Monitoring and Evaluation
The purpose of the PAIMAN monitoring and evaluation component is:
- To track implementation of project activities, as planned and suggest corrective actions where needed.
- To document and disseminate lessons learned from project planning and implementation
- To evaluate the impact of the project on maternal and neonatal health status
- To provide evidence regarding the effectiveness and reliability of interventions for possible scale-up
- To increase the capacity of the health system, especially at the district level, to monitor and evaluate MNH activities.
The conceptual framework for the M&E plan builds on the "Pathway to Care and Survival" framework and specifies the causal linkages among project outcomes, behavioral and systems strengthening components of the MNH project. It assumes that improvement in health status of the mothers and children are the results of better knowledge, skills and practices of the mothers, family members, especially husband, and care providers (Fig 1). Improved behaviors of mothers and family members and care providers, in turn, are assumed to be brought about by strengthening the health systems processes. Thus, by measuring changes in each component and relating it to outcomes, it would be possible to separate out the direct and indirect impact as well as the overall magnitude of the impact created by both components and their specific activities.
The outcomes of the project are operationalized as a) increased demand for health services as reflected by improved health seeking behaviors of the mothers and b) decreased complications of pregnancy, decreased case fatality rate for hospitalized mothers and children (Fig 1). Changes in behaviors of the mothers and care providers will be the immediate impact of the systems strengthening interventions. Illustrative indicators include improved knowledge of pregnancy-related risk factors, complications during pregnancy, safe birthing practices and health-seeking practices. The project would improve health providers' skills to provide essential obstetric care, better counseling, and maintaining quality of services. By improving the skills and quality of care, it is assumed that utilization rate of the facility would increase. There is also a causal link between counseling skills of the care providers and changes in the mothers' knowledge and practices, which would be tested during the project life.
Health systems strengthening interventions are varied and would target both non-government organizations and public health sector (Fig 1). NGOs and other civil society partners/members would assure community participation in and accountability of the health system. Increased accountability of the health system would mean community representatives taking actions to improve staff availability, lower absenteeism, essential supply availability, quality of care and service target monitoring. NGOs will play an important role in ensuring improved community participation in promoting maternal and neonatal health.
Proposed Conceptual Framework of PAIMAN M&E Plan