for the possibility that changes in one part can reverberate and affect other parts of the system (Albert, 2022).

A system serves the vital function of converting inputs into outputs, a transformation that is essential for the system’s continued existence. This transformation process involves three core elements: inputs, a mediator, and outputs. Inputs are drawn from the external environment and are subsequently converted into outputs, which are then returned to the environment. Inputs encompass a wide range of elements, including information, financial resources, materials, and human capital. Outputs may take the form of goods and services. This overall relationship constitutes the input-output process, with the system acting as a mediator in this process (Ali, 2022).

The principles of systems theory have found application across various fields, including community development. In this particular study, we focus on specific factors such as; Human capacity for M&E which Includes knowledge & skills, Routine program monitoring and dissemination of results by considering factors such as; Data dissemination and use, Data collection, Data source, Data accuracy and Data analysis (Hiver, Al-Hoorie, & Larsen-Freeman, 2022).

2.3 Conceptual Review

This section presents the literature review as reviewed by various scholars in line with the study objectives and conceptual frame work.

Monitoring and Evaluation (M&E) systems are essential components of any project, program, or organization. They help assess the effectiveness and efficiency of activities, track progress toward goals, and ensure accountability. Here’s a comprehensive overview of monitoring and evaluation systems.

Monitoring involves the systematic collection, analysis, and use of information to track the progress of a project or program and to ensure that activities are on course.

Components; Gathering feedback from beneficiaries and stakeholders, Qualitative methods for in-depth understanding, Detailed examination of specific instances within a project, For in-depth quantitative analysis. Ensure that findings from monitoring activities feed into the evaluation process, enabling real-time adjustments.

An effective monitoring and evaluation system is crucial for evidence-based decision-making, learning, and demonstrating accountability. It provides the necessary insights to improve programs, policies, and projects, ultimately leading to more impactful outcomes.

2.4 Actual Review

This section presents the the discussion of the study inline with the study objectives and conceptual frame work as discussed by various scholars.

2.4.1 Human capacity for M&E

Establishing a sufficient pool of human resources is essential for ensuring the long-term viability of the Monitoring and Evaluation (M&E) system, and this remains a continuous challenge (Tengan, Aigbavboa,  & Thwala, 2019). It’s important to acknowledge that nurturing capable evaluators demands a more extensive focus on technically oriented M&E training and growth compared to what can typically be accomplished through a few isolated workshops (McKenzie, Neiger, B& Thackeray, 2022).  The process of developing evaluators necessitates a combination of structured education and hands-on experience. Multiple avenues for training and growth are available, including engagement in the public sector, participation in the private sector, enrolment in universities, involvement with professional associations, task assignments, and mentorship programs (Nyauma, 2022).

The Monitoring and Evaluation intervention is a systematic process that involves the integration of strategies aimed at achieving sustainability within community-based conservancies Kabonga (2018). The elements of monitoring and evaluation practices geared toward sustainability encompass the following: establishing program objectives and goals, collecting data, conducting analysis, disseminating findings, and utilizing the research outcomes, as articulated by Tubey (2020). By integrating monitoring and evaluation practices into community-based conservancies, the effectiveness of the program is ensured. These interventions in monitoring and evaluation play a pivotal role in program management, as they promote the most efficient allocation of resources. Ultimately, monitoring and evaluation interventions guarantee that conservancy programs can adequately address the needs of both the present and future generations (Warinda, 2019).

Adequate human capital, when equipped with the right training and experience, plays a crucial role in generating Monitoring and Evaluation (M&E) outcomes. Ensuring an effective M&E workforce, both in terms of quantity and quality, necessitates the implementation of M&E human resource management practices to establish and retain a stable M&E team, as emphasized by the World Bank in 2011. This is because the competence of personnel poses a significant challenge when selecting M&E systems, as pointed out by Koffi-Tessio in 2002. Given that M&E is a relatively new professional domain, it encounters difficulties in delivering results effectively. Consequently, there is a substantial demand for proficient professionals, capacity enhancement for M&E systems, the alignment of training programs, and the provision of technical guidance, as underscored by (Gorgens & Kusek , 2019).

Monitoring and evaluation (M&E) of projects enhances overall project planning, management, and implementation efficiency, and as a result, a variety of projects are launched with the express purpose of improving the socio-political and economic status of residents in a specific region (Estrella, 2017). Monitoring is the project-long process of ensuring that the plan has been followed, that any deviations have been identified, and that remedial action has been performed in a timely manner (ADRA, 2017). As the project progresses, the information is gathered in an orderly and sequential manner. An ongoing or completed project, program, or policy, as well as its design, implementation, and outcomes, is evaluated in a systematic and objective manner (Rumenya, & Kisimbi, 2020), It is a systematic and objective evaluation of a current or completed policy, program, or initiative, including its conception, implementation, and outcomes. The goal is to provide timely assessments of intervention relevance, efficiency, effectiveness, impact, and sustainability, as well as overall progress toward original goals. Monitoring and evaluation, according to Ballard (2017), is a process that uses objective evidence to assist program implementers in making educated decisions about program operations, service delivery, and program effectiveness.

The UNDP (2009) handbook on planning, monitoring and evaluation for development results, emphasizes that human resource is vital for an effective monitoring and evaluation, by stating that staff working should possess the required technical expertise in the area in order to ensure high-quality monitoring and evaluation. Implementing of an effective M&E demands for the staff to undergo training as well as possess skills in research and project management, hence capacity building is critical (Nabris, 2012). In-turn numerous training manuals, handbooks and toolkits have been developed for NGO staffs working in project, in order to provide them with practical tools that will enhance result-based management by strengthening awareness in M&E (Hunter, 2009). They also give many practical examples and exercises, which are useful since they provide the staff with ways of becoming efficient, effective and have impact on the projects (Shapiro, 2011).

Competent Personnel, when monitoring and evaluation tasks are entrusted to individuals lacking proper training and experience, the consequences are likely to include prolonged timeframes, increased costs, and the production of results that may lack practicality and relevance (Obura et al., 2019), Consequently, the overall success of projects is at risk, as noted by Nabris in 2002. In the evaluation of Civil Society Organizations (CSOs) in the Pacific, the United Nations Development Programme (UNDP) in 2011 (p. 12) addresses certain obstacles in organizational development, notably highlighting the presence of insufficient monitoring and evaluation systems. Additionally, the deficiency in staff capabilities and limited opportunities for technical skill development in this domain remains a critical consideration. During the consultation processes, consensus emerged among CSOs that the absence of monitoring and evaluation mechanisms and skills represented a significant systemic gap across the region. Moreover, while CSOs may not require exceedingly intricate monitoring and evaluation systems, there is an undeniable need for them to possess fundamental knowledge of and proficiency in utilizing reporting, monitoring, and evaluation systems (Masvaure, & Fish, 2022).

The M&E system cannot function without skilled people who effectively execute the M&E tasks for which they are responsible (Clemente, 2020). Therefore, understanding the skills needed and the capacity of people involved in the M&E system (undertaking human capacity assessments) and addressing capacity gaps (through structured capacity development programs) is at the heart of the M&E system. In its framework for a functional M&E system, UNAIDS (2008) notes that, not only is it necessary to have dedicated and adequate numbers of M&E staff, it is essential for this staff to have the right skills for the work (Kaberia, & Mburugu, 2019). Moreover, M&E human capacity building requires a wide range of activities, including formal training, in-service training, mentorship, coaching and internships. Lastly, M&E capacity building should focus not only on the technical aspects of M&E, but also address skills in leadership, financial management, facilitation, supervision, advocacy and communication (Kabeyi, 2019).

A study conducted by White in (2016) concerning best practices in monitoring and evaluation within development International Non-Governmental Organizations (INGOs) highlights several challenges faced by INGOs in the implementation and management of M&E activities. One such challenge is the insufficient M&E capacity, where M&E personnel typically advise multiple projects concurrently and carry out regional or sectoral responsibilities with extensive portfolios. Moreover, taking on M&E responsibilities for numerous individual projects strains the limited M&E capacity and results in rapid burnout among M&E staff. This high burnout rate and frequent staff turnover further complicate the recruitment of skilled M&E professionals and constrain the organizational expertise available for supporting M&E development. Mibey’s study in 2011, on factors influencing the execution of monitoring and evaluation programs in the “Kazi Kwa Kijana” project recommends the inclusion of capacity building as a central component of the project throughout Kenya. This underscores the need for increased investment in training and human resource development, particularly in the critical technical field of monitoring and evaluation.

Human capacity plays a pivotal role in ensuring effective monitoring and evaluation (M&E) processes. Here are some key aspects of human capacity in M&E; Technical Expertise, Individuals involved in M&E need to possess technical knowledge and skills related to data collection, analysis, and reporting (Gathege, N. W., & Yusuf, M. (2019). This includes familiarity with relevant data collection methods, statistical tools, and data analysis software. Proficiency in various M&E methodologies and frameworks is essential for designing and implementing effective M&E systems (Kanyamuna, Kotzé, & Phiri, 2019). This includes understanding the difference between impact evaluations, process evaluations, and other evaluation types, Data Collection Skills, M&E professionals should be skilled in designing data collection instruments, conducting surveys, interviews, and focus groups, and ensuring data quality and accuracy, the ability to analyse data, identify trends, and draw meaningful conclusions is crucial. M&E practitioners should be comfortable working with data to inform decision-making (Warinda, 2019).

2.4.2 Routine program monitoring

Routine program monitoring and evaluation (M&E) play a crucial role in enhancing the performance of cervical cancer hospitals. Routine M&E is essential for cervical cancer hospitals to ensure that they are meeting their objectives effectively and efficiently (Abdi, Majdzadeh, & Ahmadnezhad, 2019). It helps in M&E enables hospitals to continually assess the quality of cervical cancer screening, diagnosis, treatment, and patient care (Adamou, Iskarpatyoti, Agala, & Mejia, 2019), Through data analysis, hospitals can identify areas where resources need to be allocated or reallocated for optimal results, M&E allows hospitals to measure the impact of their programs on reducing cervical cancer incidence and mortality rates (Ruel-Bergeron, et al., 2019).

Methodologies for Routine Program Monitoring and Evaluation, collecting data on key performance indicators such as screening rates, treatment outcomes, and patient satisfaction is crucial (Dixon et al., 2019). Statistical analysis and data visualization tools can help hospitals make sense of the collected data and identify trends and patterns, establishing feedback mechanisms with healthcare providers and patients can provide valuable insights into the hospital’s performance (Sithomola, & Auriacombe, 2019).

Frequent data collection leads to an increased number of data points, which in turn empowers managers to monitor trends and comprehend the dynamics of interventions. Consequently, the more frequently measurements are conducted, the less uncertainty there will be concerning events occurring between specific measurement intervals (Milner et al., 2019). However, when more time elapses between measurements, the likelihood of missing out on events and changes within the system increases (Gebremedhin et al., 2010). Mulandi (2013) shares this perspective, emphasizing that for information to be valuable, it should be gathered at strategic moments and with a specific frequency. Furthermore, unless mutually agreed-upon indicators are genuinely comprehended by all involved parties and everyone’s schedules are considered, identifying optimal moments for data collection and analysis becomes challenging (Waylen et al., 2019).

Enhancing project or program effectiveness: Bourckaert, Verhoest, and De Corte (2009) note that identifying indicators for evaluating program performance can be challenging unless the results from monitoring and evaluation are delivered promptly. Thus, it is crucial to establish a well-defined system of indicators for timely measurement and monitoring of program performance. Supporting this notion, a study conducted by Cunnen (2006) underscores the need for a timely system of over two thousand societal indicators to measure outcomes for Canadians across various sectors.

Pertinent Information, In a study report from an Australian NGO conducted by Spooner and Dermott (2018), staff members expressed uncertainty about the effectiveness of the current monitoring and evaluation system as the organization, known as WAYS, evolved over time. Furthermore, there was a lack of dedicated resources for data analysis, resulting in infrequent data analysis (Cherian et al., 2020), A notable issue with data analysis was that program managers, who were responsible for it, had limited time to analyse data that was not mandated by funding agencies. Some staff members mentioned that they were tasked with data collection and analysis but faced challenges due to their limited research skills (Sithomola, & Auriacombe, 2019). Lastly, certain staff members highlighted the absence of a feedback mechanism within the existing system. While they reported their activities to management, they remained unaware of what happened to the information after reporting (Kissi, et al., 2019).

In the context of African countries and potentially other regions, a common problem is the collection of various performance data by sector ministries, often characterized by poor data quality (Boehmer, & Zaytsev, 2019), This problem stems from the fact that the responsibility for data collection primarily rests on overburdened officials at the facility level. These officials are tasked with providing data to officials at district offices and the capital but seldom receive feedback on whether or how the data are actually utilized (Lavoie et al., 2023). This dilemma contributes to another issue, data quality suffers because the data are underutilized, and conversely, they are underutilized because their quality is subpar. Consequently, in such countries, there is an abundance of data but a scarcity of meaningful information (Mackay, 2006).

Well-articulated; In a study examining Results-Based Management (RBM) in Northern Ghana, Obure (2008) highlights an issue concerning the post-collection management of data. Field officers often confessed to ineffective handling of data storage, processing, and interpretation. The study’s findings strongly underscore a systemic weakness stemming from stakeholders’ inability to manage and process data in a meaningful manner. The challenge could potentially result in the mere accumulation of large volumes of data that may ultimately prove unhelpful. It is imperative to collect and regularly analyse data concerning objectives and intermediate outcomes (Binnendijk, 2019).

Furthermore, the Performance Monitoring, Evaluation, and Reporting (PME&R) system offers three tiers of information, encompassing project, activity, and organizational levels (Leiter, 2021). Data from all organizations involved in a specific activity can be aggregated to the activity level, and data from all activities can be aggregated to the project level (Booth, Ebrahim, & Morin, 2008).

In a study investigating the factors influencing the utilization of Monitoring and Evaluation (M&E) results in malaria control projects in Uganda, Gamba (2016) identified that evaluation quality and effective communication of M&E results had a notably positive impact on utilization. Additionally, the timeliness of M&E activities had a moderately positive effect on the utilization of M&E findings across various organizations during the implementation of the Malaria Control Program (MCP) activities.

A study conducted by Barton (2007) suggests that when designing an M&E system, the primary objective is to gather indicator data from a variety of sources, including the target population, to monitor the progress of a project (Bennett, , Schuhbauer, Skerritt, & Ebrahim, 2021), The methods employed for data collection within the M&E system encompass various approaches, such as engaging in discussions or conversations with relevant individuals, conducting community or group interviews, undertaking field visits, reviewing records, conducting key informant interviews, participating in observations, facilitating focus group interviews, directly observing activities, administering questionnaires, conducting one-time surveys, implementing panel surveys, carrying out censuses, and conducting field experiments (Chen et al., 2019).

Kusek and Rist (2014), on the other hand, argue that the development of key indicators to monitor outcomes provides managers with the means to evaluate the extent to which the intended or promised outcomes are being realized. Consequently, collecting data at regular intervals results in more data points, allowing managers to utilize them effectively for tracking trends and comprehending the dynamics of interventions (Collyer et al., 2020), This, in turn, reduces the need for guesswork concerning events occurring between specific measurement intervals (Cherian et al., 2020).

Ability to have a dedicated team ready to learn; In this context, learning is defined as formulating responses to identified constraints and implementing them in real time. Useful at project/plan level are knowledge-sharing and learning instruments which can pick up information and analysis from the M&E systems as studies (Kanyamuna, Mubita, & Kotzé, 2020),  such as;  summarized studies and publications on lessons learned, case studies documenting successes and failures, publicity material including newsletters, radio and television programmes,  formation of national and regional learning networks,  periodic meetings and workshops to share knowledge and lessons learned, research-extension liaison or feedback meetings, national and regional study tours, preparation and distribution of technical literature on improved practices; and routine supervision missions, mid-term reviews or evaluations and project completion (end-of-project) reports (Orubu, Zaman, Rahman, & Wirtz, 2020).

Assefa, (2021) overwhelmingly support the assertion that indicators measured are just as important as the timing of M&E. This means that it is imperative to get the measurement correct, but also be done in such a way that when the said information is needed, it is readily available for its utilization. Kusek and colleagues note that the practice of using inappropriate baselines defeats the whole concept of “data quality triangle”, which encompasses elements of data reliability, data validity and data timeliness, for its usability (Uwizeyimana, 2020).

Methodologically sound, as per Cornielje, Velema, and Finkenflugel (2008), it is only when the users take ownership of the monitoring system that it becomes likely to produce valid and dependable information. However, it is all too common that these very users may find themselves overwhelmed by their daily workload, which they often perceive as more significant than data collection (Karimi, Mulwa, & Kyalo, 2021),  Consequently, the system may deteriorate or lose its integrity. Their conclusion stresses the utmost importance of involving frontline workers in both monitoring and evaluation while keeping them informed about the status of the services and activities they primarily deliver, in collaboration with other stakeholders and beneficiaries (Kibukho, 2021).

Empirical evidence suggests that the quality of evaluations significantly influences the utilization of evaluation findings. According to an IFAD (2008:26) annual report on results and impact, recurrent criticisms directed at M&E systems include limitations in scope, complexity, poor data quality, insufficient resources, weak institutional capacity, and a lack of baseline surveys, resulting in limited utilization. Additionally, the most common critique of M&E systems in IFAD projects pertains to the nature of information included in these systems. While most IFAD projects gather and process data on project activities, the average IFAD project fails to provide information regarding the achievements at the purpose or impact level. For example, the M&E system of the Tafilalet and Dades Rural Development project in Morocco exclusively focused on financial operations and lacked the capacity for impact assessment. In the Pakistan IFAD Country Program Evaluation, cases were reported where contradictory logical frameworks were combined with arbitrary and irrelevant indicators, while in Belize, two different logical frameworks were created, resulting in increased confusion and complexity. The Ethiopia IFAD Country Program Evaluation highlighted that project appraisal documents inadequately accounted for systematic baseline surveys and subsequent beneficiary surveys. In one Ethiopian project, for instance, the baseline survey was conducted 2-3 years after the project’s initiation.

A study by Guijt, (1999) also finds that useful information needs to be collected at optimal moments and with a certain frequency, if it is to be of quality. Moreover, unless negotiated indicators are genuinely understood by all involved, and everyone’s timetable is consulted, optimal moments for collection and analysis will be difficult to identify. On the other hand, Cornielje, Velema and Finkenflugel (2008) report that it is only when the monitoring system is owned by the users that it can generate quality data that is valid and reliable for utilization in future projects. The author however notes that all too often, the very same users may be overwhelmed by the amount of daily work, which, in their view, is seen as more important than collecting data; and that subsequently, the system may become corrupted and thus not usable in subsequent implementations.

2.4.4 Data Dissemination

Data dissemination in monitoring and evaluation (M&E) is a crucial step in the M&E process that involves sharing information and findings with relevant stakeholders to inform decision-making, improve program effectiveness, and enhance transparency and accountability. Effective data dissemination ensures that the insights and lessons learned from M&E activities are put to practical use (Gu et al., 2023). Here are some key considerations and steps for data dissemination in monitoring and evaluation; Identify the key stakeholders who will benefit from the M&E data and findings (Chambers, 2023). These may include program managers, funders, policymakers, project beneficiaries, and other relevant parties. Develop a Dissemination Plan; Create a comprehensive plan that outlines the objectives, methods, and timelines for data dissemination. Consider how different audiences prefer to receive information (e.g., reports, presentations, dashboards, or infographics). Present data in a clear and accessible manner (Geng, Yang, Wang, Zhou, & Geng, 2023). Use charts, graphs, tables, and other visualization tools to make complex information easier to understand. Customize the message and format for each target audience. Stakeholders may have varying levels of technical expertise, so adapt your communication to their needs and interests (Liu, Tian, & Zhu, 2023).

Employ a variety of communication channels, including meetings, workshops, reports, websites, newsletters, and social media, to reach different stakeholders effectively. Encourage active engagement and discussion when presenting findings. Answer questions, seek feedback, and promote a two-way dialogue to ensure that stakeholders understand and can use the information (Paul, & Das, 2023).

Despite the global efforts, monitoring and evaluation data continues to be affected by a lack of standards, insufficient guidelines, and support services hindering its adoption in low developing countries (Fuhr, 2019). Monitoring and evaluation Data management has been given lukewarm attention in low developing countries and as a consequence, it remains in formative years, fragmented, and lacking (Patterton, 2016; Patterton, et al., 2018) . This may be attributed to continued research data loss, mishandling, misuse, and inaccessibility when needed (Chawinga and Zinn, 2020a) . Studies carried out in the Republic of South Africa, Kenya, Tanzania, Malawi, and Zimbabwe revealed several challenges obstructing RDM practices (Chawinga, 2019; Chiparausha and Chigwada, 2019; Mushi, et al., 2020; Ng' Eno, 2018 ). The challenges identified included: lack of legal/policy frameworks and standards to guide the research life cycle processes, absence of technological infrastructure and related services, a diverse range of types of data, and low-quality data associated with inconsistencies in collection methods (Fuhr, 2019 ; Antell, et al., 2014) .

Other challenges noted were: limited funding, lack of training and leadership as well as the absence of funders’ proactive role to manage research data better (Ashiq, et al., 2020 ; Carter,  2020) . Though there is plenty of literature in the developed nations about RDM, supportive literature in low developing nations is scarce and only emerging due to participation in international research collaborations (Mohammed and Ibrahim, 2019; Mushi, et al., 2020; Tripathi, et al., 2017).

The credibility of reported results relies significantly on the quality of evaluations, underscoring the importance of incorporating data from diverse sources to validate discoveries. Additionally, primary data, which the M&E system collects directly for its monitoring and evaluation purposes, differs from secondary data, gathered by other organizations for purposes unrelated to M&E (Gebremedhin, Getachew & Amha, 2010:24). In the M&E system’s design, the goal is to gather indicator data from various origins, including the target population, to monitor project progress (Barton, 1997). Methods for data collection within the M&E system encompass various approaches, such as engaging in discussions or conversations with relevant individuals, conducting community or group interviews, undertaking field visits, reviewing records, conducting key informant interviews, participating in observations, facilitating focus group interviews, directly observing activities, administering questionnaires, conducting one-time surveys, implementing panel surveys, conducting censuses, and carrying out field experiments. Furthermore, the development of key indicators for monitoring outcomes empowers managers to assess the extent to which intended or promised results are being realized.

Gebremedhin, Getachew, and Amha (2010) emphasize the critical role of the data source in establishing the credibility of reported performance results and their potential utilization in future program implementations. The author underscores the significance of incorporating data from diverse origins to validate the outcomes. The Result-Based Management (RBM) approach, encompassing planning, monitoring, and evaluation processes, is designed to facilitate decision-making in pursuit of specific objectives. Planning aids in concentrating efforts on meaningful results, while monitoring and evaluation promote learning from past achievements and challenges encountered during implementation. Key components of an M&E system, developed in collaboration with relevant stakeholders, serve to encourage participation and enhance ownership of a project or plan (Impouma et al., 2021).

Result Frameworks or Logframes (RF), These tools organize intended results, defining measurable developmental changes. RFs inform the development of the M&E plan and must align with it. The M&E plan, in turn, outlines the functions required to collect pertinent data, the associated methods, and tools. It systematically coordinates data collection, designating the roles and responsibilities of project/plan stakeholders. This ensures the regular collection, processing, and analysis of relevant progress and performance data, enabling evidence-based decision-making (Andriani, & Mbato, 2021).

Monitoring Processes and Methods: These encompass various techniques such as regular input and output data gathering and review, participatory monitoring, and process monitoring, Evaluation methods include impact evaluation, thematic assessments, surveys, and economic analyses of efficiency. Management Information System: This serves as an organized repository of data, aiding in the management of crucial numeric information related to the project/plan and facilitating analysis (Cheney et al., 2023).

The credibility of reported results relies significantly on the quality of evaluations, underscoring the importance of incorporating data from diverse sources to validate discoveries. Additionally, primary data, which the M&E system collects directly for its monitoring and evaluation purposes, differs from secondary data, gathered by other organizations for purposes unrelated to M&E (Gebremedhin, Getachew & Amha, 2010:24). In the M&E system’s design, the goal is to gather indicator data from various origins, including the target population, to monitor project progress (Barton, 1997). Methods for data collection within the M&E system encompass various approaches, such as engaging in discussions or conversations with relevant individuals, conducting community or group interviews, undertaking field visits, reviewing records, conducting key informant interviews, participating in observations, facilitating focus group interviews, directly observing activities, administering questionnaires, conducting one-time surveys, implementing panel surveys, conducting censuses, and carrying out field experiments. Furthermore, the development of key indicators for monitoring outcomes empowers managers to assess the extent to which intended or promised results are being realized (Kusek & Rist, 2004).

Furthermore, while primary data are collected directly by the M&E system for M&E purposes, secondary data are those collected by other organizations for purposes different from M&E. However, a study by Booth, Ebrahim  and  Morin,  (2008)  reports  that  the  Monitoring  and Evaluation system allows for three levels of information by project, activity and organization, where the data for all organizations involved in a specific activity (Waaswa, Nkurumwa, & Kibe, 2021). These can be averaged up to the activity level, and the data for all activities can be averaged up to the project level, easing utilization (Bhatt et al., 2021).

M&E systems will only add value to project implementation through interpretation and analysis, by drawing on information from other sources and adapting it for use by project decision makers and a range of key partners (Fan et al., 2021). Knowledge generated by the M&E efforts should never stop at basic capturing of information or relying exclusively on quantitative indicators, but also to address the “why” questions. Here the importance of more qualitative and participatory approaches become particularly important, to analyse relationship between project activities and results (Meenaakshi Sundhari, et al., 2021).  Evaluation therefore serves the purpose to establish attribution and causality, and forms a basis for accountability and learning by staff, management and clients (Gupta, Bouadjenek, & Robles-Kelly, 2023).

2.5 Empirical review

2.5.1 Human capacity for M&E

Empirical Literature on Human Capacity in Monitoring and Evaluation (M&E) ,  Importance of Technical Expertise in M&E:The effectiveness of M&E processes relies heavily on the technical expertise of individuals involved. This includes proficiency in data collection methods, statistical tools, and data analysis software (Gathege, N. W., & Yusuf, M., 2019).

Data Collection Skills and Quality Assurance; M&E professionals need strong skills in designing data collection instruments, conducting surveys, interviews, and focus groups. Ensuring data quality and accuracy is paramount to the credibility of M&E outcomes (Kanyamuna, Kotzé, & Phiri, 2019).

Data Analysis and Interpretation; Competence in data analysis is crucial. M&E practitioners must be capable of analyzing data, identifying trends, and drawing meaningful conclusions. This analytical ability is vital for utilizing data effectively in decision-making processes (Warinda, 2019).

Combination of Education and Experience; Developing skilled evaluators requires a combination of structured education and hands-on experience. Training avenues include public and private sector engagement, university programs, professional associations, task assignments, and mentorship programs (Nyauma, 2022).

Addressing Capacity Gaps; M&E capacity building should encompass various activities such as formal training, in-service training, mentorship, coaching, and internships. These activities should not only focus on technical aspects but also address skills in leadership, financial management, facilitation, supervision, advocacy, and communication (Kabeyi, 2019).

Challenges and Solutions in M&E Capacity; Insufficient M&E Capacity in INGOs; INGOs often face challenges due to insufficient M&E capacity. Overburdened M&E staff handling multiple projects can lead to burnout and staff turnover. Investment in training and human resource development is crucial, especially in the technical field of M&E (White, 2016).

Need for Fundamental Knowledge in CSOs; Civil Society Organizations (CSOs) require fundamental knowledge and proficiency in reporting, monitoring, and evaluation systems. Lack of monitoring and evaluation mechanisms and skills poses a significant gap in organizational development (Masvaure, & Fish, 2022).

Role of Training Manuals and Toolkits; Capacity Building through Manuals:

Manuals, handbooks, and toolkits have been developed to provide practical tools to NGO staff. These resources enhance result-based management by strengthening awareness in M&E. Practical examples and exercises are crucial for staff efficiency and effectiveness (Hunter, 2009; Shapiro, 2011).

The empirical literature underscores the critical importance of human capacity in ensuring effective M&E processes. This capacity encompasses technical expertise, data collection skills, analysis capabilities, and a combination of education and practical experience. Addressing capacity gaps, especially in organizations such as INGOs and CSOs, requires targeted training programs and resources. The availability of comprehensive training materials and the integration of fundamental M&E knowledge into organizational practices are essential for building a proficient M&E workforce.

Routine program monitoring

The empirical literature on routine program monitoring and evaluation (M&E) in the context of cervical cancer hospitals reveals several key themes and challenges. This body of research emphasizes the critical role of timely and accurate data collection, proper analysis, and effective utilization of the gathered information. Several studies highlight the following aspects:

Importance of Routine Program Monitoring and Evaluation; Enhancing Program Effectiveness; Routine M&E is essential for assessing the quality of cervical cancer screening, diagnosis, treatment, and patient care. Proper data analysis allows for the identification of areas needing resource allocation or reallocation. Monitoring the impact of programs aids in reducing cervical cancer incidence and mortality rates.

Challenges in Data Collection and Analysis; Limited resources and skills hinder effective data analysis. Absence of a feedback mechanism results in a lack of understanding about the fate of reported data, Overburdened officials in certain regions lead to poor data quality and underutilization.

Data Quality and Utilization; Importance of appropriate baseline data for meaningful analysis. Involvement of frontline workers in monitoring and evaluation is crucial for data validity and reliability.

Learning and Adaptability; Importance of a dedicated team for real-time learning and adaptation based on M&E results. Knowledge-sharing mechanisms, such as case studies and workshops, aid in disseminating lessons learned.

Methodologies and Indicators; Various methodologies for data collection, including interviews, surveys, and field visits. Development of key indicators to monitor outcomes facilitates effective program evaluation. Negotiated and mutually understood indicators are vital for meaningful data collection and analysis.

Standardization and Coordination; Standardization of data collection methods and indicators across different regions. Coordination between various levels of healthcare administration to ensure seamless data flow and utilization.

Routine program monitoring and evaluation are vital components of improving cervical cancer hospitals’ performance. Addressing challenges related to resource allocation, feedback mechanisms, and capacity building is crucial for ensuring the effectiveness of M&E systems. Standardization and coordination across different levels of healthcare administration can further enhance the quality and utilization of collected data.

Data Dissemination

The empirical literature provided presents a comprehensive overview of the challenges and considerations in data dissemination within the context of monitoring and evaluation (M&E) processes.

Importance of Data Dissemination in M&E; Informing Decision-Making and Transparency; Data dissemination is crucial for informing decision-making processes, enhancing program effectiveness, and ensuring transparency and accountability (Gu et al., 2023).

Identifying Key Stakeholders; It is essential to identify stakeholders such as program managers, funders, policymakers, and project beneficiaries who would benefit from M&E data (Chambers, 2023).

Effective Dissemination Strategies; Developing a dissemination plan is essential. This plan should consider the preferences of different audiences in terms of information format (reports, presentations, etc.) and employ clear and accessible visualization tools (Geng, Yang, Wang, Zhou, & Geng, 2023).

Customized Communication; Messages and formats should be customized for different stakeholders based on their technical expertise and interests (Liu, Tian, & Zhu, 2023).

Engaging Stakeholders; Various communication channels, such as meetings, workshops, reports, websites, newsletters, and social media, should be utilized to engage stakeholders effectively (Paul & Das, 2023).

Challenges in Data Management and Dissemination; Lack of Standards and Support; Low developing countries face challenges due to the absence of legal frameworks, technological infrastructure, funding, and training, hindering effective data management and dissemination (Fuhr, 2019; Antell et al., 2014; Ashiq et al., 2020).

Diversity of Data and Quality Issues; Challenges include handling diverse types of data and ensuring data quality through consistent collection methods (Fuhr, 2019; Chawinga & Zinn, 2020a).

Limited Supportive Literature; Supportive literature in low developing nations is limited, with emerging research due to international collaborations (Mohammed & Ibrahim, 2019; Tripathi et al., 2017).

Data Collection Methods in M&E; Diverse Data Sources: The credibility of reported results depends on the quality of evaluations, emphasizing the incorporation of data from various sources to validate findings (Gebremedhin, Getachew & Amha, 2010).

Primary and Secondary Data; Primary data collected directly by M&E systems differ from secondary data collected by other organizations. M&E systems should integrate information at different levels to enhance utilization (Booth, Ebrahim, & Morin, 2008; Waaswa, Nkurumwa, & Kibe, 2021).

Qualitative and Participatory Approaches; Qualitative and participatory approaches are vital to understanding the relationship between project activities and results, addressing the “why” questions, and establishing attribution and causality (Meenaakshi Sundhari et al., 2021; Gupta, Bouadjenek, & Robles-Kelly, 2023).

In conclusion, effective data dissemination in M&E requires careful planning, customization, engagement of diverse stakeholders, and the incorporation of various data sources. Addressing challenges, especially in low developing countries, necessitates the development of supportive frameworks, technology infrastructure, and funding, along with a focus on qualitative and participatory methods to enhance the credibility and usability of M&E data.

2.6 Synthesis of the literature review.

Monitoring and Evaluation (M&E) in development projects is a multifaceted process crucial for ensuring project effectiveness, accountability, and sustainability. The literature presents a comprehensive view of the challenges, methodologies, and importance of M&E systems. Here is a synthesized overview of key themes and insights from the literature:

Human Capacity for M&E:

Developing a competent M&E workforce is essential for effective M&E systems. Training and experience are fundamental, and a combination of structured education and hands-on practice is necessary.

Various avenues such as public sector engagement, private sector participation, university programs, professional associations, task assignments, and mentorship programs contribute to building capable evaluators.

Adequate human capital, equipped with proper training, is vital for generating meaningful M&E outcomes. Challenges include selecting suitable M&E systems due to staff competence issues.

Civil Society Organizations (CSOs) often lack monitoring and evaluation mechanisms. Fundamental knowledge and proficiency in utilizing reporting, monitoring, and evaluation systems are crucial for CSOs.

Routine Program Monitoring:

Routine M&E is indispensable in enhancing the performance of projects, such as in cervical cancer hospitals. It involves continuous data collection, analysis, and feedback mechanisms to ensure program quality and effectiveness.

Frequent data collection enables timely identification of trends and dynamic intervention planning. However, challenges exist in balancing the frequency of data collection with its quality and usability.

Data Dissemination:

Effective data dissemination is vital for informing decision-making and improving program effectiveness. Tailoring the message and format for various stakeholders is essential.

Challenges in data dissemination include lack of standards, insufficient guidelines, and support services in low-developing countries. Legal frameworks, technological infrastructure, and training are vital components for successful data dissemination.

Data Sources and Credibility:

The credibility of reported results depends on the quality of evaluations. Incorporating data from diverse sources, both primary and secondary, validates outcomes and strengthens M&E findings.

Properly designed Result Frameworks (RF) and Logframes are essential for organizing intended results and guiding the M&E process. Monitoring processes and methods, along with robust Management Information Systems (MIS), facilitate effective data collection, processing, and analysis.

Challenges in M&E include staff burnout, limited resources, inadequate training, and issues in data analysis. Addressing these challenges requires increased investment in training, better human resource management, and proactive funders’ role in managing research data.

Utilizing qualitative and participatory approaches alongside quantitative data analysis is crucial. Evaluation serves to establish causality, attribution, and accountability, forming the basis for organizational learning and project improvement.

Conclusion

Monitoring and Evaluation, when conducted with skilled human resources, robust methodologies, and proper dissemination strategies, significantly enhance the effectiveness and impact of development projects. Addressing challenges and investing in capacity building are fundamental steps toward creating meaningful and sustainable M&E systems. Ongoing research and international collaboration are necessary to refine existing frameworks and overcome emerging challenges in the field of M&E.

CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter will present the methodology that will be adopted during the study. It will describe and discuss the research design, sample size and selection, the data collection methods to be used and their corresponding data collection instruments, data management and analysis procedures, as well as the steps that will be taken to ensure validity and reliability during the study and the measurement of variables.

3.2 Research Design

The study will adopt a cross-sectional design. Explanatory research assists researchers in analyzing patterns and formulating hypotheses that can guide future endeavors. Exploratory research serves as an excellent initial step for researchers aiming to gain a deeper understanding of the relationships between variables (Bloomfield, & Fisher,2019). Since the study aims to examine the relationship between variables, it employs a simple bivariate correlation design to determine the relationship between Routine program monitoring, Human capacity for M&E, Data dissemination and use and performance.  The study used both qualitative and quantitative approaches. The quantitative approach Will be adopted because the study intends to examine the factors affecting the of M&E findings. Such an endeavor can best be achieved when a quantitative approach is used because it allows for collecting numeric data on observable individual behavior of samples, then subjecting these data to statistical analysis (Camic, 2021).  A qualitative approach will also be adopted to enable the researcher capture data that is left out by the quantitative approach. This will be aimed at capturing more in-depth information on the topic under investigation.

3.3 Study Population

Sekaran (2018) defines a population as the entire group of people, events or things that a researcher wishes to investigate. The study will use total population of 877 , since this is the total population of Health workers in wakiso district, (2022)

Table 1: Population of the study

 Source: Wakiso, (2020)

3.4 Study Sample

Mugenda and Mugenda (2003), argue that it is impossible to study the whole targeted population and therefore the researcher shall take a sample of the population. A sample is a subset of the population that comprises members selected from the population. Using Krejcie and Morgan’s (1970) table for sample size determination approach, a sample size of 52 Health workers will be selected from the total population of 58 Health workers in wakiso district.

Table 2: Sample Size  determination

Source: Chief Administrative Office, wakiso District (2023)

3.5 Sampling Techniques and Procedure

A number of sampling techniques are being used to select respondents for the study, namely simple random and purposive sampling techniques. The lower-level staff are selected using the simple random sampling technique. This method is chosen because it ensures the generalizability of findings and minimizes bias, as suggested by Sekaran (2003). On the other hand, the health facility Incharges are selected using the purposive sampling technique. These key informants are purposively sampled because they are believed to possess technical and specialized knowledge about the topic under investigation by virtue of the offices they hold.

3.6 Data collection Methods

The section presents data collection methods that include the survey method, interviews, and documentary review. These data collection methods are chosen because of their numerous advantages.

3.6.1 Survey

The study uses the questionnaire method to collect data. The questionnaire is chosen because it enables the collection of data from a large group of respondents in a short period, as suggested by Mugenda and Mugenda (1999: 107). Additionally, the questionnaire is being used because it permits busy respondents to fill it out at their convenience. It also provides a platform for respondents to express their views and opinions without fear of being victimized, as noted by Oso and Onen (2008: 18).

3.6.2 Interview

The study employs the interview method. Interviews in this study help the researcher obtain more information on the topic under investigation. Interviews are used because they fetch a variety of ideas needed for the study and provide a deeper understanding of the topic. This method is also used because it offers the researcher an opportunity to adapt questions, clarify the questions using appropriate language, clear doubts, establish rapport, and probe for more information, In face-to-face interviews, researchers can observe participants’ body language, facial expressions, and tone of voice, which can provide valuable context to their responses and also Interviews can provide insights into the context in which certain behaviors or opinions occur, offering a more holistic view of the participant’s world (Zina, 2021).

3.6.3 Document Review

The researcher reviews documents to obtain recorded information related to the issue under investigation. This method is employed because it allows the researcher to access data at their convenience, acquire thoughtful data that informants have given careful attention to, and obtain data in the language of the respondent, as recommended by Oso and Onen (2008), this is because , A documentary review allows researchers to synthesize existing knowledge and identify key concepts, theories, and findings related to the research topic. It provides a comprehensive overview of the existing literature in the field (Winata, Fadelina, R., & Basuki, S. (2021).

3.7 Data Collection Instruments

The instruments used in this study are a questionnaire, an interview guide, and a document review checklist.

3.7.1 Self-Administered Questionnaire

The study will employ a questionnaire as a tool of data collection. The questionnaire for health workers  have 5 sections. Section A dealt with the demographic characteristics of the respondents, section B will focus on Routine program monitoring, Section C Human capacity for M&E, Section D  Data dissemination and use and section E performance

The questionnaires are closed-ended. Closed-ended questions are developed to help respondents make quick decisions. Additionally, closed-ended questions assist the researcher in easily coding the information for subsequent analysis and narrowing down the error gap during data analysis, as observed by Sekaran (2003).

3.7.2 Interview Guide

An unstructured interview is used as a tool for collecting in-depth information from the key informants. The guide contains a list of topical issues and questions that are explored during the interviews. The guide is drawn with questions that solicit the perception of the key informants regarding the topic. The interview guide is employed because it obtains in-depth data that may not be possible to obtain when using self-administered questionnaires, as noted by (Huntington-Klein, 2021).

Interviews offer a wealth of benefits in qualitative research, providing researchers with a deep understanding of participants’ viewpoints and experiences. When conducted effectively, interviews can yield valuable insights that might be challenging to obtain through other research methods (Winata,  Fadelina, & Basuki, 2021).

3.7.3 Documentary Review Checklist

A document review checklist is being used to collect more in-depth data on the topic under investigation. This also allows the researcher to supplement the data acquired from the interviews and questionnaires. The researcher is currently analysing the documents and publications related to the study topic. Documents expected to be reviewed include Ministry of Health reports, journals, and newspapers.

3.8 Validity and Reliability of the Research Instruments

3.8.1 Validity

Validity is defined as the extent to which results can be accurately interpreted and generalized to other populations (Oso & Onen, 2008). Borg & Gall (1989), as cited in Onyinkwa (2013), defines validity as the degree to which results obtained by the research instrument correctly represent the phenomenon under study. Mugenda & Mugenda (1999) define it as the accuracy and meaningfulness of inferences based on the research results. Amin (2005) recommends a minimum CVI of 0.7 to be used. Validity is being tested using content validity index, which involves judges scoring the relevancy of the questions in the instruments in relation to the study variables.

The formula for Content Validity Index is;

CVI =

Where CVI = content validity

n= number of items indicated relevant.

N = total no. of items in the instrument

In this study, validity will be achieved by establishing content validity. The researcher will achieve content validity by using the experts to assess the validity of the research instrument. The experts especially research supervisors and consultants from UTAMU will be given data collection tools to assess whether the items in the instruments are valid in relation to research topic, objectives, and questions. From the instruments they will declare some items valid and others invalid. Those declared invalid will be dropped, others adjusted, while the valid ones will be maintained.  Then content validity index (CVI) will be computed by dividing the number of items declared valid by total number of items/questions in the data collection instrument.

3.8.2 Reliability

According to Mugenda and Mugenda (2003), reliability measures the extent to which research instruments provide consistent results when tested repeatedly. Cronbach’s coefficient alpha (α), as recommended by Amin (2005, p. 302), is currently being used to assess the reliability of the research instrument. The instrument is considered reliable if a reliability coefficient of 0.7 or higher is obtained, and therefore, it is adopted for use in data collection

Formula for reliability is

=      ()

Where  = alpha reliability co efficiency.

K=Number of items included in the questionnaire

= sum of variance of individual items

= variance of all items in the instrument.

To ensure credibility and trust worthiness of qualitative data the researcher will ensure that only the officials who are health workers of wakiso District local government will be interviewed.

The coefficient ranges between a=0.00 for no reliability, a =1.00 for perfect reliability. The closer alpha gets to 1.0 the better. If the study findings result to Cronbanch’s Alpha of 0.7 and above, this will signify that research instrument is good enough for the study. According to Amin (2005), all the measurements in the instrument that show adequate levels of internal consistency of cronbach’s alpha of 0.77 and above are accepted as reliable.

3.9 Data Collection Procedure

The researcher will obtain a letter of introduction from UTAMU which will be presented to the Health workers in the organization.

The researcher will randomly select respondents to participate in the study, a self-administered questionnaire will be used to collect information from the above-mentioned respondents. The researcher also will purposively select senior and middle level managers who will be interviewed.

3.10 Data Analysis

3.10.1 Analysis of quantitative Data

Descriptive statistics namely frequency counts, percentages will be used to analyse the respondents’ demographic characteristics and the mean and standard deviation will be used to analyse the respondents’ opinions on the topic under study. Data will be analysed and correlated using Pearson Product-Moment correlation coefficient to establish the relationship between Routine program monitoring, Human capacity for M&E and Data dissemination and use

Sekaran (2003), Amin (2005) and Oso and Onen (2008). Regression analysis will be used in determining the strength of the relationship between the variables, this will be possible by determining the value of R-squared value the higher the R-squared value the stronger the relationship. For this study, the three dimensions of Routine program monitoring, Human capacity for M&E, Data dissemination and use and regressed performance of cervical cancer hospitals findings within the health facilities. This will be aimed at determining the effect of each of these factors on the topic study.

The statistical package which will be used for analysis of data in this study is the SPSS version 16.0. Different statistical techniques will be used namely: correlation and regression analysis. The upper level of statistical significance for hypothesis testing will be at 5%. All statistical test results will be computed at 2-tailed level of significance.

3.10.2 Analysis of qualitative data

Qualitative data will be analysed using content analysis. Responses from key informants will be grouped into recurrent issues. The recurrent issues which will emerge in relation to each guiding questions will be presented in the results, with selected direct quotations from participants offered as illustrations.

3.11 Measurement of variables

Data on the respondent’s views and opinions about the monitoring and evaluation systems and performance of cervical cancer units in Uganda will be obtained using scaled variables from a self-developed questionnaire.

A five point Likert ordinal scales ranging from; strongly agree which shall be assigned 5, strongly Agree, 4 agree, Not Sure assigned 3, Disagree allocated 2 and strongly disagree allotted 1 to obtain responses on the variables. The Likert ordinal scale has been used by numerous scholars who have conducted similar studies such as Bowling, (1997). The structured questions will be measured using the key dimension in the conceptual frame work.

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APPENDICES

Questionnaire

Dear respondent

This is a research leading to the award of Masters in Monitoring and Evaluationof Uganda Technology and Management University.The study topic is Monitoring and Evaluation systems and Performance of cervical cancer units in selected facilities within Wakiso district.The purpose of the study is to gaps  in the performance of cervical cancer units in  relation to Monitoring and Evaluation systems.

The information provided will be treated with atmost confidentiality and under no circumstances will be personalized.

Thank you for cooperation.

Researcher

Winfred Ibanda.

Section A   Questionaire

Social Demorgraphic characterisitics (Please tick as appropriate)

1.Age in years

2.Gender:

3.Level of Education:

4.Department

5.Designation

6.How many years have you worked with this health facility?

Section B: Human Capacity for M&E.  Here you are requested to indicate the level at which you agree with the statement by circling a number on a scale of 1-5. The keys have been displayed below where; SA=Strongly Agree,  A=Agree,  NS=Not Sure,   D=Disagree,   SD=Strongly Disagree

Section C: Routine program monitoring: Here you are requested to indicate the level at which you agree with the statement by circling a number on a scale of 1-5. The keys have been displayed below where; SA=Strongly Agree,  A=Agree,  NS=Not Sure,   D=Disagree,   SD=Strongly Disagree

Section D: Data Dissemination. Here you are requested to indicate the level at which you agree with the statement by circling a number on a scale of 1-5. The keys have been displayed below where; SA=Strongly Agree,  A=Agree,  NS=Not Sure,   D=Disagree,   SD=Strongly Disagree

Section E: Performance of cervical cancer units.  Here you are requested to indicate the level at which you agree with the statement by circling a number on a scale of 1-5. The keys have been displayed below where; SA=Strongly Agree,  A=Agree,  NS=Not Sure,   D=Disagree,   SD=Strongly Disagree

Interview guide

Wakiso district employs well-educated personnel.

The staff have required knowledge to execute their tasks.

Staff are placed in departments for which they qualify.

The staff employed have the skills that match their job.

Employees are taken through professional development courses periodically.

Employees are given enough orientation to ensure that they are well-equipped for their roles.

The staff have enough experience to execute the tasks at hand.

The staff in the public health facilities in Wakiso District have the technical capacity to collect M&E data.

The staff in the public health facilities in Wakiso District have the technical capacity to analyze M&E data.

The staff in the public health facilities in Wakiso District have the technical capacity to prepare M&E reports using the M&E findings.

The number of staff for the different tasks is adequate.