MONITORING AND EVALUATION SYSTEM AND HEALTH SERVICE DELIVERY IN PUBLIC HEALTH INSTITUTIONS IN JUBA, SOUTH SUDAN

Introduction: The recent policy changes across the world are important steps towards public sector system strengthening including health. Several countries are now embracing M&E to improve services, although it has received less attention in developing nations. The study aimed to analyze the effect of M&E system on health service delivery in public health institutions in Juba, South Sudan, with the objectives to examine the influence of organizational structure, M&E human capacity and data use on health service delivery.

Methodology: Descriptive cross-sectional surveys with both quantitative and qualitative approaches were applied. A total of 315 participants were involved in the study. These included 124 patients selected using systematic random sampling as they exited the facility after discharge and 191 healthcare workers using simple random sampling. The key informants were purposely selected from the 315. Data was analyzed using descriptive statistics, spearman correlation and multinomial logistic regression.

Results: Emergency health services were available in facilities and the available health workers responded faster when needed. However, absence of some critical health care workers, supplies stockout, longer waiting time and dysfunctional equipment led to inaccessibility of services and compromised the quality. The organizational structure improves health service delivery 0.158 times less than that of the data use (p-value 0.019, OR= 0.854) and has a weak and negative association with health service delivery (Spearman r=-0.042, p-value = 0.003). M&E human capacity improves health service delivery 0.997 times less than that of the data use (p-value = 0.010, OR= 0.369) with strong and positive association with health service delivery (r =0.802, p-value 0.000). The data use had a composite mean score of 4.702 and Standard deviation. of 1.2554, a significant influence on health services and r =-0.770, p-value =0.007). 

Conclusions. The organizational structure has a weak relationship with health service delivery but less than that of data use. M&E human capacity has a strong positive relationship with health service delivery. Data use has a strong negative correlation with health service delivery.

Recommendations. The organizational structure with a functional M&E unit should be set with full financial support for M & E unit. M&E should be integrated in the overall health system and appropriate M&E professionals employed. Advocate for data use to ensure demand creation for decision-making and accountability in health sector.