Full Project – Monitoring and evaluation as critical tool in measuring quality healthcare delivery

Full Project – Monitoring and evaluation as critical tool in measuring quality healthcare delivery

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Monitoring and evaluation have a complementary relationship. Monitoring gives information on the status of a policy, program, or project at any given time relative to respective targets and outcomes. Evaluation gives evidence of why targets and outcomes have (or have not) been achieved. Monitoring and evaluation can be used for a wide range of purposes, including tracking expenditure, revenues, staffing levels, and goods and services produced. M&E is a key element of development assistance, to understand and track mutual contributions to a partnership. This is defined in DFAT’s Aid Programming Guide. Importantly, M&E needs to be considered, and defined before the start of any activity so that it can provide the evidence required to make assessments of program performance. Key guidelines for developing M&E are provided.

Monitoring and evaluation is an essential tool of management, extending to almost every aspect of public sector activity, including development. There are multiple purposes of M&E. It provides a basis for accountability to stakeholders. When reported clearly, M&E processes and outcomes help identify shared learning about a range of areas, including good practice, effective strategies and tools, and information about specific issues. M&E supports well-informed management through evidence-based decision making. All donors, bilateral and multilateral, conduct a large array of performance assessments at all stages of project or program cycles as part of their ongoing commitment to M&E. Donors also tend to align M&E to higher level, global commitments. The Sustainable Development Goals (SDGs) Goals are probably the best-known M&E mechanisms in development. The SDG indicators specify time-based goals to improve social and economic conditions in developing countries. SDG 4 sets out the goal to ensure inclusive and quality of all Specific indicators of a program/project are evaluated to assessprogress towards that goal.  M&E is to underpin the overall policy setting. Making Performance Count: Enhancing the Accountability and Effectiveness high-level priorities, broad programs and specific investments. This policy directive provides a credible and effective system for overseeing performance. ( United Nations 2017; DFAT 2014).

Monitoring is the regular tracking of inputs, activities, outputs, outcomes, and impact of development activities at the project, program, sector and national levels. It provides information by which Management can identify and solve implementation problems and assess progress towards project’s objectives (Jaszczołt, 2009).

Monitoring as a continuing function that uses the systematic collection of data on specified indicators to inform Management and the main stakeholders of an ongoing program/project of the extent of progressand  achievements (Guijt, 2008).

Evaluation is the systematic and objective assessment of an on-going or completed operation, programme or policy, its design, implementation and results. Evaluations should provide credible and useful information to enable the incorporation of lessons learned into the decision-making process (Jaszczołt, 2009).

Evaluation usually refers to infrequent in-depth studies that seek to understand changes in a certain situation as a result of a development effort, primarily in order to assess overall merit (Patton, 1997).

Evaluation relates to longer-term objectives and aims to establish a summary of activities that have taken place, whether these activities have achieved their desired objectives, and the extent to which they have had an impact on the lives of the intended beneficiaries (Estrella &Gaventa, 1998).

According to WHO, every country needs to have a strong monitoring and evaluation system in place as the foundation for national health sector strategic planning. It should cover and guide the implementation of all major programs and health systems activities. The system should not only address the need for better data, but it should be central to ensuring effective management and accountability (WHO, 2010).

The need to improve quality of health care is gaining prominence worldwide. Delivery of quality health care services is crucial since clients tend to seek out high quality services in the first place and are likely to complete the treatments that they receive (Brook et al., 2000). In Nigeria, enhancing the quality of care is a priority in health reforms (Ministry of Medical Services, 2008).

Performance monitoring is one important area of focus in the proposed reforms. Therein the Government of Nigeria states that it intends to improve the quality of hospital services by at least 50% when measured technically and by clients (GON, 2006). However, the included outputs and their indicators indicate a bias towards assessment of quality of services at the level of the health facility. In this direction, emerging reports indicate that patients are satisfied with their hospital visits (Ministry of Health, 2007); Ministry of Public Health and Sanitation, 2010). In such reports however, the assessment of the quality of care offered by different cadres of providers such as doctors, nurses and clinical officers (COs) is neglected or not explicitly emphasized.

The need to appraise the performance of individual health providers is a key health policy agenda in Nigeria (MOMS, 2008). Availability of reliable data on the quality of care offered by different cadres of health care providers is critical in monitoring health reforms and indicating areas where action is required.

This study however, focused only on COs, an important cadre of middle level health providers in the country (GON, 1990). Focusing on these providers is warranted since they are front line managers of patients in both rural and urban health facilities across the country (MOPHS, 2009).

Quality of care is generally defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Institute of Medicine, 1990). The definition highlights two components that are important to people. The first component is provision of high technical quality. Patients should receive only the procedures, tests, or services for which the desired health outcomes exceed risks by a sufficiently wide margin. The second component underscores the need of patients to be treated in a humane and culturally appropriate manner and be invited to participate fully in deciding about their therapy.

Operationally, the concept of quality in health care systems has at least three aspects: structure (structural measures give consumers a sense of a healthcare provider’s capacity, systems, and  processes to  provide high-quality care), process indicate what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition. These measures typically reflect generally accepted recommendations for clinical practice) and outcomes (Outcome measures reflect the impact of the health care service or intervention on the health status of patients) (Ahrq, 2015). Debate on which of these three measures of the quality of health care is appropriate is rife in literature (Donaldson, 1999; Brook et al., 2000; Campbell, 2010). Overall this debate suggests that quality of health care can be measured and improved. Assessing the quality of health systems in the developing countries, Nigeria included is attractive since health requirements are enormous and resources are always in short supply.


Monitoring & Evaluation tend to identify the strengths and weakness of healthcare delivery system. Monitoring & Evaluationenhance the quality of healthcare services through provision of accurate, reliable, consistent and valid data for proper planning, decision-making, resource utilization, and, research and education.Monitoring & Evaluation results are not properly applied,  M&E system that can make a well-informed decision and also design appropriate intervention, enhances the quality of services offered in health facilities is limited. In Nigeria there has been little evidence to suggest that M&E data have been used to ensure program accountability and sound decision-making (2010 Monitoring & Evaluation Report). When decision-makers want to use evidence from monitoring and evaluation (M&E) systems to assist them in making choices, there is a demand for M&E. When there is great capacity to supply M&E information, but low capacity to demand quality evidence, there is a mismatch between supply and demand,(Picciotto, 2009). Also the attitude of most healthcare providers in recognizing the impact of data management is already in alarming stage. Clinical officers(COs) are required to among others run health units, examine and treat patients, prepare legal documents such as medical certificates, death notification, police medical examination report (P3 forms) and present medical evidence in court. They are expected to offer services of the highest standards (MOH, 2005). In addition, the authorities concern to oversee the affairs of health facilities and control the quality of care rendered in health facilities were not giving much attention to quality control.

Emphasis was only giving in deploying financial and material resources to redress the   compounded issues surrounding data management. More over it is believed in some quarter that engaging nonprofessionals in data management will ameliorate the existing problem but rather deteriorate the situation in most cases.

Organizations are still short of accurate, reliable, relevant data for effective planning in other to make a well-inform decisions. With the persistence of inadequate data management organizations cannot utilize their resources effectively and efficiently.

Lack of accurate and reliable data affects government policies, plans and decisions in so many areas ranging from misinformation to under/over reporting of data. Limited monitoring & evaluation result-oriented system mislead organizational programs/projects priorities.

This research tends to identify and amend the strength and weakness of monitoring & evaluation in healthcare delivery setting.


To assess the importance of monitoring and evaluation (M&E) as a critical tool in measuring quality health care delivery in Aminu Kano Teaching Hospital (AKTH).The specific objectives are as follows:

  • To assess the importance of M&E as a critical tool in measuring quality healthcare delivery in AKTH.
  • To assess the performance of health care worker in AKTH
  • To assess patient satisfaction with services offered in AKTH


  • Is M&E a critical tool in measuring quality healthcare delivery in AKTH?
  • In what ways can the performance of health care workers in AKTH be assessed?
  • What is the level of patient’s satisfaction toward services rendered by health care workers?


Monitoring& Evaluation provides blue prints to the management of AKTH in utilizing their resources and also helps researchers in the facility, health organizations (National and Inter-national),have interest in monitoring and evaluation unit of AKTH which require accurate and reliable data,student and practicing Monitoring & Evaluation officers in AKTH will also find these work developing and training material, moreover these study will also intimate the public about the factors facilitating and militating effective monitoring & evaluation. Patients will also enjoy effective and efficient services.


This study is limited to the survey of monitoring and evaluation (M&E) in measuring quality healthcare delivery in Nigeria.The survey is carried out in Aminu Kano Teaching Hospital located in North-Western Nigeria. Data Assistants and data entry clerk in the institution were selected for the study. However, Monitoring and evaluation beyond Aminu Kano Teaching hospital will not be included in this research as it is beyond the scope of this study.


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Full Project – Monitoring and evaluation as critical tool in measuring quality healthcare delivery