FACTORS AFFECTING THE UTILIZATION OF MONITORING AND EVALUATION FINDINGS IN PUBLIC HEALTH FACILITIES IN IBANDA DISTRICT, UGANDA
ABSTRACT
This study investigated the factors affecting the utilization of monitoring and evaluation (M&E) findings in public health facilities in Ibanda District, Uganda. The research was guided by three specific objectives: first, to establish the relationship between technical capacity and the utilization of M&E findings in public Level III and IV health facilities in Ibanda District; second, to assess the relationship between financial capacity and the utilization of M&E findings in these facilities; and third, to examine the relationship between the quality of M&E systems and the utilization of M&E findings.
The Pearson correlation analysis coefficient was 0.831**, indicating a strong correlation between financial capacity and the utilization of M&E findings. The p-value of 0.000 (<0.005) led to the rejection of the null hypothesis and the acceptance of the alternative hypothesis. These findings further demonstrate a relationship between financial capacity and M&E findings. The results also show that a one percent change in financial capacity leads to a 0.682 change in the utilization of M&E findings, indicating a positive relationship between the two variables.
Regression analysis was conducted to examine the effect of financial capacity on the utilization of M&E findings. The R-squared value of 0.691 indicates that 69.1% of the factors affecting the utilization of M&E findings are explained by the financial capacity of the organization.
Regarding the availability of adequate financial resources to execute key activities in Ibanda District, the findings indicate that financial resources were inadequate, as none of the responses exceeded even half of the adequacy threshold. On the question of whether funds are made available to support decisions once made, the majority of respondents were uncertain. Similar results were obtained regarding whether funds are made available in a timely manner to execute key decisions.
To examine the relationship between the quality of M&E systems and the utilization of M&E findings, Pearson correlation analysis was performed. The correlation coefficient was 0.833**, indicating a strong positive relationship between the quality of M&E systems and the utilization of M&E findings. The R-squared value of 0.694 indicates that 69.4% of the variation in the utilization of M&E findings is explained by the quality of M&E systems.
Based on the finding that adequate financial resources to execute key activities in Ibanda District were lacking, this study recommends that sufficient financial resources be allocated to M&E to enhance the utilization of M&E systems. Regarding the finding that the majority of respondents were uncertain, with a considerable number disagreeing, that funds are made available to support decisions once made, this study recommends that funds be provided to support the utilization of M&E findings. Furthermore, the study recommends that health facilities in Ibanda District provide funding capable of supporting organizational M&E activities, as financial resources are not always sufficient.
CHAPTER ONE: INTRODUCTION
1.1 Introduction
This study examines the determinants of the utilization of monitoring and evaluation (M&E) findings within public health facilities at Levels III and IV in Ibanda District. Technical capacity, financial capacity, and the quality of M&E systems serve as the independent variables, while the utilization of M&E findings is the dependent variable. This chapter focuses on the background of the study, the statement of the problem, the purpose of the study, specific objectives, research questions, research hypotheses, conceptual framework, scope of the study, significance, justification, and operational definitions of key terms.
1.2 Background to the Study
1.2.1 Historical Background
Evaluation is as old as civilization itself and has evolved alongside human progress (Basheka, 2016). Evaluation practices can be traced back to biblical times, notably in the creation story extensively addressed in Genesis (1:31), where the biblical account reports that on the fifth day, God saw everything He had created and it was good. From the philosophical works of Socrates, Plato, and Aristotle to the mathematical methodologies of Pythagoras and Euclid, the ideas of the ancient Greeks shaped many institutions and contributed to numerous fields, including evaluation (Zanakis, Theofanides, Kontaratos, & Tassios, 2003). Existing scholarly accounts indicate that the Delphic oracle of the ninth to third centuries BC served as the first central intelligence database of the ancient world—an interdisciplinary think tank of approximately ninety priests, regarded as the best-educated experts of antiquity (Theofanides et al., 2003). They collected and evaluated information and advised ordinary people and leaders, including Alexander the Great. Major project management existed in the fourth century BC, with evaluation and monitoring as key components. Griffin (2005) notes that management practice can be traced back thousands of years. The great pyramids, built around 2900 BC, exemplify management and coordination, demonstrating that the Egyptians used the management functions of planning, organizing, and controlling in their construction.
In the contemporary world, the international status of M&E research remains theoretically and methodologically influenced by the American tradition. The United States is regarded as the birthplace of the field in terms of its trends, number of authors and their academic and professional influence, degree of professionalization, focus of academic programs, legislation and institutionalization of evaluation, development of evaluation models and approaches, evaluation capacity-building initiatives, evaluation standards and guiding principles, number and attendance of evaluation conferences and workshops, publications and their impact factor, and evaluation guides and handbooks (Basheka, 2016:4). The American Evaluation Association (AEA), for example, remains the most dominant evaluation society globally, with membership growing from just over 3,000 in 2001 to approximately 7,000 by mid-2015 (Basheka & Byamugisha, 2015:76). Other countries, however, have also achieved notable developments in evaluation. In Europe, the professionalization of evaluation has progressed to varying levels across countries, with Sweden, the Netherlands, Great Britain, Germany, Denmark, Norway, France, and Finland currently leading. Recent rankings further highlight impressive developments in Switzerland, Japan, Spain, Italy, Israel, and Africa. In 2011, the International Organization for Cooperation in Evaluation (IOCE) identified 117 evaluation associations, 96 of which were national organizations located in 78 different countries. By 2013, the number had increased to 145 (IOCE, 2013:2; BaTall, 2009:7).
In Africa, the oldest evaluation association was established in 1997 in Ghana, while the African Evaluation Association was established in 1999, with the peak period of intense professional association development reported between 2000 and 2004 (Basheka & Byamugisha, 2015). Both domestic and global forces contributed to this growth. Globally, Mertens and Russon (2000:275) state that the emergence of many new regional and national evaluation organizations illustrated the growing worldwide recognition of the importance of evaluation. Before 1995, only five regional or national evaluation organizations existed worldwide, but by 2000 there were more than thirty—a 500% increase over five years. Much of this growth occurred in developing countries, particularly in Africa (p. 275). Malefetsane, Lungepi, and Tembile (2014:5) observe that evaluation has been increasing in Africa, a trend predicted to continue, especially given political recognition of evaluation’s utility for good governance. De Kool and Van Buuren (2004:173) conceded that the rise of New Public Management (NPM), constructed around key philosophies emphasizing outputs, outcomes, transparency, and accountability, created demand for M&E in Africa.
In Uganda, over the past two decades, considerable efforts have been made to establish a robust basis for assessing both private and public spending. To achieve this, M&E was considered a means for the government and NGOs to measure their development interventions. Consequently, M&E was enshrined in the National Development Plan and institutionalized in governance systems and processes (National Development Plan, 2010/11–2014/15). The Office of the Prime Minister (OPM) was given the constitutional mandate to oversee reforms and service delivery in all government ministries, departments, and agencies and established an M&E function to support this role (National M&E Policy, 2013).
A National Integrated Monitoring and Evaluation Strategy for government programs was developed to enhance M&E capacity and ensure that sound, evidence-based data and information are available to inform decision-making (NIMES, 2006). Significant effort was directed toward introducing planning, results-based budgets, and monitoring systems, as well as developing institutional capacity to design ministry strategies and plans to implement M&E arrangements. These efforts aim to monitor results and provide a basis for performance improvement as provided for in the National Development Plan (Annual Performance Assessment Report, 2013/2014).
1.2.2 Theoretical Background
This study is based on General Systems Theory, developed by Bertalanffy (1934), as cited in Tama (1987). The theory provides an analytical framework for explaining the factors affecting the utilization of evaluation data. According to Bertalanffy (1968), a system is an assemblage of things connected or interrelated so as to form a complex unity: a whole composed of parts and sub-parts in orderly arrangement according to some scheme or plan. Key features of a system include: a combination of parts, sub-parts, and sub-systems (each part may have various sub-parts); mutually dependent parts, each of which may include many sub-systems; parts and sub-parts are mutually related, some more than others, some directly, some indirectly, with the relationship existing within the context of the whole; any change in one part may affect other parts; and a system is an interdependent framework in which various parts are arranged (Tamas, 1987).
