Participatory Monitoring and Evaluation (PartMe)

This case study was originally published in the mHealth Compendium Volume , developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study, submitted by the implementing organization in March 2021, appear in the final section of this case study.

Introduction

About PartMe

PartMe is an ICT for development project that uses technology to facilitate data collection and information dissemination between SEND-Ghana, its grassroots partners, health providers, national health insurance and policy – makers in the health sector in Ghana. The project has developed and deployed an information management tool (customized ODK) to enable mobile data collection. This tool is installed on mini laptops and mobile phones, which have been distributed to the newly formed District Citizen Monitoring Committees (DCMCs). For data collection DCMCs download the surveys, while they have internet access, but during the data collection itself they don’t have to be online. Once the data has been collected, internet access is needed to submit the data to a remote server (central database).

At the SEND-Ghana office, SPSS software is being used to analyze the collected data. The findings are used by SEND for advocacy on the accessibility and utilization, as well the quality of implementation of pro-poor health policies. SEND conducted surveys to monitor the National Health Insurance Policy, the Free Maternal Care policy, the Community-based Health Planning and Service Policy. The findings are also being used to enhance the quality of SEND-Ghana’s website (http://www.sendwestafrica.org/) by ensuring regular and timely updates on the results of the surveys and advocacy activities.

In addition, a virtual platform (e.g D-Group) is being used to discuss key-issues on pro-poor health policies with stakeholders. The evidence from the reports are used to encourage policy makers to change the policies based on collected evidence and used to start sensitization activities by DCMCs in districts were citizens lack certain knowledge about health policies.

Evaluation and Results

In August 2014 an impact analysis was conducted. Results are expected in December 2014, however internal learning and review meetings conducted give very promising results for the PartMe program:

• 50 Focal NGO’s leading the 50 DCMCs effectively use the technology to collect data and improve communication
• 550 members of the DCMCs are trained and able to collect mobile data
• Mobile data collection using PartMe is 70 percent more efficient than paper based collection leading to more quality research reports
• More pro-poor policies have been reviewed based on evidence collected with the PartMe tool
• Based on data from research on the free maternal care policy, a sensitization program towards couples has been conducted in 25 districts reaching 3,200 participants; This has led to increased health seeking behavior by pregnant women, but also towards commitments to improve transport delays between communities and clinics through acquisition of tricycle ambulances
• Based on collected evidence in the free maternal care policy research an outreach program for 55 health professionals (nurses and midwives) in different districts was developed on respectful maternal care

Lessons Learned

• Evidence gathering is essential for effective public policy advocacy
• Using a mobile data collection system is much more efficient than paper based questionnaires
• A feedback system using SMS and Voice messages in local languages strengthened the message spread
• Equipping DCMCs with modern data collection tools and a feedback system gives them local credibility and empowerment; Some of the DCMCs members have been elected or appointed in the district assemblies

Collecting evidence in 50 districts provides benchmark data to compare districts; This gives input for dialogue with health providers and policy makers to define local action plans to improve health care

Conclusion

The shift from paper to electronic data collection has allowed SEND Foundation to create a better picture of civic involvement in Ghana. Starting this dialogue between DCMCs, local policy makers and health providers has created a focus on local improvements. SEND’s activities have also led to an increase in the number of subscribers of the National Health Insurance Scheme.

Project Updates

The PartME project utilized a mobile information management approach to empower citizens, collect data, and disseminate information for SEND GHANA’s monitoring and evaluation of government policies and programs, but is no longer active.

Following the end of the PartME project in 2015, SEND GHANA scaled the model up, incorporating it into its public policy advocacy work across all sectors. For example, the PartME model was used to implement the European Union-funded IMPROVE project, which focused on improving maternal health through participatory governance in Northern Ghana.

The PartME project contributed to improved maternal health service delivery (i.e., prenatal care, postnatal care, skilled delivery, and family planning) and increased responsiveness of health service providers and government. Citizens’ efforts to raise awareness of maternal health issues prompted stakeholder engagement, and project participants were able to gather evidence, monitor health service provisions, and engage in policy dialogues and responsiveness tracking.

Specifically, the project findings indicated that citizens were meaningfully engaged in regular and successful interaction with metropolitan, municipal, and district assemblies (MMDAs) and with ministries, departments, and agencies (MDAs) and achieved the following outcomes:

• Twenty-six district citizen monitoring committees (DCMCs) engaged their MMDAs to share outcomes and experiences of district sensitization on maternal health activities. Challenges related to the need for the demarcation and construction of additional community-based health planning and services (CHPS) compounds were identified and reported to the MMDAs. DCMCs raised a number of important health issues, including poor attendance at prenatal and postnatal clinic visits by pregnant women, limited uptake of family planning, low quality of healthcare services, lack of payment of taxes by citizenry, poor accountability by duty bearers, negative attitudes of health professionals, and the issue of respectful maternal health care. Based on this, MMDAs made commitments to improve maternal health delivery in the districts. Using mobile phones for data collection, about 100 issues were raised by DCMC to their MMDAs and MDAs.
• DCMCs secured 136 commitments from state actors during maternal health sensitizations and policy dialogues sessions. Examples include:

• • In Wa West, the district assembly is undertaking the construction of a maternity ward in Dorimo and a children’s ward with capacity for 40 patients at the District Hospital.
  • In Sissala East, four additional midwives were posted to the district, which has resulted in enhanced health care service delivery by reducing the client to midwife ratio.
  • Radio for Development, a locally based radio station in Sissala East, has fulfilled their commitment to provide free airtime to the district health department to sensitize the general public on maternal health issues.

• MMDAs and MDAs acted upon 78% of state commitments. Analysis of the responsiveness tracking data in SPSS software shows that 38 commitments have been delivered on completely (27.9%) while 68 are on track for delivery (50%).

The PartMe project ended upon its successful implementation, but the model has been scaled up to cover other sectors beyond health to ensure sustainability.