Monitoring and Evaluation Practices on the Implementation of Maternal Healthcare Project: the Case of Linda Mama Maternity Project in Nyandarua County, Kenya

Abstract

The study sought to examine the impact of monitoring and evaluation practices on implementation of Linda Mama Maternity Healthcare Project in Nyandarua County. The study specifically sought to scrutinize the effect of Health Information Systems Stakeholder Participation; Client Satisfaction Survey; and Utilization of Monitoring and Evaluation findings on implementation of Linda Mama Maternity Project. The study was guided by the Realistic Evaluation Theory and Stakeholder Theory. The study utilized mixed method research design and its sampling techniques were Stratified and simple random sampling which selected 234 healthcare staff from a target population of 569 healthcare staff in public hospitals in Nyandarua County. Purposive sampling was used to select Nurse Managers in Charge of Maternity Services as key informants. Data was collected from hospital staff using questionnaires; interviews were held with 6 Nurse Managers and FGDs conducted with 32 mothers. The SPSS software (version 23) was utilised in the analysis of collected data which generated descriptive statistics and conduct regression analysis. Thematic analysis was used to analyze qualitative data. The study established that M&E Practices account for 61.8% variation in Implementation of Linda Mama Maternity Project. Health Information Systems has a positive and significant effect on Implementation of Linda Mama Maternity Project (β1=0.542; p=0.000); Stakeholder Participation has a positive and significant effect on Implementation of Linda Mama Maternity Project (β2=0.594; p=0.001); Client Satisfaction Surveys have a positive significant effect on Implementation of Linda Mama Maternity Project (β3=0.431; p=0.000); and Utilization of M&E information has a positive and significant effect on Implementation of Linda Mama Maternity Project (β4=0.567; p=0.000). This study found out that Health Information Systems provides data that used is used to determine if women have access to all essential maternal services before, during and after delivery. The system also provides data on adequacy of hospital staff and maternal facilities for planning purposes to ensure that public health facilities in Nyandarua County have sufficient facilities and staff in proportion to the number of mothers seeking maternal services. The study found out that only 2.9% of hospital staff was involved in designing M&E plan; 67.5% of the hospital staff and 84.4% of mothers were involved at the data collection phase of M&E. Participation of stakeholders in monitoring enhances reliability and validity of M&E data and the quality of maternal health care services. However, limited participation of NHIF in the joint semi-annual M&E meeting has resulted insufficient reimbursement of expenses to hospitals. This study also found out that 85.2% of mothers participated in the client satisfaction surveys on a quarterly basis to provide data that is used to determine if quarterly targets are met and taking corrective action to ensure the Project is on track to facilitating mothers access to all essential maternal services. Linda Mama Maternal Healthcare project M&E data is utilized for developing solutions to challenges facing public hospitals in provision of maternity services; evaluating effectiveness of Linda Mama Project interventions; enhancing accountability and as a learning experience. However, staff shortages; high workload on the nurses and shortage of facilities has limited level 2 hospitals from providing caesarean section deliveries and ultrasound services. Therefore this study recommends that: the joint stakeholder M&E meetings to be held on a quarterly basis to facilitate periodic tracking of mothers access to maternal services particularly PNC; County Government and management of public hospitals coordinates with NHIF to enhance their participation in the joint stakeholder M&E meeting; NHIF provides timely and sufficient reimbursements to hospitals; the County Government of Nyandarua expedites employment of more nurses and procurement of ultrasound machines and construction of theatres in all Level 2 hospitals.