2 - The Role of M&E in The Program Space

Monitoring and Evaluation of
Health Programs
Session II: The role of M&E in Program
Improvement
For MPH Students
HU, School of PH
November, 2022
Session Objectives
 After completing this session, students are expected to be

able to:
 Describe program as a system of actions
 Discuss the role of M&E in the program system
 Describe different components of an M&E system
05/20/24 The role of M&E in program improvement 2

The object of evaluation?
 Medicine deals with patients
 Education deals with students
 Zoology deals with animals
What is the object of evaluation?

The object of evaluation cont…
 The object of evaluation could be:

 Students for student evaluation
 Products for product evaluation
 Staff for personnel evaluation
 Software for software evaluation
 The focus of this course is Program Evaluation

 Our object is “Program”
What is a program?

Two views to define a program
Views
Systemic view Linear Rationalist view
Program as a complex Program as linearly connected

General
system of actions components
Socio - technical process
Technical process (Objectives -
Process (Structure - Process -
actions - results)
Finalities)
Continuous transformation of
form with changes in context
and time (changes in
Definite form, fixed in space and
structure, process and
Adjustment over time
finalities as a result of
s
interaction with a changing
environment)
Reflexive Non-reflexive
Program as a system of actions

Program as a system of actions
• System is a set of
interacting or
interdependent entities
forming an integrated
whole.
(Wikipedia)
The role of M&E in program

05/20/24 8
improvement
Program as a system cont…
 Characteristics of systems
 Systems are abstractions of reality.
 Systems have structures defined by their parts and

relationships between them.
 The various parts of a system have functional as well as

structural relationships between each other.
 Systems have behavior, which involves inputs, processing

and outputs.
 From systemic view, Potvin, et al. defined a program as:
“systems of actions in which actors mobilize

knowledge, networks and resources in order to produce
some change”.
 She also argued that programs can only be represented and such
representations are necessarily partial and biased in order to
highlight specific features to support specific interests.
The Program Space
Time
Context Program
Form

The Program Space cont…
 Time
 Programs are dynamic systems that change themselves
through time
 Most programs reached their current status by evolution, not
just created at a point in time

E.g. PMTCT → PMTCT option “B” → PMTCT option
“B+” → PMTCT option “A” → ?
 Discussion question:
• How do you see priorities of the Ethiopian health policy in light of
time element?

 Context
 The environment in which programs exist
 Social, political, physical
 Form
 The structure, process and finalities of a program

Time
Process
Structure Program System
Finalities
Context
Form

The Program Form
 Structure
 Is the socio-technical network consisting of relations amongst
actors, knowledge and resources
 Defined by its elements and the relationship that exists between

them
 Includes a range of almost indefinite relationships between

different constituents which can be categorized into operationally
manageable artificial categories (eg. internal and external, strong
and weak, etc.)

The Program Form cont…
 Process
 Series of activities that are linked to each other by their

intended finality/result.
 Involves activities that are performed by

 Actors
 Users

The Program Form cont…
 Finality/Result
 Is the change that is expected following the

implementation of processes
 are operational ends of programs
 In reality, no result can be considered as a program’s

end result.

What happens to these components of a program form
(structure, process and finalities) as the environment
changes through time?

The program dynamics
 The form of a program changes from time to time as the

environment in which it exists changes.
 This dynamic nature of program forms is called program

reflexivity (Potvine).

Program as a system of actions cont…
Time
Process
Structure Programming
System
Finalities
Context
Form

Program as a system of actions cont…
Time
Process
Structure Programming
System
Finalities
Context
Form

Program Reflexivity
 Transformation of program forms based on
information generated by the program
 Such changes are natural to programs
 But are they important to program implementers?

 What about to beneficiaries?
 Can program managers control the extent and direction of
change?

Program Reflexivity
 Systemization of this transformation process in order to align the
direction of change with the needs of program stakeholders is
what we call M&E system (Evaluation system for some
authors).
 Therefore, the role of M&E is guiding the transformation process
of programs/projects.

The program dynamics
Context
i t y
xiv
e f le
R
Time
05/20/24 24
improvement
Program as a system of action
Time
Process
Structure
Program System Systemization
Finalities
Context
Form
05/20/24 From Louise Potvin (adapted based on permission)

25
The role of M&E in program improvement
Program and M&E systems in the
program space
Time
Program M&E System

System
Context
Form

 Implications of understanding program as a system of actions
changing its form with context and through time
 Organizations need to have a process to systematically guide

program/project transformation processes
 M&E system
 Deviations from program designs should not always be

considered as implementation failures as a dynamic program
transforms itself to fit in the changing environment.
 Evaluations should take the responsibility of assessing the

worth of deviations from initial “program” design

Program and M&E cont…
Time
Program M&E System

System
Context
Form

Components of M&E Systems
 Like any other system, M&E systems have also dynamic
forms with three interrelated components changing with
context and through time.
 Structure: socio-technical network of people, knowledge and
resources for M&E
 Process: set of interrelated activities that lead into the

achievement of M&E results
 Finalities/Results: improved program functioning,

accountability and knowledge about interventions leading to
improved social conditions

Structure of a M&E system
 Socio-technical network to enable implementation of
M&E activities possible and useful
 A complete M&E structure in the health sector requires:
 M&E unit in the organizational structure
 Expertise (M&E and programmatic)
 Budget for a costed M&E Plan
 Established inter and intra organizational networks of stakeholders
 A culture of informed decision making

Processes in a M&E system
 Processes in a M&E system include:
 Routine data collection (HMIS)
 Performance Monitoring
 Data based quality improvement processes
 Surveillance and surveys
 Evaluations addressing priority questions
 Sharing M&E results / dissemination

Finalities/Results of M&E Systems
 Intermediate results
 A culture of informed decision making
 Improved performance and quality of programs
 Longer term
 Improved social conditions

Components cont…
An example from the World Bank
12 Components for HIV M&E
Read further at
http://gametlibrary.worldbank.org/
05/20/24 34
improvement
Further readings and references
(1) Carol H.Weiss. Understanding the program.
Evaluation. Second ed. Prentice Hall; 1997. p. 46-71.
(2) Louise Potvin and Sherri Bisset. There is More to
Methodology than Method. In Louise Ptvin and David
Mc Queen, editor. Health Promotion Evaluation
Practices in the Americas.
(3) GAMET HIV M&E library available at
http://gametlibrary.worldbank.org/

Class Activity
Develop components of M&E for TB prevention
and control program in Ethiopia

Any Question?
I THANK YOU!

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Monitoring and Evaluation of

For MPH Students

 After completing this session, students are expected to be

 Describe program as a system of actions

 Discuss the role of M&E in the program system

 Describe different components of an M&E system

05/20/24 The role of M&E in program improvement 2

 Education deals with students

 Zoology deals with animals

What is the object of evaluation?

05/20/24 The role of M&E in program improvement 3

 The object of evaluation could be:

 The focus of this course is Program Evaluation

05/20/24 The role of M&E in program improvement 5

Program as a complex Program as linearly connected

05/20/24 The role of M&E in program improvement 7

The role of M&E in program

 Systems have structures defined by their parts and

 The various parts of a system have functional as well as

 Systems have behavior, which involves inputs, processing

“systems of actions in which actors mobilize

05/20/24 The role of M&E in program improvement 11

just created at a point in time

05/20/24 The role of M&E in program improvement 12

 The environment in which programs exist

 Social, political, physical

 The structure, process and finalities of a program

05/20/24 The role of M&E in program improvement 13

Structure Program System

05/20/24 The role of M&E in program improvement 14

 Defined by its elements and the relationship that exists between

 Includes a range of almost indefinite relationships between

05/20/24 The role of M&E in program improvement 15

 Series of activities that are linked to each other by their

 Involves activities that are performed by

05/20/24 The role of M&E in program improvement 16

 Is the change that is expected following the

 are operational ends of programs

 In reality, no result can be considered as a program’s

05/20/24 The role of M&E in program improvement 17

05/20/24 The role of M&E in program improvement 18

 The form of a program changes from time to time as the

 This dynamic nature of program forms is called program

05/20/24 The role of M&E in program improvement 19

05/20/24 The role of M&E in program improvement 20

05/20/24 The role of M&E in program improvement 21

 Such changes are natural to programs

 But are they important to program implementers?

05/20/24 The role of M&E in program improvement 22

 Systemization of this transformation process in order to align the

direction of change with the needs of program stakeholders is

what we call M&E system (Evaluation system for some

 Therefore, the role of M&E is guiding the transformation process

05/20/24 The role of M&E in program improvement 23

05/20/24 From Louise Potvin (adapted based on permission)

Program M&E System

05/20/24 The role of M&E in program improvement 26

 Organizations need to have a process to systematically guide

 Deviations from program designs should not always be

 Evaluations should take the responsibility of assessing the

05/20/24 The role of M&E in program improvement 27

Program M&E System

05/20/24 The role of M&E in program improvement 28