Monitoring & Evaluation

Performance lmprovement (PI), a process pioneered in industry, is now helping to strengthen reproductive health organizations. PI focuses on meeting the needs of service providers and other staff members. When programs enable and inspire staff to do their best, the quality of care improves. [author’s description]


This Population Report covers how to: define desire performance, describe actual performance, measurs/describe performance gaps, find the root causes, select and implement interventions, monitor and evaluate performance and manage change.

This monograph provides an introductory overview of QA for developing countries. It will be of interest to policy makers, upper-level ministry of health (MOH) officials, and district-level health service managers. Part I describes how quality assessment and improvement have been carried out in less developed countries (LDCs). Part II discusses the feasibility and rationale for applying QA in the developing world. Part III proposes some definitions and dimensions of quality. Part IV reviews the definition and basic tenets of QA.

This monograph presents a conceptual framework to help healthcare systems and organizations analyze, plan, build and sustain efforts to produce quality healthcare. The framework synthesizes more than ten years of QA Project experience assisting in the design and implementation of QA activities and programs in over 25 countries. [author’s description]

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card.

Training and innovative tools were key to the success of the Tanzania Essential Health Interventions Project, along with small funding increases. The tools and strategies allowed the districts of Rufiji and Morogoro to target their new resources on the largest contributors to the burden of disease and on health care delivery. The most dramatic result, among many, has been an average decline in child mortality of more than 40%. [from author]

The 2003 technical review report covers only one main strategy: district health services. It looks at district health service performance from the viewpoint of Council Health Management Teams (CHMT) and LG. The report presents a short general appraisal of district health services (section 1). Planning and budgeting for better health (section 2) looks at what the requirements are for a performing planning and budgeting process (section 2.1, including guidelines and process) and what information should be available at council level to develop a comprehensive council health plan (section 2.2). Issues related to implementing the council health plan (section 3) include financial resources (3.1), non-financial resources (3.2), systems development (3.3) and service delivery (3.4).

A successful leprosy care and control program within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of, and practical training on, leprosy. This study describes PHC workers’ knowledge of leprosy, and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa, where leprosy still occurs. [author’s description]

Health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis, while the results of the district hospital performance data and in-depth interviews are reported elsewhere.

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and, most acutely, by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa. The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. [author’s description]

The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement. [abstract]

This tool permits countries to compare performance with objective standards for health information and provides the basis for evaluation of country health information systems. The tool consists of a standardized questionnaire through which the current status of the health information system is evaluated against specific criteria. The tool provides both a baseline asssesment, diagnosis of critical gaps in health information results, processes, context and resources; and also serves as an ongoing monitoring tool to gauge performance and achievements. [author’s description]

This framework paper is aimed at policy makers who are involved in the development or management of programmes in the health sector in developing countries. It provides a snapshot of the type of information and communication technology (ICT) interventions that are being used in the health sector, and the policy debates around ICTs and health…The paper describes the major constraints and challenges faced in using ICTs effectively in the health sector of developing countries.

This Kwik-Skwiz addresses the important area of clinic supervision. This document is aimed at district management teams; clinic supervisors and program managers may find it especially useful. Key areas of effective supervision are presented with the aim of assisting district management teams to critically assess clinic supervision in your district. [author’s description]

The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that trainees go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often face constraints that limit their ability to provide quality services. Factors that can affect the performance of the healthcare provider include: job expectations, performance feedback, supplies and equipment, motivation, possessing the knowledge and skills to provide services, and supervision.

This report presents the results of a longitudinal, quasi-experimental study evaluating the introduction and use of COPE and the resulting changes in service quality in two countries, Kenya and Guinea. At the end of a 15-month period, providers’ attitudes, providers’ ability to solve problems, service quality, and client satisfaction were assessed at eight intervention sites and at eight matched control sites, using both qualitative and quantitative methods. [author’s description]

During the past several years there has been a global trend in business and industry to move from training to performance improvement. This paper presents a review of selected performance improvement and training literature that has been helpful to JHPIEGO in identifying issues related to this trend and in shaping our performance improvement strategy. [author’s description]

The Performance Improvement approach gives organizations the tools they need to find out which essential components of good performance are missing, and then match interventions to root causes, closing the gaps between the performance they are experiencing and the performance they desire.


This document is in English, French and Spanish.

COPE, which stands for “client-oriented, provider-efficient” services, is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients’ needs. COPE provides staff with practical, easy-to-use tools to identify problems and develop solutions using local resources, and it encourages all levels of staff and supervisors to work together as a team and to involve clients in assessing services. Through COPE, staff develop a customer focus, learning to define quality in concrete terms by putting themselves in their clients’ shoes.

This report summarizes findings from Phase 2 of a two-phase case study to determine why certain reproductive healthcare facilities in low-resource settings perform better than others. The study examined the characteristics, behaviors, and coping strategies of high-performing reproductive healthcare facilities in Kenya, exploring elements of resilience and factors influencing performance.

While the need to measure performance in the field of family planning and reproductive health care FP/RH) is widely recognized, there is no consensus on a standard definition of the term. Consequently, when organizations and projects describe or measure performance, particularly in the context of health worker or program evaluations, the term may be used in ambiguous and confusing or even contradictory ways. [author’s description]

To identify problems and barriers to [family planning] services specific to each district, to provide data that could assist with project implementation, and to allow determination of benchmarks and targets to measure success, the project started with a baseline assessment of facilities, providers, and community members in the five core districts. The objectives of the assessment were to evaluate factors contributing to the current use of FP services, including: the supply of FP in the public and private sectors: the availability and quality of facilities providing FP services, including the availability of contraceptive methods, IEC materials, and trained providers; and the demand for FP: the population’s knowledge of, attitudes toward, and practice of pregnancy prevention.

In family planning programs, good face-to-face interaction between the client and providers is key to meeting clients’ needs and program goals. Programs can best improve client-provider interaction (CPI) when they move beyond just training providers and strengthen CPI continuously in multiple ways. [summary]

Using all of the tools in the document will provide a comprehensive assessment of skills and service delivery. Each tool, however, may be used separately or combined with others to create a document appropriate for the content of a specific maternal and newborn health training course. [author’s description]

This document summarises underlying evidence and issues related to good human resource management (HRM)in the health sector with reference to: (a) indicators of performance and measurement of nursing outcomes; (b) performance issues related to individuals and teams; and (c) employee engagement, commitment and organisational citizenship behaviour (OCB). There are two key themes: What are the interventions and indicators associated with good HRM outcomes, and how can these be measured? [author’s description]

This review paper…looks at strategies that have been undertaken to increase the productivity of health workers. It examines the evidence to support or reject the hypothesis that short term training, incentives, better equipment, supplies and conditions and other things can be employed that improve outputs and health outcomes without increasing the numbers of health workers. The review provides an overview of key aspects and options for improving productivity, with country illustrative examples. [author’s description]

This study analyzed and compared the knowledge base of trained community health workers with that of doctors and nurses in Afghanistan to determine the differences in their abilities to provide healthcare and health information to patients.

The Population Council and The Pubcomm Group, Inc. have developed simple, inexpensive, user-friendly computerized job aids to assist supervisors in improving the quality of family planning, maternity care, and postabortion care services. The software is free to download. [publisher’s description]

Against the backdrop of growing concern about shortages of health personnel, the report focuses on one of the most critical components of the workforce

Intended to complement Working Together for Health: The World Health Report 2006, these policy briefs are intended to assist those who make and carry out health policy worldwide. The briefs address the following, Strengthening information and research on the health workforce: strategies for action; Investing in education for expanded capacity and lifelong learning; Making the most of the existing health workforce; Addressing the complex challenges of health worker migration; Bridging between health workers in separate public health programs; and Financing health workforce development. After describing an issue, the briefs propose ways to address it, many of which have been drawn from experience in countries. [author’s description]