Monitoring and Evaluation of Health Programs in Nigeria.
Nigeria has been one of the largest recipients of health aid in the last decade, and most critical public health interventions in the country are primarily funded by donors (Organization for Economic Co-Operation and Development, 2019). 2017 Nigeria was among the top recipient of Official Development Assistance to the health sector (OECD 2019). In addition, the country is accordingly the single biggest recipient of Global Fund grants, having been allocated over US$1.5 billion for the 2017-2019 and 2020- 2022 funding cycles (Global Fund Grants, 2023).
Despite the collaborative efforts of the Nigerian government, donor agencies, and nongovernment organizations (NGOs) to implement health interventions, health outcomes in the country remain poor. Recent estimates rank Nigeria fourth among nations with the highest Maternal Mortality Ratio globally (UNICEF, 2022; 2023), which begs the question of the effectiveness and sustainability of these interventions. This question is especially pertinent for Nigeria, where despite billions of dollars received for funding of health programs over the past years, more is needed to know about their effectiveness, impact, and sustainability. With the decline in donor funding, the question of effectively allocating limited resources with a more pronounced aim of impact and sustainability is germane. As a result, M&E has become a necessary component of health programs.
Like many developing countries, Nigeria’s public health M&E is weak. This was also reiterated by the Federal Ministry of Health in its Monitoring and Evaluation Plan for The Second National Strategic Health Development Plan (NSHDP) 2018 – 2022. “The End Term Evaluation of NSHDP revealed systemic weakness in Nigeria’s Health Sector M&E system including, but not limited to, lack of consensus on the roles and responsibilities across M&E structures, low priority given to M&E, poor demand for, and use of data and evidence for decision making; and fragmentation of M&E sub-systems notably due to vertical programs” (FMoH, 2018-2022). Thus, the availability of quality data for decision-making has become a significant problem.
key to a successful M&E implementation is a comprehensive M&E Plan that highlights what data is needed to be collected, how best to collect the data, and how to use the results of the data (MEASURE Evaluation, 2016). Several M&E plans have been developed in Nigeria, but not all aspects have been implemented. For instance, program areas within the health sector still have their disease-specific M&E systems creating vertical M&E interventions that make coordination and data sharing difficult and increase the burden of data collection on the service providers (FMoH, 2018-2022). Funding for M&E interventions is often lacking, even for capacity building and training of health care staff. The need for more human capacity to implement effective and efficient M&E systems in the country is another barrier to having good quality data available for decision-making about patient care or management of health facilities.
In recognition of the highlighted challenges and the large number of stakeholders in the health sector, the Federal Government of Nigeria, through the FMoH developed an M&E framework for the second National Strategic Health Development Plan covering the period 2018-2022 (FMoH, 2018-2022). The M&E plan was based on the WHO Global M&E Framework (WHO, 2018), which links inputs to intended results, ensuring that considerations are made for influencing and facilitating factors. The M&E Plan provides a tool to track and report Nigeria’s progress towards global health reporting requirements and global commitments such as SDGs. However, the M&E framework was not developed until almost midway into the implementation. The success of the M&E plan was dependent on sufficient funding and human resources with the adequate technical capacity to manage the various components of the M&E strategy (FMoH, 2018-2022), all of which are factors that have been identified as significant impediments to the successful implementation of M&E frameworks in Nigeria. In light of the above, the Nigeria M&E system is evolving, and issues of refining and building human capacity have become a priority for the government and other stakeholders.
To improve M&E efforts in Nigeria, there is a need to develop a robust M&E framework that outlines the goals, objectives, and indicators for each health program. The framework should be based on a logical or results-based management approach and should be designed to capture qualitative and quantitative data.
Capacity building is paramount. Nigeria needs to build capacity for M&E by providing training and technical assistance to government officials, civil society organizations, and other stakeholders. This will help to ensure that M&E efforts are standardized, rigorous, and systematic.
There is a need for effective data collection, analysis, and management. This can be achieved by establishing data collection protocols, setting up data management systems, and ensuring that data is regularly collected, analyzed, and reported. This will help ensure decision-makers have access to accurate and reliable data for informed decisions. Nigeria can leverage technology to support M&E efforts using mobile data collection tools, online reporting systems, and other digital platforms. This will help to streamline data collection and analysis processes and make monitoring and evaluation efforts more efficient and effective.
There is a need for Strengthened coordination and collaboration among stakeholders involved in M&E efforts. This includes government agencies, civil society organizations, donors, and other stakeholders. By working together, stakeholders can share information, resources, and best practices and ensure that M&E efforts are aligned with national development priorities.
Lastly, Nigeria needs to foster a culture of accountability by ensuring that monitoring and evaluation efforts are transparent and that results are communicated to stakeholders promptly. This will help to ensure that programs and project managers are held accountable for their performance and that resources are being used effectively.
The ultimate goal of health programs is to improve the health outcomes of the population. To reach this goal, Nigeria must devote its resources to monitoring and evaluation of public health interventions. However, since the targets of public health actions have expanded beyond infectious diseases to include chronic diseases and the social contexts that influence health disparities, the task of monitoring and evaluation has become more complex. Developing a responsive M&E system remains the answer in order to ensure that amidst the complex transition in public health, the government and key stakeholders will remain accountable and committed to achieving measurable health outcomes. Overall, improving M&E in Nigeria requires a concerted effort from all stakeholders.
Federal Ministry of Health (2018-2022). Monitoring And Evaluation Plan for the Second National Strategic Health Development Plan 2018 – 2022. https://health.gov.ng/doc/NSHDP_II_ME_Plan.pdf
Global Fund Grants in the Federal Republic of Nigeria (2023). Audit report. Available at: https://www.theglobalfund.org/media/11864/oig_gf-oig-22-003_report_en.pdf Accessed 04 May 2023
MEASURE Evaluation (2016). M&E Fundamentals. Available at: https://www.measureevaluation.org/resources/publications/ms-07-20-en/at_download/document Accessed 04 May 2023
Organization for Economic Co-operation Developments (2019). Development Aid at a Glance. https://www.oecd.org/dac/financing-sustainable-development/development-finance-data/World-Development-Aid-at-a-Glance-2019.pdf Accessed 04 May 2023
UNICEF (2022). Maternal Mortality. Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/ Accessed 6 April 2023
UNICEF (2023). Situation of Women and Children in Nigeria | UNICEF Nigeria. Available at: Situation of women and children in Nigeria | UNICEF Nigeria
World Health Organization (2018). International Health Regulations 2005- Monitoring and Evaluation Framework. Available at: https://apps.who.int/iris/rest/bitstreams/1164859/retrieve Accessed 05 May 2023