As USAID’s flagship global program in maternal, newborn and child health (MNCH), MCHIP had the opportunity and responsibility to promote and apply monitoring and evaluation (M&E) best practices and the use of standardized indicators for the measurement of MNCH results. The M&E approach used by the Program kept with the common evaluation framework that guided the work of countries and initiatives seeking to accelerate the achievement of Millennium Development Goals 4 and 5, and which had been adopted by the International Health Partnership, the Catalytic Initiative, and others.
MCHIP’s wide programmatic scope and integrated approach presented unprecedented opportunities to scale up proven interventions and test innovative approaches to achieve improved outcomes at scale. MCHIP measured outcomes such as coverage of high-impact MNCH interventions by drawing on existing population-based surveys and through the rigorous M&E efforts of in-country implementing partners and PVO/NGO grantees, and directly in selected countries where MCHIP received the mandate and funding from USAID missions to conduct population-based surveys. Health management information system (HMIS) data was also used for this purpose in some cases.
A basic M&E function of MCHIP was to document program results to guide program implementation and ensure accountability to USAID and Ministry of Health partners. In addition to this basic function, MCHIP identified four major priorities related to monitoring, evaluation and research (MER):
- Developing M&E indicators, tools and resources;
- Contributing to the evidence base on high-impact MNCH interventions;
- Strengthening health information systems; and
- Building the capacity of MCHIP staff and collaborators in MER.
M&E Guiding Principles
- Collective action: Primary focus on the contribution of the collective efforts to scale up the health sector response in countries
- Alignment with country processes: Build upon national processes countries have established to monitor and evaluate progress of implementation of national plans
- Balance between country participation and independence: Driven by country needs but conducted to maintain independence of evaluation
- Harmonized approaches: Common protocols and standardized outcome indicators and measurement tools, with appropriate country adaptations
- Capacity building and health information system strengthening: Systematic involvement of country institutions
- Adequate funding: Between 5% and 10% of the overall scale-up funds set aside for monitoring, performance, evaluation and operational research and strengthening health information systems
MCHIP conducted targeted research studies and program evaluations that contribute to the evidence base regarding programmatically effective MNCH interventions; in particular, how these interventions can best be delivered at scale and how they can best be monitored and evaluated. MCHIP’s MER efforts provided evidence that contributed to the program’s global PL agenda, which identified questions that needed focused attention across countries. With the support of the MER team, MCHIP investigated research topics of global interest including: community Kangaroo Mother Care; quality of MNCH services; community case management; scale-up of the Helping Babies Breathe intervention; implementation processes and outcomes of malaria in pregnancy programs; and delivery of integrated MNCH/family planning services.
At the country level, MCHIP M&E systems relied on existing health information systems, such as national HMIS, to the extent possible rather than introducing new parallel systems. MCHIP aimed to strengthen elements of the national HMIS in countries working to improve the quality of MNCH care in facilities and/or communities and/or where the Program was contributing to health systems strengthening efforts and documented what was done.
MCHIP worked to improve national HMIS by:
- Identifying and building global consensus on new indicators to include in national HMIS;
- Advocating at the national, regional/state, and district levels for revision of HMIS forms;
- Working with country stakeholders to incorporate evidence-based MNCH indicators into client records and facility and community-based registers;
- Training health workers in how to complete existing and new recordkeeping forms and aggregate and display health service statistics data; and
- Revising district health management team supervision forms and training supervisors on how to use the forms and data for decision-making.
i Morris SS, Black RE, Shibuya K, Cousens S, Bryce J. 2005. How many child deaths can we prevent? New estimates for 2003. Paper presented at Tracking Progress in Child Survival: Countdown to 2015; London.
ii Black RE et al. on behalf of International Evaluation Consortium, Institute for International Programs. 2008. Background paper for “Roundtable on Evaluation of Large-Scale Initiatives to Achieve the Health MDGs Related to Maternal, Newborn and Child Survival and Nutrition” convened by NORAD and CIDA, Cape Town, South Africa/Technical meeting convened by Institute for Health Metrics and Evaluation and The Lancet, Seattle, WA.