Development of Monitoring and Evaluation Systems in Four National Programs Addressing Mother and Child Health in Cote d’Ivoire: Qualitative Analysis of the Emergence and Formulation Process

Esme Marie Laure Essis,1– 3 Wambi Maurice Evariste Yaméogo,4 Olivier Gbènamblo Sossa,5 Daouda Doukouré,1,2 Rachidatou Compaoré,4,6 Djoukou Olga Denise Kpebo,1,2,7 Marie Laurette Agbré-Yacé,1,2 Joseph Aka,1,7 Issiaka Tiembré,7,8 Blaise Sondo,4 Seni Kouanda4,6 1National Institute of Public Health, Abidjan, Cote d’Ivoire; 2Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d’Ivoire; 3Doctoral School in Science, Health, and Technology, Saint Thomas Aquinas University, Ouagadougou, Burkina Faso; 4African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso; 5Department of Economics and Management, Thomas Sankara University, Ouagadougou, Burkina Faso; 6Research Institute of Health Sciences, Ouagadougou, Burkina Faso; 7Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire; 8National Institute of Public Hygiene, Abidjan, Cote d’IvoireCorrespondence: Esme Marie Laure Essis, National Institute of Public Health, Abidjan, BP V 47, Cote d’Ivoire, Tel +225 07 07 88 72 13, Fax +225 20 22 44 02, Email essismarie2007@yahoo.frBackground: Monitoring and evaluation were introduced into the management of national health programs to ensure that results were attained, and that donors’ funds were used transparently. This study aims to describe the process of the emergence and formulation of monitoring and evaluation (M&E) systems in national programs addressing maternal and child health in Cote d’Ivoire.Methods: We conducted a multilevel case study combining a qualitative investigation and a literature review. This study took place in the city of Abidjan, where in-depth interviews were conducted with twenty-four (24) former officials who served at the central level of the health system and with six (06) employees from the technical and financial partners’ agencies. A total of 31 interviews were conducted from January 10 to April 20, 2020. Data analysis was conducted according to the Kingdon conceptual framework modified by Lemieux and adapted by Ridde.Results: The introduction of M&E in national health programs was due to the will of the technical and financial partners and the political and technical decision-makers at the central level of the national health system, who were concerned with accountability and convincing results in these programs. However, its formulation through a top-down approach was sketchy and lacked content to guide its implementation and future evaluation in the absence of national expertise in M&E.Conclusion: The emergence of M&E systems in national health programs was originally endogenous and exogenous but strongly recommended by donors. Its formulation in the context of limited national expertise was marked by the absence of standards and guidelines that could codify the development of robust M&E systems.Keywords: monitoring and evaluation, emergence, formulation, health program, Africa, Cote d’Ivoire