Role of Monitoring and Supervision to Improve Health Service Delivery in Basic Health Units of Punjab, Pakistan

Abstract

Effective and efficient monitoring and evaluation system with a strong accountability mechanism have shown good results over the past few years in many countries of the world. Punjab has also successfully developed and implemented e-monitoring system by providing android phones to all district level health managers including Executive District Officer of Health (EDO), District Officer Health (DOH) and Deputy District Officer Health (DDOH). This e-monitoring system called as Health watch is being implemented successfully in all 36 districts of Punjab and real time data about availability of health facility staff, medicines and functional equipment and important service delivery indicators are being captured and reflected on a dashboard managed by Punjab Information Technology Board (PITB). In order to validate and verify the data collected by district level health managers, a second tier of monitoring and evaluation was introduced by hiring of 172 Monitoring Evaluation Assistants (MEAs) to monitor the primary health care facilities on the same dataset. The paper shows that field monitoring and validation of field monitoring through MEAs is bringing an improvement in service delivery indicators of Basic Health Units (BHUs). It also describes the process of e-monitoring for the improvement in health service delivery at BHUs. A real time data of all BHUs of 36 districts of Punjab has been taken into account. A quantitative comparison of Healthwatch data and MEAs data has been made to assess the situation of stock position of medicine, availability of functional equipments, staff absenteeism, and service delivery indicators. Subsequently evidence generated through the Healthwatch and MEAs data are used to develop appropriate strategies to address the bottlenecks. It has been shown that there is positive relationship between the results achieved and the resources used. This paper aims to provide a future course of action to strengthen the MEAs and Healthwatch data to be used for planning and policy making.

Keywords: Healthwatch, Basic Health Units, Monitoring Evaluation Assistants, Policy and Strategic Planning Unit.