Research consultancy
FACTORS AFFECTING UTILISATION OF MONITORING AND EVALUATION FINDINGS IN PUBLIC HEALTH FACILITIES IN IBANDA DISTRICT, UGANDA
1.2.1 Historical Background
Evaluation is as old as the world itself and has moved side by side the journey of human civilization (Basheka, 2016). The practices of the field of evaluation can be traced as far back as the biblical times during the known creation story extensively addressed in Genesis (1:31) where the biblical account informs us that on the fifth day of creation God saw everything he had created and everything appeared 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 contributions to many fields including evaluation (Zanakis, Theofanides, Kontaratos and Tassios, 2003). Existing scholarly accounts inform us that the Delphic oracle of the ninth to the third centuries BC was the first central intelligence database of the ancient world, an interdisciplinary think tank of approximately 90 priests, deemed the best educated experts of antiquity (Theofanides et al., 2003. They collected and evaluated information and advised ordinary people and leaders, among them Alexander the Great. Major project management in the fourth century BC existed where evaluation and monitoring were key. Griffin (2005) notes that: “The practice of management can be traced back thousands of years. These great pyramids, which were built in 2900B.C., are a classic example of management and co-ordination. Griffin (2005) notes that: The practice of management can be traced back thousands of years. The Egyptians used the management functions of planning, organizing and controlling when they constructed the pyramids. These great pyramids, which were built in 2900B.C, are a classic example of management and co-ordination.
In the contemporary world, the international status of M&E research remains theoretically and methodologically influenced by the American tradition. The United States (US) is regarded as the motherland 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 models and approaches for evaluation, evaluation capacity building initiatives, evaluation standards and guiding principles, number and attendees of evaluation conferences and workshops, publications and their impact factor, guides and evaluation handbooks (Basheka, 2016: 4). The American Evaluation Association (AEA) for example remains the most dominant evaluation society in the world with membership that has grown from just over 3000 members in 2001 to approximately 7000 by mid-2015 (Basheka & Byamugisha, 2015:76). Other countries however, equally have noticeable developments regarding evaluation. In Europe, professionalization of evaluation has progressed to different levels across countries with Sweden, the Netherlands, Great Britain, Germany, Denmark, Norway, France and Finland currently topping the list. Recent rankings further point to impressive developments of the field 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 itself established in 1999 with the heyday period of intense professional associations reported between 2000 and 2004 (Basheka & Byamugisha, 2015). Domestic and global forces played a role in this growth. Globally, Mertens and Russon (2000:275) proclaim that the emergence of many new regional and national organizations illustrated the growing worldwide recognition of the importance of evaluation. Before 1995 there existed only five regional and/or national evaluation organizations in the world but by 2000 there were more than 30 – a 500% increase in a 5-year period. Much of this growth was occurring in developing countries, particularly in Africa (p. 275). Malefetsane, Lungepi and Tembile (2014:5) observe that in Africa, evaluation has been on the increase; a trend predicted to continue especially with political recognition of the utility of evaluation to good governance. De Kool and Van Buuren (2004:173) conceded that the rise to New Public Management (NPM) which was constructed around key philosophies that emphasized outputs and outcomes, transparency and accountability, created a demand for M&E in Africa.
In Uganda, over the past two decades, considerable efforts have been made to establish a strong and robust basis for assessing both private and public spending. In achieving this, M&E was considered as a means of Government and NGOs measuring their development interventions. M&E was therefore enshrined in the National Development Plan and institutionalized in the 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 of Government programmes was developed with the aim of enhancing M&E capacity as well as ensuring that sound evidence based data and information are available to inform decision making (NIMES, 2006). Significant effort went into introducing planning, results based budgets, monitoring systems and developing the institutional capacity to design ministry strategy and plans to implement M&E arrangements 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
The study will be based on the General Systems Theory which was developed by Bertalanffy (1934), as cited in Tama (1987). The theory provides an analytical framework which can be used to explain 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. The following are the features of a system. A system is basically a combination of parts, sub-parts, sub-systems. Each part may have various sub-parts. A system has mutually dependent parts, each of which may include many sub-systems. Parts and sub-parts of a system are mutually related to each other, some more, some less; some directly, some indirectly. The relationship is in the context of the whole. Any change in one part may affect other parts also. A system is an interdependent framework in which various parts are arranged (Tamas, 1987).
A system transforms inputs into outputs. This transformation is essential for the survival of the system. There are three aspects involved in this transformation process: inputs, mediator, and outputs. Inputs are taken from the environment, transformed into outputs and given back to the environment. The various inputs may be in the form of information, money, materials, human resources, etc. Outputs may be in the form of goods and services. The total relationship may be called the input–output process, and a system works as a mediator in the process (Bertalanffy 1968). In this study, it is assumed that inputs like technical, financial and the quality of M&E systems are the inputs and utilization of M&E data is the output.
1.2.3 Conceptual Background
Technical capacity refers to the extent to which the human resources in an organization are able to manage evaluations (Byamugisha, 2016). For this study, technical capacity will be measured in terms of whether staff are qualified, experienced and knowledgeable about using M&E systems.
Financial Capacity refers to the extent to which funds are available to finance and facilitate the monitoring and evaluation function in an organization (USAID, 2015). In this study therefore financial capacity will be measured in terms of whether there are adequate financial resources, whether the funds are released in a timely manner and whether the funds are accounted for. Quality of M&E systems refers to the extent to which the M&E systems and activities meet the specified requirements and standards (Mulandi, 2013:12). For this study, the qualities of M&E systems will be measured as the extent to which the M&E systems meet the methodological and quality standards.
Utilization of Monitoring and Evaluation Information refers to putting monitoring and evaluation results to use. The use of monitoring and evaluation findings for decision making and project control ensure that there is a baseline against which to undertake new measurements (Mulandi, 2013). For this study utilization of M&E data will be measured in terms of the extent to which the data is used to inform decisions, improve organizational processes and learning.
1.2.4 Contextual Background
There has been poor utilization of Monitoring and Evaluation findings that have been characterized by poor performance of Health Facilities in Uganda and as a result The Health sector in Uganda is faced with numerous challenges despite the High Budget Health Funding as of 2018/2019 fiscal year, out of the total government funding of US$ 144.61 per capita, funding to the health sector, inclusive of external financing, was an estimated US$ 10.40 per capita, which was estimated at UGX 2,310 Billion (Duchoslav, & Cecchi, 2019), Uganda is still facing huge challenges with high deaths in preventable deaths like malaria as of 2013 Uganda had the sixth highest number of annual deaths from malaria in Africa, as well as some of the highest reported malaria transmission rates in the world, with approximately 16 million cases reported in 2013 and over 10,500 deaths annually , while by 2019 there was 40% surge in malaria cases , apart from malaria the leading causes of death in Uganda include communicable diseases such as HIV/AIDS, respiratory tract infections, and diarrheal disease Anywar et al., (2020).
According to Annual Performance Assessment Report, 2013/2014) there have been significant efforts towards the utilization of Monitoring and Evaluation findings that have been noticed characterized by the introduction of planning, results based budgets, monitoring systems and developing the institutional capacity to design and implement M&E arrangements, this has been inorder to mitigate the challenges in Uganda’s Health sector like shortage of Drugs in most of the Health Facilities in Uganda.
National efforts have been directed towards providing a basis for performance improvement as provided for in the National Development Plan (National Development Plan, 2010/11-2014/15) that the utilization of Monitoring and Evaluation findings have been valued to improve the performance of the health sector Such efforts have also been characterized by the establishment of an M&E function to support this role enshrined in the M & E national policy (National M&E Policy, 2013). Unfortunately, much as national efforts have been directed towards enhancing M&E capacity as well as ensuring that sound evidence-based data and information are available to inform decision making (The Republic of Uganda, National Integrated Monitoring and Evaluation Strategy, 2006), the use of M&E results remain questionable, according to a 2009 published report, there is one doctor for every 7,272 Ugandans. The related statistic is 1:36,810 for nurse/midwifery professionals. The shortages are worse in rural areas where 80 percent of the population resides, as 70 percent of all doctors are practicing in urban areas. There are 61 institutions that train health workers, with five medical colleges, twenty-seven allied health training schools, and twenty-nine nursing schools, which indicates that Uganda’s Health sector is at risk of total collapse (Ogwal et al., 2020). This study will therefore attempt to examine the factors affecting utilization of M&E findings in Uganda’s health sector using a case study of Ibanda District.
1.3 Statement of the Problem
Findings from the M&E function ought to be used to inform decision making, planning and organizational learning (Basheka, 2016). However, in the public health facilities at level III and above in Ibanda, health information is not adequately used (Ibanda District, 2017). In order to increase use of health information, the Ministry of Health has devoted significant human, technological and financial resources to the Monitoring and Evaluation function. Despite the significant investment in M&E, there is widespread concern that the utilization of evaluation findings in public health facilities in the district is low, According to the PPDA report, (2019) the completion of maternity ward at Ishongororo HCIV in Ibanda district was marred by irregularities despite the district monitoring and evaluation warning the district authorities , it was also further revealed that the construction of Kashozi HC II in Ibanda district was further delayed despite the reports from monitoring and evaluation that could have reversed the situation all these therefore poses several questions to implementation of monitoring and evaluation report by the Ibanda District authorities. In another note the ministry of Health (2018) monitoring and evaluation team witnessed the high prevalence of HIV/AIDS scourge in Ibanda district at the prevalence rate of 6% indicating that the district needed to increase the level of sensitization to the people inorder to reduce the increase in HIV/AIDS spread however there is high spread of HIV/AIDS in the district. The annual report of the District Health Officer in Ibanda District indicates that M&E findings are not effectively utilized to track and measure performance so there was little/no improvement and learning from the practices. (Ibanda District, 2017). It is against this background that this study seeks to determine the factors affecting utilization of M&E findings within the public health facilities in Ibanda District. Without this information, utilization of evaluation findings may deteriorate further and affect the performance of the public health facilities.
1.4 Main objective
The study seeks to establish the factors affecting the utilization of M&E findings in the level III and IV public health facilities in Ibanda District.
1.5 Specific objectives
- To Establish the relationship between technical capacity on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District.
- To assess the relationship between financial capacity on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District;
- To examine the relationship between the quality of M&E systems on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District.
1.6 Research questions
- What is the relationship between technical capacity on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District?
- What is the relationship between financial capacity on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District?
- What is the relationship between the quality of M&E systems on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District?
1.7 Study hypotheses
H1. There is a relationship between technical capacity and the utilization of M&E findings.
H2. Financial capacity does not affect the utilization of M&E findings in public health facilities
H3. The quality of M&E systems has a significant effect on the utilization of M&E findings in public health facilities
