Act Together

Program Team Monitoring

The program team monitors the overall program, including progress on health, community capacity, and process indicators and its own performance to inform team building and program learning.

To monitor progress on health status, your team may use the same types of monitoring tools as used by community groups (service statistics, community-based health information systems, such as SECI, periodic surveys, and other surveillance systems). It is not sufficient to merely collect the data; the whole team needs to review, analyze, and discuss the information on a regular basis. Depending on your particular circumstances, you may decide that monthly, bi-monthly or quarterly reviews are reasonable. Some information may only make sense to collect every six months or annually (e.g., household surveys), and this information can be incorporated into the regular review meeting.

BOLIVIA: Using Health Information to Catalyze Action and Monitor Progress A community health information system, "SECI", consolidates primary health care data collected by community health promoters and health service providers using simple forms and community maps. The methodology facilitates increased communication between communities and health service providers first by bringing promoters and service providers together to consolidate the data. They then present the data in easy to understand graphics to the community so that together they can obtain and analyze new information about community health problems and articulate health priorities that reflect the community's perspective. The methodology builds in a series of analytic questions and ways to present the data so that community members and service providers can compare trends over time, monitor progress and determine where alternative strategies are needed. Community representatives share the consolidated information, plans and strategies that have been developed and other results of these community meetings at district level meetings. As changes are implemented, the health information system helps the communities and health staffers work together to monitor progress toward achievement of agreed upon objectives and make decisions on municipal and community resource allocation. Working with District, Regional and National Ministry of Health and Johns Hopkins University staff, SC/Bolivia developed and field tested the components of the health system including a manual, health problem picture cards, and pictorial ways of presenting quantitative information to literate and illiterate community members. SC/Bolivia also worked with local partners at the national, regional, district and community level to develop a complementary software package. The software package consolidates community level data from health promoters with national health information system service-based data and translates this more complete epidemiological picture into graphics that can be used with communities. Designed to be fun to use, the software package helps service providers at the district level analyze the data to help them plan program strategies. SECI meetings stimulated joint community and service provider action that led to a number of significant achievements to improve health services. Some examples of these achievements include: In Tarucamarca community, community members expressed their concern to hospital staff that in spite of mass media promotion of the new national health insurance benefits that announced that services for children under five and pregnant women were now free, the hospital continued to charge for consultations. The district nurse explained that the hospital felt obligated to charge for the services because the mayor of the municipality had not reimbursed the hospital for its costs over the last eight months. Community leaders met with the mayor to insist that he pay what was owed to the hospital. The mayor reimbursed the hospital what was owed and services are now covered by municipal funds as per the national policy. In Huayllamarca, in a SECI meeting, community members lamented the poor conditions in the hospital. Save the Children/Bolivia offered to assist with $2,000 to upgrade the hospital on the condition that the community work with the mayor to contribute also. Community pressure to fund this activity led to inclusion of a line item in the Municipal Operational Plan for $6,000 to upgrade health services. The hospital and community are now making the improvements and the mayor's office is disbursing the funds. In Amachuma, lay midwives became angry when they saw that the births that they had attended were being classified as 'yellow' (risky) on the 'health flag' used in the SECI feedback session, and insisted that their deliveries be considered 'green' (safe). The community, midwives and health service providers arrived at an agreement that the births attended by midwives could be considered 'green' if the midwives successfully completed a formal training course in safe birth. As a result of monitoring and these and other joint actions, child immunization rates increased significantly as did Vitamin A supplementation, growth monitoring, immediate breastfeeding, institutional births and other preventive health practices. JHU/PCS4 Project, Save the Children Federation Bolivia Field Office & District Ministry of Health Team

You will need to decide whether you will do joint reviews with community groups or whether you will do an internal program team review and then accompany community groups in their own analysis. Regardless of who participates, you will need to determine the range of participants’ knowledge and skills related to numeracy concepts (percentages, denominators, and other basic statistics) and how participants interpret information. Can they understand pie charts, bar graphs or other types of presentation? Don’t assume that everyone has these skills. Experience suggests that many field workers, even those with high school and university education, may not have a good understanding of these concepts. They may feel embarrassed and try to hide their confusion. A basic math class for everyone may be a good investment for your team if this is your situation. Even if some members have no problems with math, they can benefit from the course by learning appropriate ways to introduce these concepts in communities where project participants are grappling with quantitative information.

In addition to monitoring change over time, you should also monitor the types of assistance that community groups may need in the future and prepare your team to be able to provide this assistance or identify other possible sources of help if you cannot, or choose not, to provide the assistance yourself. As your team members gain experience, they will often be able to spot potential challenges that communities may face or be able to identify current issues that are blocking progress that those most closely involved may not yet be able to see.

Similarly, your own team may deal with many of the same issues that are blocking the community’s progress. You will need to identify these issues and address them with your team internally. For example, after a year of project implementation, it became clear to program managers that the Warmi project team was experiencing many of the same gender issues internally as were evident in the communities with which they worked. Rather than ignore the issues, the program managers believed that the team was strong enough at that point to deal with some of them. They held a workshop that looked at how gender relations affected the effectiveness of teamwork. Team members identified specific instances in which these issues hindered progress or strained working relationships, and team members came up with their own proposed strategies and solutions. Over the next six months, the team implemented its strategies and then reviewed its progress. This intervention significantly improved team members’ attitudes and behavior toward each other and strengthened team effectiveness. It also affected how they worked with community groups on these same issues, issues that were key to improving women’s status and ultimately reducing maternal mortality, the project’s goal.

Monitoring changes in the key underlying themes (sometimes also thought of as process outcomes), such as power relationships, gender, autonomy, shared responsibility, and quality, usually tends to be a more qualitative exercise. Generally, this type of information can be collected through transcripts or notes from community meetings, field worker diaries, in-depth interviews with participants and non-participants, periodic use of the “community history” technique, and a number of other participatory techniques such as socio-dramas, drawing and dialogue, storytelling, or puppet shows. The Puentes (Bridges) project videotaped most community meetings throughout its implementation. An anthropologist reviewed all of the tapes and transcripts and analyzed them, noting the evolution of dialogue between service providers and community members related to the underlying themes (see the project design example at the end of Phase One). This analysis was used to document changes over the life of the project related to these themes and helped the project team identify areas for further exploration during the Evaluate Together phase.

In addition to identifying areas in need of attention or adjustment, monitoring also identifies successes. It is very important to celebrate these successes with communities. Each success, however small, contributes to a growing sense of confidence and accomplishment and motivates participants to continue their efforts. Furthermore, successes often point to areas in which community group capacity is being strengthened. Refer back to your community capacity building plans developed earlier in this phase to document progress and propose new objectives if participants want to do so.

Finally, as with any program, your team will also need to monitor the overall management of program activities, including budget versus expenses, work plans, personnel performance and staff development, reporting to donors, relations with partners, management of logistics, and program resources.

Individual and Family Monitoring
Community and Group Monitoring
Donor and Stakeholder Monitoring