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Factors Influencing the Use of Monitoring and Evaluation Findings in Public Health Facilities in Ibanda District, Uganda

1.2.1 Historical Background

Monitoring and Evaluation (M&E) has existed since ancient times, evolving alongside human civilization (Basheka, 2016). Early traces of evaluation can be found in biblical accounts, such as in Genesis (1:31), where God assessed His creation and deemed it good. Philosophical contributions from Socrates, Plato, and Aristotle, along with mathematical advancements by Pythagoras and Euclid, further shaped evaluative thinking (Zanakis et al., 2003). The Delphic oracle (9th–3rd century BC) functioned as an early intelligence hub, where priests collected and analyzed data to advise leaders, including Alexander the Great (Theofanides et al., 2003). Large-scale projects, such as the construction of the Egyptian pyramids (2900 BC), also demonstrate early applications of planning, organization, and control—key components of modern M&E (Griffin, 2005).

In the modern era, M&E has been heavily influenced by the United States, which leads in evaluation research, professionalization, and policy institutionalization (Basheka, 2016). The American Evaluation Association (AEA), for instance, has grown from 3,000 members in 2001 to over 7,000 by 2015 (Basheka & Byamugisha, 2015). Other regions, including Europe (Sweden, the Netherlands, UK) and parts of Africa and Asia, have also seen significant progress. By 2013, the International Organization for Cooperation in Evaluation (IOCE) recorded 145 evaluation associations worldwide, up from 117 in 2011 (IOCE, 2013).

In Africa, formal evaluation began gaining traction in the late 1990s, with Ghana establishing the first evaluation association in 1997, followed by the African Evaluation Association (AfrEA) in 1999 (Basheka & Byamugisha, 2015). The rise of New Public Management (NPM), emphasizing accountability and results, further spurred M&E adoption (De Kool & Van Buuren, 2004).

In Uganda, M&E has been integrated into national development planning, with the Office of the Prime Minister (OPM) overseeing its implementation across government agencies (National M&E Policy, 2013). The National Integrated Monitoring and Evaluation Strategy (NIMES, 2006) was introduced to strengthen evidence-based decision-making, though challenges persist in fully utilizing M&E findings (Annual Performance Assessment Report, 2013/14).

1.2.2 Theoretical Background

This study is anchored in the General Systems Theory (Bertalanffy, 1934), which views organizations as interconnected systems where changes in one component affect others (Tama, 1987). A system comprises inputs (resources), processes (transformation), and outputs (results). In this context:

• Inputs include technical expertise, funding, and M&E systems.
• Processes involve data collection and analysis.
• Outputs refer to the application of M&E findings in decision-making.

The theory helps explain how deficiencies in inputs (e.g., lack of skilled personnel or funding) hinder the effective use of M&E outputs in public health facilities.

1.2.3 Conceptual Background

Key concepts include:

• Technical Capacity: The ability of staff to conduct M&E, measured by their qualifications, experience, and knowledge (Byamugisha, 2016).
• Financial Capacity: The availability and timely disbursement of funds for M&E activities (USAID, 2015).
• Quality of M&E Systems: Compliance with methodological standards (Mulandi, 2013).
• Utilization of M&E Findings: The application of M&E data to improve decision-making and health service delivery (Mulandi, 2013).

1.2.4 Contextual Background

Despite increased health sector funding (UGX 2,310 billion in 2018/19), Uganda faces persistent challenges, including high malaria mortality (10,500 annual deaths), HIV/AIDS, and inadequate healthcare staffing (1 doctor per 7,272 Ugandans) (Ogwal et al., 2020). Although M&E systems have been strengthened (e.g., NIMES, 2006), utilization remains weak, as seen in Ibanda District, where delayed infrastructure projects and rising HIV prevalence (6%) persist despite M&E warnings (PPDA Report, 2019; Ministry of Health, 2018). This study investigates why M&E findings are underutilized in Ibanda’s public health facilities (levels III–IV).

1.3 Statement of the Problem

Despite investments in M&E, public health facilities in Ibanda District underutilize findings, leading to poor service delivery (Ibanda District, 2017). For instance:

• M&E reports on stalled constructions (e.g., Ishongororo HCIV) were ignored (PPDA, 2019).
• HIV/AIDS sensitization gaps persist despite M&E recommendations (MoH, 2018).
  This study explores the barriers to M&E utilization to improve health outcomes.

1.4 Main Objective

To examine the factors affecting the use of M&E findings in Ibanda’s public health facilities (levels III–IV).

1.5 Specific Objectives

1. To assess the impact of technical capacity on M&E utilization.
2. To evaluate the influence of financial capacity on M&E utilization.
3. To analyze the effect of M&E system quality on utilization.

1.6 Research Questions

1. How does technical capacity affect M&E utilization?
2. What is the relationship between financial capacity and M&E use?
3. How does M&E system quality influence utilization?

1.7 Hypotheses

• H₁: Technical capacity significantly affects M&E utilization.
• H₂: Financial capacity has no effect on M&E utilization.
• H₃: M&E system quality significantly influences utilization.