Monitoring progress

In this step we look at the reasons why we monitor and evaluate district plans. This article is adapted from: Planning for VISION 2020 at the district level International Centre for Eye Health, London School of Hygiene & Tropical Medicine; 2006.

To measure is to know

There are four key reasons why we monitor and evaluate district plans:

1. To help everyone involved in the plan to track progress towards the agreed objectives and to enable necessary implementation changes to be made
2. To motivate staff through performance feedback
3. To provide evidence for fundraising
4. To share information with other programmes of the successes achieved and problems experienced in a specific district plan.

To monitor progress towards agreed objectives, we need to have clear indicators. These may need to be monthly, quarterly or annually depending on the purpose and level they are collected at.

It is essential that a monitoring and evaluation system is agreed and operational before implementation begins. By setting up a reliable management information system (MIS) at the beginning of the project we can establish baseline data and measure the impact of the plan’s later interventions.

Great care should be taken that selected indicators are:

• valid – measuring what is intended to be measured
• reliable – even when used by different people at different times
• sensitive – reacting to changes in the situation or target being measured
• specific – reflecting the changes only in the situation or target concerned. Monitoring indicators should focus on:
• the impact on the burden of blindness and visual impairment
• performance in prevention and treatment with respect to individual disease control
• human resource development with respect to the availability of technical skills
• development of the eye health system with respect to provision, resources and management.

All indicators collected should be used.

Monitoring will enable the management team to decide whether:

• objectives and targets are realistic/achievable
• strategies are effective and efficient
• the programme is well managed.

As we begin to plan, there will be a number of assumptions. Planning is a continuously evolving process: as implementation takes place, we learn more about the situation, gain a fuller insight and therefore through evaluating past practices we need to adjust and improve our strategies and targets.

For example, in any school vision health programme, the number of spectacles may initially be small. As uptake of refraction tests proceed, the number of spectacles needed increases and with it the cost of the intervention. This may require increasing the number of donors of spectacles or by requesting parents to pay (nominal cost). Subsequent procedures in other schools will be better prepared to expect this resource need to achieve the desired outcomes.

In this example, teachers maintain records of children referred for refraction, those who are wearing spectacles and children’s school performance before and after referral. These indicators enable:

1. progress to be tracked in reducing one cause of blindness which affects learning
2. assessment of procedures for controlling and reversing sight impairment caused by refractive error.

By carrying out regular monitoring we can reveal results which differ from the expected norm. This allows us to ask questions, work to improve procedures, and, ultimately, evaluate our plan’s original purpose.

Discussion

Who are the key stake holders interested to know the information from a monitoring process? How can/should management use this information?