Principles of monitoring

SPEAKER: Welcome. By the end of this presentation, you should be able to define monitoring, explain process, outcome, and impact indicators and relate them to the level they are collected at, and explore the role of managers in monitoring.

In this stage of the planning cycle, planners consider the implementation of the project. Step five is the monitoring phase. This is planned in detail at the beginning of the project and then managed throughout the project lifespan. Imagine that you have planned a journey from point A to point Z. In the plan, you know what car you will use, the routes you will travel, how many people will be travelling, and the amount of fuel needed for the journey. You also have an estimate of the time for travelling. Once the journey starts - the implementation of the plan - every few hours, you look at the fuel gauge, check the distance travelled, and perhaps even ask how the passengers are doing.

This is known as monitoring. You may have planned to assess this information at several points along the way. Here, you decide if the car needs to be refuelled or if a break is necessary to rest the passengers. Information on fuel, distance, and how the passengers are doing are referred to as indicators. Indicators tell you how the journey is going.

Monitoring is the continuous surveillance of the implementation of a programme or project. Monitoring activities check if a project is proceeding according to the plan. Are you doing what you said you will do?

Monitoring is important for a number of reasons. What gets monitored is more likely to get done. If you don’t monitor performance, you can’t tell success from failure. If you can’t see success, you can’t reward it. And if you can’t recognise failure, you can’t correct it. Finally, if you can’t demonstrate results, you can’t sustain support for your actions.

In any plan or programme, achievement is aligned with completion of objectives and there are usually several activities that need to be carried out for an objective to be achieved. Each activity requires inputs, such as finance, resources, et cetera, and for specific tasks to be completed. This is known as the process. As a result of process, activities and objectives are completed. And this, in turn, leads to an outcome and an impact.

Indicators measure what or how much has been done. Process indicators provide information on tasks done and inputs consumed as part of activities to achieve objectives. Process indicators are collected regularly on a weekly, monthly, or quarterly basis. Outcome indicators are used during a project to assess if the path taken is working well and if changes need to be made to the plan’s objectives. These are collected over longer intervals, once or twice a year. An impact indicator is an indication of change that has resulted from a plan. Impact indicators are collected and reported on at the end of a project, after objectives have been completed.

In any programme or plan, it is important to decide what information should be collected and when. Planners must decide on what could be monitored, what should be monitored, and what must be monitored.

For example, Zrenya District eye unit develops a plan which aims to reduce cataract blindness in the district. One of the plan’s objectives is to increase cataract surgical rate by 50% each year. The unit decides to carry out several activities to achieve this objective. Two of the main activities are to establish regular outreach and to improve surgical efficiency at the hospital. To check that these two activities actually happen and to manage their progress, managers regularly collect data on several process indicators, such as the number of outreach operations and hospital surgeries carried out each month.

To see if activities actually make a difference, managers review the data and calculate an outcome indicator, in our example, cataract surgical rate at the end of each year to see if it has increased by the required 50%. Impact indicators are more complicated and may require a new population-based survey to be carried out to the end of the implementation phase of the project.

Here are some examples of process indicators– number of cataract operations per month, visual outcome of every 100 operations, number of patients diagnosed with refractive errors per month, expenditure and staff salaries per month, income from user fees per month, and number of outreach activities per month. Here’s some examples of outcome indicators– the cataract surgical rate– this is the number of surgeries per million each year– the percentage of schools where vision testing has been completed in a year, the number of community health workers trained in eye care in a year, and the percentage of poor outcome following cataract surgery, less than 6/60 in a year.

Here’s some examples of impact indicators– prevalence of cataract blindness at the end of a five-year period, percentage of self-sustaining school vision testing programmes in the district after three years. Golden rules for monitoring– do not collect too many monitoring indicators or collect indicators too often. Use all the monitoring indicators you collect and discard indicators that aren’t used. Use the monitoring indicators at the level that they are collected at, as process, outcome, or impact. Educate stuff about the need to collect monitoring indicators. And don’t make things worse. Don’t destroy a monitoring system that works. Managing monitoring– planners need to decide who collects the indicators at each level.

Once the data has been collected, where are the reports sent and who will review them? And how will the programme act on the feedback from the review? These are key details that must be managed by the programme or project manager. Appropriate selection and training of key people to carry out monitoring is essential. As an example, let’s return to the Zrenya eye unit’s plan to reduce cataract blindness in the district.

In order to monitor activities towards the objective of increasing cataract surgical rate by 50% each year, the outreach clinical officer must send back a report on the number of outreach surgeries that are being done each month and the theatre nurse must also report monthly on the number of surgeries done with the hospital. These reports are collected and reflected on by the manager on a regular basis. It is important that the district manager gives feedback to staff about how the plan is doing. The district manager reports to the national coordinator. At the end of the programme period, it is the final responsibility of the national coordinator to identify resources and address the impact of the programme.

Collecting the right data is important to guide the programme and its success. There is a saying that if you put rubbish in, you get rubbish out, so planners must remember to select indicators properly. In summary, monitoring is important because it improves accountability for the use of funds and resources, improves performance to achieve outcomes, and provides a system for recording lessons learned. These can then be shared to improve strategies in the future.