Monitoring & Evaluation

Monitoring the Health Workforce: Measurement Issues and Selected Tools

Drawing upon a combination of complementary data sources, both new and existing, can result in useful and rich information for measuring and monitoring health workforce stock and flows, and the impact on health and health systems. [from author]

Monitoring Education and Training for Health Workers

Measuring and monitoring the whole education and training pipeline is essential to the planning, management and quality control of the health workforce in a country. This requires timely and reliable data on each of its phases. [from author]

Health Systems Database

This easy-to-use web-based tool compiles and analyzes country data from multiple sources, provides charting options, and generates automated country fact sheets, helping users to assess the performance of the country’s health systems.

Are You Being Served? New Tools for Measuring Service Delivery

Improving service delivery for the poor is an important way to help the poor lift themselves out of poverty. This resource presents and evaluates tools and techniques to measure service delivery and increase quality in health and education.

Monitoring the Health Workforce: Measurement Issues and Tools

This brief provides a list of facility-based data collection tools that have been developed by the World Health Organization and other partners. The resources can be used to meet a wide range of specific information needs on human resources in health systems. [adapted from summary]

Developing a Competence Framework and Evaluation Tool for Primary Care Nursing in South Africa

Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. The objective of this study was to identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. [from abstract]

Assessing Clinical Skills: Standard Setting in the Objective Structured Clinical Exam (OSCE)

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

Guidelines for Evaluating Basic Nursing and Midwifery Education and Training Programmes in the African Region

The aims of these guidelines are to provide information about the concepts and processes essential for quality assurance of basic nursing and midwifery education in the African Region; propose a process and content for evaluating existing basic nursing and midwifery education programs; stimulate ideas for establishing a quality assurance system for basic nursing and midwifery education; guide allocation of human and financial resources in current and future programmes and services; provide well-defined international and regional standards of education. [from introduction]

Using HMIS for Monitoring and Planning: the Experience of Uganda Catholic Medical Bureau

Uganda has been successful in implementing the national “Health Management Information System” (HMIS). Disease surveillance reports and monitoring of key output indicators within the health sector seem to be the areas with the most remarkable advance. But little mention has been made on the importance of the use of information for monitoring performance indicators and for management/decision making purposes. The existing HMIS makes this possible.

TRACE: a New Way to Measure Quality of Maternal Health Care

To evaluate the quality of maternal clinical care, Immpact, a global research initiative, developed an innovative method, called TRACE, to trace adverse and favourable events in pregnancy care. It is based on the confidential enquiry technique, whereby expert panels of health care professionals assess the quality of health care provided to clients in an
adverse event, such as a maternal death. [author’s description]

Impact of an In-Built Monitoring System on Family Planning Performance in Rural Bangladesh

This article assesses interventions aimed at improving family planning mechanisms and reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the Ministry of Health and Family Welfare of the Government of Bangladesh. [adapted from author]

Guidelines for Introducing Human Resource Indicators to Monitor Health Service Performance

This manual describes the purpose and processes for developing and using a system of Human Resources for Health (HRH) performance indicators in order to monitor the activities of a public sector health service. It is particularly aimed at enhancing the management process in developing countries and draws on experiences of pilot work. [from purpose]

Mapping Capacity in the Health Sector: a Conceptual Framework

This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries.

Guide to Monitoring and Evaluation of Capacity-Building Interventions in the Health Sector in Developing Countries

The focus of this guide is the measurement of capacity for the purpose of monitoring and evaluating capacity-building interventions. It responds to a demand among public health planners, evaluators, and practitioners for advice on assessing the many aspects of health programming that fall under the rubric of capacity building. [author’s description]

IUD Training Site Assessment for Key Social Marketing Project, Pakistan

This IUD assessment tool provides performance standards for IUD provision based on type of visit-new client or revisit. It may be used as part of a programmatic performance improvement initiative, by the site or individual providers to self-assess or by external evaluators to assess achievement of the standards. Often, performance standards are used to affect change at multiple sites. [author’s description]

Measuring Health Worker Motivation in Developing Countries

A conceptual framework of motivation processes is presented and used to identify strategies and options for the measurement of health worker motivation in developing countries. Measures of motivation are broadly organized into determinant and consequent categories, and determinants are further distinguished in terms of measures that influence worker–organization goal congruence (“will do” motivation) and those directed toward goal striving (“can do” motivation).

Development of Tools to Measure the Determinants and Consequences of Health Worker Motivation in Developing Countries

Problems related to health worker motivation are remarkably pervasive, but to-date little attention has been paid to them in developing and transition countries. Basic tools to measure the determinants and consequences of motivation have not been adapted to contexts outside the industrialized world. This paper assesses the feasibility of transferring psychometric tools, typically used in industrialized countries to measure motivational processes, to other contexts. The paper draws upon two field studies conducted in two hospitals in the Republic of Georgia and two hospitals in the Hashemite Kingdom of Jordan.

Competency Development in Public Health Leadership

As the complexity of the challenges facing the public health workforce has increased, many have argued that insufficient resources have been devoted to the preparation of the workforce, including its leaders. Here we describe the growth of national advocacy for public health leadership and workforce development.

Cost-Effectiveness of Self-Assessment and Peer Review in Improving Family Planning Provider-Client Communication in Indonesia

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated.

Assessing Health Worker Performance of IMCI in Kenya

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

Health Systems Assessment Approach: a How-To Manual

The Assessment Approach is designed to provide a rapid yet comprehensive assessment of key health systems functions and related resources. The approach is organized around technical modules which guide data collection, and cover the following areas: stewardship, health financing, service delivery, human resources, pharmaceuticals, and ealth information systems. [publisher’s description]

Evaluating Teaching Effectiveness in Nursing Education: an Iranian Perspective

The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. [from abstract]

Participatory Supervision with Provider Self-Assessment Improves Doctor-Patient Communication in Rural Mexico

In this setting, physicians were already making site visits to clinics to monitor technical standards of care. An intervention was designed to reinforce doctors’ interpersonal communication (IPC) training. Under the intervention, doctors received IPC job aids, self-assessment forms, and tape recorders. They taped themselves during consultations and assessed their skills from the recordings, using the forms and in consultation with their supervisors. The self-assessment form and the supervisor assessment form were modified to be reproduced in this report. [publisher’s description]

Practice of Physicians and Nurses in the Brazilian Family Health Programme: Evidences of Change in the Delivery Health Care Model

The article analyzes the practice of physicians and nurses working on the Family Health Program. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams’ work agenda to their routine labour activities. [abstract]

Using Problem-Solving Teams to Improve Compliance with IMCI Guidelines in Kenya

The research described in this report investigated whether facility-based teams that had been trained and coached to develop and implement improvements in performance of the Integrated Management of Childhood Illness (IMCI) algorithm through problem-solving teams would improve case management. The study compared 21 facilities with teams and 14 without, all in rural facilities in Kenya.

Safe Motherhood Studies: Timeliness of In-Hospital Care for Treating Obstetric Emergencies: Results from Benin, Ecuador, Jamaica, and Rwanda

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

Safe Motherhood Studies: Results from Rwanda: Competency of Skilled Birth Attendants; The Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

Safe Motherhood Studies: Results from Benin: Competency of Skilled Birth Attendants; the Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)

Through its Safe Motherhood Research Program, the Quality Assurance Project carried out three studies to explore issues regarding competence of skilled birth attendants, the elements that contribute to an enabling environment and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility in countries with high maternal mortality ratios.

Quality of Obstetric Care Observed in 14 Hospitals in Benin, Ecuador, Jamaica and Rwanda

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

Improving the Management of Obstetric Emergencies in Uganda through Case Management Maps

Case management maps (CMMs) are a type of job aid: a sheet of paper with information that guides healthcare providers in treating patients. Each patient has his or her own condition-related CMM, which is maintained in the patient’s chart or on the wall near the patient’s hospital bed to inform providers of the treatment protocol, what treatment was provided when and by whom, what to do should a critical event occur, etc. This report describes a study that implemented two CMMs that were introduced about a year apart in a 500-bed hospital where such job aids had not previously been used.