BRIDGING THE MONITORING AND EVALUATION GAPS IN NIGERIA

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Monitoring and evaluation offer vital insights into the development, results, and outcome of public health efforts, assisting stakeholders in making data-driven decisions to improve health outcomes and allocate resources more effectively. Data availability is one of the M&E challenges in Nigeria’s public health system, which affects the evaluation and improvement of various public health activities and initiatives1,2. In low- and middle-income countries like Nigeria, healthcare facilities have struggled to maintain complete, accurate, and validated service delivery data over the years3. However, the health systems have been strained, especially since the COVID-19 pandemic which led to urgency in collecting, assessing, and analyzing all available data to gain insight into the scope and scale of the pandemic, as well as how the disease is spreading, and the effects of the actions put in place to control the pandemic. The strain on the health system can be ascribed to several factors such as a shortage of workers, a lack of technical knowledge, and an increase in patient flow3.

Another issue with the M&E system is the lack of adequate infrastructure and funding, which affects quality healthcare service delivery in rural areas more than urban4. Nigeria’s healthcare system is still in need of improvement and lacks contemporary health infrastructures and systems. There are roughly 35,000 doctors in Nigeria’s healthcare system compared to 237,000 required according to the WHO statistics5. At the same time, 180,709 nurses and 126,863 midwives were recorded to be available in March 2020 by the Federal Ministry Of Health6.

The Government of Nigeria approved the second national strategic health development plan (NSHDP II) to improve the planning and delivery of the health system and assure the availability and accessibility of health care to all Nigerians.  The Nigerian Sovereign Investment Authority (NSIA), in partnership with the Federal Ministry of Health (MOH), has signed a series of agreements to enhance and expand healthcare services through private-sector participation. The agreements aim to improve the M&E systems and build the capability of specialized hospitals and diagnostic facilities to deliver cutting-edge medical care services5.

The following suggestions can bridge the gaps in the M&E systems in Nigeria:

  1. Standardized Monitoring and Evaluation (M&E) Framework: Develop a standardized and uniform M&E framework for public health programs in Nigeria. This framework should include clear indicators, data-gathering techniques, reporting procedures, and evaluation timelines. A cohesive strategy will provide uniformity and comparability among various health interventions and initiatives..
  2. Capacity Building: Invest in training programs and workshops on M&E practices and training courses for healthcare professionals and program managers. This will improve their capabilities to gather, analyze, and understand data which will result in better evidence-based decision-making.
  3. Use of Technology: Incorporate digital tools and technologies into data gathering, storage, and analysis processes. Electronic health records and mobile data collecting technologies help accelerate data analysis and reduce errors during the M&E process.
  4. Involve regional groups and local communities in the M&E procedure: Incorporating grassroots stakeholder engagement can yield insightful information, guarantee the applicability of interventions, and promote ownership of public health interventions and initiatives.
  5. Public-Private Partnerships: Fostering public-private partnerships will help M&E initiatives by utilizing the resources and experience of the private sector, non-governmental organizations, and international organizations.
  6. Policy Support: Advocate for supportive policies that give M&E in public health programs and initiatives top priority. The integration of M&E activities and sustainable investment depends on commitment at the policy level.
  7. Research and Innovation: Encourage and promote M&E methodology research and innovation development. To supplement conventional data collection techniques, this entails investigating new data sources like big data and remote sensing.
  8. Long-term Funding: Integrate M&E operations in critical funding activities to ensure it receives sufficient and regular funding for sustainability. To continue M&E activities with its related benefits, and to be able to track long-term health impacts, sustainable funding is essential.

These recommendations could improve the M&E practices and systems in Nigeria. And could lead to better program outcomes, more evidence-based decision-making, and ultimately better health outcomes for Nigerians.

REFERENCES

  1. Federal Ministry of Health Nigeria. National health policy 2016: promoting the health of Nigerians to accelerate socio-economic development. Nigeria: Federal Ministry of Health Nigeria, 2016: 15–16. [Google Scholar]
  2. Azubuike MC, Ehiri JE. Health information systems in developing countries: benefits, problems, and prospects. J R Soc Promot Health 1999;119:180–4. 10.1177/146642409911900309 [PubMed] [CrossRef] [Google Scholar]
  3. Anifalaje AA. Decentralization and health systems performance in developing countries: impact of “decision space” on primary health care delivery in Nigeria. Int J Healthcare Delivery Reform Initiatives. 2009;1(1):25–48.
  4. Hart JT. The inverse care law. Lancet. 1971 Feb 27;1(7696):405-12. doi: 10.1016/s0140-6736(71)92410-x. PMID: 4100731.
  5. International Trade Administration https://www.trade.gov/country-commercial-guides/nigeria-healthcare
  6. Premium Times Nigeria https://www.premiumtimesng.com/health/health-news/561929-brain-drain-like-doctors-nigerian-nurses-are-also-migrating-many-to-uk.html – :~:text=As%20of%20March%202020%2C%20the,there%20are%20only%20126%2C863%20midwives.
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