In the context of sector-wide approaches and the considerable funding being put into the health sectors of low-income countries, the need to invest in well-functioning national health sector monitoring and evaluation (M&E) systems is widely acknowledged. Regardless of the approach adopted, an important first step in any strategy for capacity development is to diagnose the quality of existing systems or arrangements, taking into account both the supply and demand sides of M&E. As no standardized M&E diagnostic instrument currently exists, we first invested in the development of an assessment tool for sector M&E systems. To counter the criticism that M&E is often narrowed down to a focus on technicalities, our diagnostic tool assesses the quality of M&E systems according to six dimensions: (i) policy; (ii) quality of indicators and data (collection) and methodology; (iii) organization (further divided into iiia: structure and iiib: linkages); (iv) capacity; (v) participation of non-government actors and (vi) M&E outputs: quality and use. We subsequently applied the assessment tool to the health sector M&E systems of Rwanda and Uganda, and this article provides a comparative overview of the main research findings. Our research may have important implications for policy, as both countries receive health sector (budget) support in relation to which M&E system diagnosis and improvement are expected to be high on the agenda. The findings of our assessments indicate that, thus far, the health sector M&E systems in Rwanda and Uganda can at best be diagnosed as ‘fragmentary’, with some stronger and weaker elements.
In recent years, international development has increased the use of a controversial approach to improve initiative uptake and to achieve targeted outcomes: performancebased incentives. Although incentives have been effective dditions to many international development projects, some scholars are highly critical of their usage in sectors such as family planning and reproductive health. Given this controversy, this thesis examines the historical use of incentives, primarily as a means to control the fecundity of populations, and unveils the institutionalization of human rights violations within the population control and family planning movements. Ultimately, this thesis provides policy solutions that suggest, in spite of a troubled history, incentives can be used to promote family planning and reproductive health services without violating the rights of men and women.
- Au cours des cinq dernières années, le financement basé sur les résultats pour la santé a été testé largement en Afrique comme un moyen prometteur d’oeuvrer à la couverture santé universelle.
- Les mécanismes de financement basé sur les résultats donnent de bons résultats, contribuant à étendre la couverture et à améliorer la qualité des services, tout en dirigeant les ressources vers les populations vulnérables.
- Un programme bien conçu de financement basé sur les résultats peut aider à renforcer les fonctions essentielles du système de santé, en accroissant la rentabilité des ressources et la responsabilité du système de santé.
- Dans de nombreux pays, la conception des programmes de financement
basé sur les résultats inclut la suppression des tickets modérateurs, ce qui permet d’élargir l’accès financier aux services de santé essentiels.