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FACTORS AFFECTING UTILISATION OF MONITORING AND EVALUATION FINDINGS IN PUBLIC HEALTH FACILITIES IN IBANDA DISTRICT, UGANDA

ABSTRACT

The topic of the study was; factors affecting utilization of monitoring and evaluation findings in public health facilities in Ibanda district, Uganda. The topic of study was guided by the following 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 and 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.

Pearson correlation analysis coefficient was 0.831^**   indicating that there was a strong correlation between Financial capacity and Utilization of monitoring and evaluations findings.

The findings of the study of the study P-value 0.000 <0.005 indicating that the null hypothesis is rejected and the alternative hypothesis is accepted. This Findings also further indicates that there is a relationship between Financial capacity and M&E findings, in the study the results further show that a one 1 percentage change on Financial capacity leads to 0.682 change on Utilization of monitoring and evaluations findings. This result shows that there is a positive relationship between Financial capacity and utilization.

A regression analysis was run between financial capacity on the utilization of M & E findings and the value was of R-squared was used to determine the strength of the relationship in a bid to answer the second objective and Hypothesis of the study, In determining the strength of the relationship between Financial capacity and utilization of M & E findings, the R-squared Value 0.691 indicates that 69% of the factors affecting utilization of M & E findings are affected by Financial capacity of the organization.

On findings out if there are adequate financial resources to execute the key activities in Ibanda District. The findings indicate that the financial resources were not adequate as indicated by the fact that none of the response was beyond even half. On findings out if when a decision is made, funds are made available to support the decision, the results indicated that majority of the respondents where not sure at and on the same note regarding the results on if the funds are availed at an appropriate time to execute a key decision.

In examining 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. The Pearson correlation analysis was performed. Pearson Correlation analysis was 0.833^** , indicating that there is a strong positive relationship between Quality of Monitoring and Evaluation Findings and Utilization of monitoring and evaluations findings.

According to the findings in the study, the R-squared value 0.694, indicates that there is 69.4%

On findings out if There are adequate financial resources to execute the key activities in Ibanda District, the findings indicate that the financial resources were not adequate, this study therefore recommends that there is need to give enough financial resources to M&E so as to enhance utilization of M&E systems.On findings out if when a decision is made, funds are made available to support the decision, the results indicated that majority of the respondents where not sure, and a considerable number of respondents disagreed, this result indicated that there is need to provide funds to support utilization of Monitoring and Evaluation funds.The study also recommends that there is need for the Ibanda Health facilities to provide funding that can be in position to provide support for the organizational financial resources are not always sufficient.

CHAPTER ONE

INTRODUCTION

1.1 Introduction

The study will examine the determinants of utilization of monitoring and evaluation findings within public health facilities at level III and IV in Ibanda District. For this study technical, financial, and quality factors will be the independent variables, while utilization of monitoring and evaluation findings will be the dependent variable. The chapter will focus on the background of the study, statement of the problem, purpose of study, specific objectives of the study, research questions, research hypotheses, conceptual framework, and scope of the study, significance, justification and operational definitions of key terms in the study.

1.2 Background to the Study

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 was 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, at 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, technical 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 Annual Health Sector report (AHSPR) 2018/2019, Ibanda District ranked 18^th in the whole country out of 128 districts, and in the AHSPR 2019/2020, it ranked 76^th. The AHSPR tracks performance of public health facilities in terms of coverage of health services, quality of health services, Human Resource for health services, as well as reporting for health services.

The current study thus sought 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 sought 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

1. 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;
2. 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 Study hypotheses

H₁. There is no relationship between technical capacity and the utilization of M&E findings in public health facilities

H_2: There is no relationship between financial capacity and utilization of M& E findings in public Health facilities.

H₃ : The is no significant effect of the Quality of M&E  findings on the utilization of M&E findings in public Health facilities.

1.7 Conceptual Framework

Independent Variables (Factors)           Dependent Variable (Utilization of M&E Findings)

Source: Adopted from Kasule (2016) and modified by the researcher

The conceptual framework above shows the factors affecting the utilization of M&E findings. The model assumes that utilization of M&E findings is enhanced by improved technical, financial and quality of M&E systems within organizations.

1.9 Significance of the Study

The study will provide information to the future scholars on the relationship between technical capacity on the utilization of M&E findings in the public level III and IV health facilities in Ibanda District and this will enable them in drawing conclusions with the present situation and other times.

The study will provide to the government of Uganda and other policy makers information regarding the relationship between financial capacity and the utilization of M&E findings in the public level III and IV health facilities in Ibanda District, this will help the government in making key critical decisions that can help M & E findings be implemented in government health facilities.

The government will be able to determine the quality of monitoring and evaluation so to understand how to improve it for the better of implementing government programs and better utilize the M& E results.

1.10 Justification of the Study

It is critical that the factors that affect the utilization of M&E findings are thoroughly examined and understood by the public sector implementing Monitoring and Evaluation system. Without clear understanding of these factors, the public health sector may continue underutilizing evaluation findings. This may affect the performance of the sector and subsequent underperformance of the public health sector.

Recent health sector studies, as well as policies, strategies and plans, acknowledge that Human Resource for Health constraints are hampering health sector planning, service delivery and ultimately health outcomes in many African countries  and world at large. Human Resource for Health inequities showed that America has 14 % world population compare to sub-Saharan Africa with 11 % of world population but Sub-Saharan Africa carries 25 % of the global disease burden and Americans taking 10 % of global disease burden. Further, America has the global health workers of 42 % compared with Sub-Saharan Africa with only global health workers of only 3%. Equally, the Americans allocate 50 % their annual expenditure to health as compared to Sub-Saharan Africa with less than 1 % annual budgetary allocation to health (WHO, 2016), all these challenges therefore indicates that there is need for a strong commitment to examine the factors affecting utilization of monitoring and evaluation findings in public health facilities.

The world faces a global shortage of well-trained health workers, which is considered as one of the biggest barriers to quality health-care services for millions of people throughout the world (World Health Organization, 2018). It is estimated that there currently is a shortfall of approximately 7.2 million doctors, nurses and midwives and that this shortfall is likely to rise to at least 12.9 million in the coming decades (Sidibe and Campbell, 2017). Although the health workforce crisis affects virtually all countries worldwide – including the high-income countries – sub-Saharan Africa and parts of Asia are most affected, as these regions have the lowest health worker densities when compared globally and are also strongly affected by poor attraction and retention as well as high attrition of health professionals (Kabbash et al., 2021), this therefore warrants this study in establishing the relationship between technical capacity on the utilization of M&E findings in the public level III and IV health facilities as such recommendations is critical in improving the general quality of Health institutions.

1.11 Scope of the Study

1.11.1 Content Scope

The study examined the factors affecting the utilization of M&E findings. The study specifically focused on the effects of technical, technological and quality factors on the utilization of M&E findings in Ibanda District.

1.11.2 Geographical scope

The study was conducted in Ibanda District which lies in South Western Uganda. It was conducted at public Health centers IIIs and Health Centre IVs within the district.

1.11.3 Time scope

The study looked at quarterly HIV data/reports for the financial year 2015/2016 and how it was used to inform the clinic processes or facilitated good quality data, monitoring and evaluation, or planning at the level III health centres and the general hospital.  In addition, the field study was conducted between September and October 2017.

1.12. Definition of Key Terms and Concepts

Technological capacity refers to the capacity of the human resources/people to use M&E findings.

Technological capacity refers to the ability of the organizations to utilize technology to manage M&E activities

Quality of M&E Findings refers to the extent to which the evaluation findings meet the specified requirements and standards

Utilization of Monitoring and Evaluation Findings. This will refer to the application of Monitoring and Evaluation findings in decision-making, quality improvement and learning.