Monitoring and evaluation in public governance: a case study of the KwaZulu-Natal department of health.

Abstract

Monitoring and evaluation (M&E) systems have in the recent past attracted attention as an important management tool that monitors performance and evaluates outcomes against set targets and within set timeframes. This means that M&E measures efficiency and effectiveness of programmes or interventions. However, despite the introduction of the Government-Wide Monitoring and Evaluation (GWM&E) System in 2007, performance was not sufficiently achieving the overall goal of the Department of Health (DOH) - optimum health for all the citizens of the Province. This deficit was expressed by the populace through media reports and corruption that was rife in the Government in general and in the DOH in particular. Simultaneously, the establishment of the DPME in the Presidency at national level resulted in the M&E being a “buzz-word or a magic bullet” (Chilimo 2009: 320) that would solve all performance problems, improve service delivery and rid of corruption. The study examined the effectiveness and efficiency of the M&E System of the DOH and its use as a management tool throughout all the spheres of the Department, namely: Province, Districts and Sub-districts or Facilities. A combination of the M&E Theories and the Public Administration Models formed the theoretical foundation of the study. The investigation was conducted in the Head Office (at Province) and in the Districts and the Facilities using the Unit and Component Managers at Head Office; the District Managers, their Deputies, Programme Managers, District Information Officers and the Facility Information Officers. Data collection was undertaken through structured interviews of 12 participants at management level; and ten focus group discussions conducted in the eight selected districts and the two at Head Office. Over and above this, the document reviews were undertaken in reports and other relevant Department records. Findings of the study indicated that despite the fact that the M&E System in the DOH was introduced in 2008; four years later it has still not been accepted by the majority of Programmes and Components particularly at Head Office. It was partially accepted at the district level. Although the Clinical Managers accepted it, they did not fully comply with some of the Framework prescripts. The non-clinical Managers did not completely feel part of the whole process. At facility level little was known about the M&E, which caused it to be poorly implemented. The study also established that poor implementation was because the M&E System was not well introduced from its inception - readiness assessment and participation was not undertaken. The staff felt that it was imposed on them resulting in poor political will. This condition was aggravated by other factors, namely: lack of the M&E structure; the M&E function not incorporated in the job descriptions of the relevant staff; the lack of knowledge of the M&E concepts; lack of necessary skills to implement M&E as well as the negative attitudes of the staff, which was counteractive to the implementation. In addition to the lack of capacity, there were inadequate data collection and verification tools; and standard operating procedures. This resulted in the poor mainstreaming of the M&E System and poor utilisation as a management tool throughout the Department. Such findings resulted in the proposal of a new model to evaluate the M&E System of the Department. The proposed model was not tested; once tested it could be adapted and used in other departments or organisations as the case may be. The study recommended that a review of the M&E System of the Department be conducted. In this regard, the priority should be the establishment of a structure that will be committed to the mainstreaming of M&E and the creation of a conducive environment. A red thread should run through the structure from the Head Office through to the facilities and vice versa. This means that a top-down and bottom-up approach should be adopted. Its function should change from the silo function and adopt a participatory approach which will involve the relevant stakeholders. The study also recommends that the M&E System should have a framework that has an Implementation Plan that monitors its implementation. The Framework should incorporate all the activities necessary to drive the process of mainstreaming the M&E System, namely: data quality measures, data verification systems, dissemination, usage and reporting to mention but a few. The M&E Framework should also include a guideline for the districts, programmes and facilities to develop their own M&E Implementation Plans to monitor the District Operational Plans based on the District Health Plans. Furthermore, an M&E Forum should be established with the terms of reference that will enable representation of all the Units. This Forum would be responsible for the review of the system, its implementation and serve as an information sharing platform. Training on M&E should be conducted for all the staff on an on-going basis and the induction for the newly employed should include a module on M&E. The correct data collection tools should be in place and the standard operating procedures are available in order for all to understand systems and processes. Additionally, the study recommends that at Head Office a Health Information Team should be formed and similar teams reinstated at all levels. In order for the Teams to properly scrutinise the data (and reports), they should be supported and guided by the M&E Component. Finally, the study recommends regular reviews of the M&E system of the Department. A model that was developed and proposed for evaluating the M&E system should be used periodically to assess if the M&E System is succeeding in achieving its goal.