The national framework for data collection, analysis, and reporting developed by MoH presents several crucial weaknesses: (i) first, the system is mainly based on paper-based processes, making the process of primary data collection time-consuming and inefficient, data analysis difficult, and leading to lack of quality; (ii) second, there are incentives for data distortion, which come from the need to correspond to imposed norms/benchmarks; (iii) third, some of the statistical forms are outdated and inconvenient, while some essential health indicators are not tracked by the system; (iv) fourth, the data is rarely used for decision-making at all levels of government. This situation results in poor data availability, accuracy and promptness.
The M&E Subcomponent was designed to address existing system weaknesses in Project monitoring as well as improve data management in health. Specifically, M&E component has following objectives:
- The first objective is to collect the data for routine monitoring of the project performance and results achievement
- The second objective is to study the access and quality of medical services, households’ expenditure on health, public feedback to the Project implementation via household and facility surveys.
- The third objective is to improve capacity of MoH and participating Oblasts to monitor system’s performance and utilize evidence for decision-making.
Expected outcome of the M&E activities within the Project will include availability of more reliable data for Project monitoring and assessment, as well as enhanced capacity of government in organizing the data collection and use.
The first objective on routinemonitoring of the project performance and results achievement includes following activities
- To collect official medical statistics and programmatic data according to developed indicator
- To complement the official statistical data with analysis of medical record
- To validate the official statistical data by means
Performance monitoring will be conducted based on indicators presented in the Results Framework of the Project. All Oblasts as well as Central Components will report to PCSU according to indicators, relevant to their planned activities.
The routine data collection will be led by M&E Manager (the Head of M&E subcomponent), responsible for coordinating timely data collection, ensuring accuracy of information, and providing necessary reports to the World Bank, Head of PCSU and Project Coordinator. In Oblasts one staff and/or consultant will be responsible for providing data on relevant results’ indicators.
Activities for complementing and validating official statistical data will be coordinated by M&E Manager.The studies will be designed by contracted international consultants, data collection from medical records in relevant oblasts will be done by independent national consultants, summary reports will be written by international consultants with inputs from national consultants.
The second objective on studying access and quality of services, expenditure on health and public opinion will be reached by joint effort of MoH, PCSU, World Bank and hired consultants; latter will be responsible for methodology development, which will be presented to stakeholders in order to receive their comments and feed-back. Data collection will be done by national research company.
Within this objective two studies are planned to be conducted twice during the Project implementation:
- Household survey
- Facility survey
Within the Household survey we plan to research following topics: self-assessment of health status, information on access and utilization of health services, perceptions about the quality of care, financial barriers, and provider attitude, perception of health reforms/projects and views on the reform progress, as well as health spending patterns and informal payments.
The Facility survey will help to examine service delivery conditions in participating Oblasts. The following topics will be covered within the study: availability of drugs, equipment and services, status of infrastructure, staff presence and vacancies, facility-level management as well as community outreach and engagement. Survey will cover both primary and secondary level facilities in Project Oblasts with additional focus on subprojects’ objectives.
The third objective on improving government capacity to monitor performance and data use will be implemented by three main activities.
First, the rapid assessment of current system of data collection and use will be conducted by international consultant with expertise in HMIS. The assessment will include issues of data collection, processing and analysis, institutional capacity, transparency, information needs and use of information.
Second, based on rapid assessment and international experience the Strategy for System Strengthening and Rationalization will be developed by international consultant in close cooperation with MoH and national stakeholders. The Action Plan to be developed upon the Strategy is finalized.
Third, 2-days seminars will be conducted for decision-makers and M&E specialists from Oblasts to build capacityto manage information and utilize evidence for decision-making. The curriculum of seminars will cover topics of key M&E and HMIS principles, logical framework approach, results-based management and evidence-informed decision-making.
Activities under this objectives will be led by M&E Manager in close cooperation with representatives of Capacity Building and E-Health subcomponents.