Equity-focused Monitoring and Evaluation and Performance of School-based Health Projects

Abstract

The purpose of the study was to examine the influence of equity-focused monitoring and evaluation on performance of school-based health projects. The study objectives were to determine to what extend does equity-focused monitoring and evaluation influence performance of school-based health projects, to establish the key constructs that drive equitable implementation of health projects, and to determine which methodological designs are used and how they compare across existing studies. A search criteria protocol was developed and adopted for systematic literature review to identify the most current peer-reviewed journal articles published in English between January 2019 and April 2024 using Google scholar and PubMed database search engines. Search terms used were as follows; Equity, Inequity, equity-focused monitoring and evaluation, performance, school-based health program, Equity in health systems. Data extraction was performed using a pre-defined eligibility criterion and a pre-tested data abstraction form. Online database search yielded 25 studies out of which five met the inclusion criteria. Data were analysed using descriptive analysis. Study results suggest that equity-focused adaptation was widely conceptualized in literature but with limited description of how to operationalize monitoring and evaluation as a tool to advance equity and improve program performance. Of the five articles reviewed (n=5), inclusion of a collaborative design, anti-racism consideration, embedding priority population expertise, cultural safety, and values were identified as key constructs that drive equitable implementation of health projects. Methodological convergence was noted across all the articles (n=5) where purposive sampling method, stakeholders as the target population was adopted while four articles (n=4) also converged on mixed method study design. Divergence was reported in sample size and data analysis methods. We conclude that current studies have not exploited the potential influence of equity-focused monitoring and evaluation on performance of school-based health projects. Key constructs for equitable implementation and methodological designs are well grounded though with limited operationalization. The study recommends that there is a need in future for equity-focused monitoring and evaluation empirical studies to test operationalization of the conceptual and theoretical frameworks currently available in literature. This will help advance equity and performance of school-based health projects.