Monitoring and evaluation (M & E)

Monitoring and evaluation is a popular concept not only in health care sector but also in all other fields because of its importance in successful program implementation. M and E is simply a process to ensure that the program does not suffer bad implementation. Therefore, M and E are two relatable lubricants to make project or program work according to plan or specification.

What is monitoring?

A process of data gathering or collection on a project or program for improvement and maintenance of program performance through well planned regular checks.

Monitoring identifies key results in hierarchy with objectives, measurable indicators for tracking progress at each level and at intervals to inform strategic and management decisions immediate result.

What is evaluation?

A systematic assessment of the project effectiveness, efficiency, performance, relevance and the impact of the project based on the objectives in order to ensure better execution of the similar project in the future.

Evaluation answers crucial questions about project success beyond monitoring data. It draws on contextual factors and information collected over time for richer analysis and broader significance-future outcomes and impacts.

An M & E system is the comprehensive set of planning, data management, information use and reporting tasks, plus the staffing, resources and management that support these functions. Therefore M & E is a crucial part of program planning and implementation such that no program can be successfully implemented without element of M & E built into it. This is what informs the decision of Federal Government to establish M & E units at the failure recorded by the past health programs and projects.

Primary health care goals and M & E

Looking at actualising PHC Goals through M & E, there is need to state what tasks involved in M & E units of any Local Government.

M & E has 4 folds namely;

Recording (collection)
Complication (collection)
Calculation (analysis)
Reporting (dissemination)

M & E officer who suppose to be Health Information Manager (Health Records Officer) collects routine data on PHC programs on appropriate formats, the analysed results are used to measure PHC indicators (goals) e.g.

% of children fully immunized with potent vaccine at first birthday (1^st year of birth)
% of pregnant women fully immunized by the 4^th months of pregnancy
% of households provided with safe and portable water.

Health information management in primary health care

Primary Health Care provides general health services of preventive, curative, promotive and rehabilitative nature to the communities as they are the entry point of health care system.

Relevant of health information are necessary to support all the components of primary health care to ensure regular and wide dissemination of needed information for effective decision making.

The person charge with this responsibility is the health information manager who is a person that had being trained and certified on the principle and manner of handling health information at all level of health care delivery.

Indeed health information management as a profession is the key to all aspect of health care delivery which demand 100% commitment.

Objectives of primary health care information system

The overall objective is for planning management and operational function of primary health care activities at all levels.
To have an effective and efficient PHCIS that can create, transmit, store, retrieve and process primary health care data and provide them to the appropriate level at the right time.
Help to ensure a standard in data processing using modern technological support of hardware and software.
It help to establish a set of criteria and standard for information system in order to enhance quality and effectiveness of primary health care monitoring and evaluation activities.

Roles of HIM in PHC LGA level

Access the performance of health facilities in the local government in term of delivery primary health care services to ensure that they met the set standard (for PHC record keeping).
Ensure that the data from the health facilities are complete and accurate.
Collation of the LGA aggregate report(monthly, quarterly and annually).
Interpretation and presentation of data in chart format e.g. histogram, bar-chart, cumulative chart etc.
Analysing the data using differentiate e.g. coverage rate, death rate, wastage rate, drop out rate, birth rate and case fatality rate etc.
Utilization and dissemination of all data in its area of jurisdiction.
Ensuring timely forwarding and sharing of data to relevant departments, agencies and programmes operating at the LGA level.
Training and supervision of health facilities to ensure the maintenance of set standard.
Planning and decision making to ensure improve the services and project future events.
Filing of the records from the various health facilities in their corresponding file and also filing the LGA duplicate copy.
Complete the local government area immunization register for every month.
Input data into the system, keep hard copies and soft copies and make them available as and when due.

Roles of HIM at the health facilities level

Registration of patients in the various registers depending on the types of care the client seeks by collecting vital information from the client.
Collation of the daily, monthly and annual statistics for the health facility.
Keeping of duplicate copies of the various statistics for the health facility and providing them when necessary.
Presentation and analysis of the data for the health facility by using charts and different rate.
Decision making as to enhance the primary health care activities in the health facility.
Prompt reporting to the local government area health information unit.
Ensure appropriate filing of the treatment and antenatal cards of patients and retrieve them when needed.
Ensure accurate entries and charting of child weight on immunization and date of next appointment.

Tools of PHCIS

The basic PHCIS recording tools are:

Health facility in patients case (IPC) daily register:

It gives a clear account of total admission in the health facility and each time a patient is admitted he/she must be registered in the inpatient register (subservient).

Health facility daily out-patients department (OPD) register:

It is used to register all patients that visit the health facility.

Health facility antenatal care (ANC) daily register.
Health facility family planning (FP) daily register
Health facility labour and delivery daily register.
Health facility daily register.
Health facility nutrition information register (0-5 years) (nutrition and growth monitoring).
Routine immunization tools which includes:

Child immunization register:

In this register each child is a unit that his client is registered once. That a client visiting the centre for the first time that has started vaccination in another clinic should also be registered.

Health facility daily immunization tally sheet register:

After each client is vaccinated the health worker should tally under the appropriate column of age and antigen administered in the tally sheet (ΦΦΦ). Do not tally for two months in one page of tally sheet but you may use more than one page per month as necessary.

Health facility summary register total recorded vaccination in health facility tally sheet and enter into appropriate age and dose of health facility summary register. At the end of the month sum total vaccinations for each antigen age group and record in the last row of the summary register. Ensure summary forms are duly signed. Submit original copy of health facility summary and VMI to the LGA immunization officer.

Child immunization card:

This contains record of immunization as well as other general health information including the infant growth monitoring chart and country immunization schedule.

The following information should be filled in the card when a child visits the health facility for the first time.

Name of infant
Infant sex
A registration number (number in immunization register)
Infant’s birth date (not age)
Infant weight at registration
Name of parents
Traceable address of child
Date of each vaccination by dose and vitamin A supplementation
Batch number/manufacture of vaccines are recorded
Due date for next immunization
Growth monitoring chart to help detect the growth and development of the child.

4. Vaccines management tool (VMI):

Record the vaccine and devices received for the session in form (VMI) and sum up the recorded doses of vaccines and devices used and the balance in the VMI form for all session of the month. Fill in the last row of the VMI (vaccines receive, used and balance) as well as the vaccine loss to other reasons.

TT register for women of child bearing age and pregnant women:

A woman is register as a unit, write the date the woman either pregnant (PW) or non pregnant (NPW) is given either first dose (TT1), second does (TT2), third dose (TT3), fourth dose (TT4), or fifth dose (TT5) of tetanus toxoid.

LGA immunization register

Data presentation

By the use of statistical graphs or charts to present information on primary health care, for example:

Bar chart
Pie chart
Histogram
Cumulative frequency curve (o-give)
Frequency polygon
Component bar chart
Data summary and graphical presentation are important exercise for the utilization of data in monitoring and evaluating primary health care and health related activities or programmes.
It gives a clear view of activities of a particular are at a specific periods.

Data analysis

The use of primary health care data could be focused on evaluation exercise particularly “situation analysis” and “progress analysis”.

Situation analysis: gives the picture of the situation within a specified period of time e.g week, month, year etc.

Progress analysis: progress analysis compare the primary health care situation reviewed against desired target or goals.

These analyses are important pre-requisites for the identification of priorities and re-emphiazing managerial effort.

Immunization data analysis

This is done by using various rates:

Immunization coverage rate: The coverage is usually calculated for a 12 months period (annually). However for proper and efficient programme management, this should be calculated for any particular session in the health facility.

To calculate immunization coverage, divide the total number of immunization given for a particular antigen children immunized over the target population.

It helps to determine the percentage of the target group that is able to receive the services.

Un-immunized infants: The indicator is a measure of route immunization performance is best assessed with the measles vaccination when the children are supposed to be fully immunized. However, Pent will be used to calculate the un-immunized children. It determines the number of infants that have not been given immunization in that target group.
Dropout rate: This refers to clients that commenced the early part of the schedule of immunization but do not complete the schedule. Drop out can be assessed by comparing BCG and measles DPT1, and DPT3, OPV1 and OPV3 or BCG and DPT3.
Vaccine wastage rate: This indicator is to assess efficient handling and of vaccines in the routine immunization programme. There are two main types of vaccine wastage.

Open wastage (programmatic)
Close wastage (storage/handling)

Protected at birth: Used to access the number of women who had received TT2^tt at least 2 weeks before given birth.

Verification factor (VF)

This is meant for the health facility and LGA level to quickly check accuracy of the data at the various levels to improve accuracy.

At the health facility, before submission of summary to LGA, the officer should check the verification factor of the health facility summary data with the tally sheet.

At the LGA, it can be done by comparing LGA summary data with the aggregated of all health facilities summary data submitted.

Formula

For example at the health facility level, immunization verified at sources is counted.

Vaccinations in tally sheet immunization found at higher level are valves for the vaccinations in health facility summary reporting form.