Moderating Influence of Contextual Determinants on Relationship between Monitoring and Evaluation Practices and Performance of County Maternal Health Programmes in Kenya

Abstract

Effective monitoring and evaluation practices is widely known to help improve performance, the quality and effectiveness of planning and decision making and achievement of results. This is because monitoring focuses on the implementation process and progress towards the achievement of project objectives. Despite the Kenya Government’s effort to promote County Maternal Health programmes through legal frameworks such as the county integrated monitoring and evaluation practices tool, and while there is empirical evidence that monitoring and evaluation practices contributes to enhanced performance, actual performance of county health sector across Kenya remains poor. The purpose of the study was to establish moderating influence of contextual determinants on the relationship between monitoring and evaluation practices and performance of County Maternal Health programmes in Kenya. The paradigm that is suitable for this study is pragmatism. The study adopted a descriptive survey research design. The study targeted 8 regional blocks in Kenya (Central,, Western Coast, Eastern, Rift Valley, North Eastern, Nyanza, Nairobi) where one county from each block was selected. From these counties the target population was 1165 respondents including Medical officers, Clinical Officers, Trained Community health workers, Nurses, County Health Management Team and County Delivery Unit officers from level 4 and 5 hospitals. Sampling procedure for this study was guided by the research design which is descriptive survey design. Stratified random sampling was used to obtain 282 respondents from which information was obtained for this study. The research instruments that were used for data collection are: a self-administered structured questionnaire and interview guides. Descriptive and inferential data analysis techniques were used in this study. Regression was conducted for testing the study hypothesis. The research established that there was a strong correlation between the performance of county maternal health programmes and contextual determinants (r=0.638, p=0.000<0.05). The study found that after introduction of contextual determinants into the relationship, and the interaction term in model 2 increased the R square by 0.08. This implies that the interaction between contextual determinants and monitoring and evaluation practices explains 8.0% variations in performance of county maternal health programmes. The study concluded that contextual determinants significantly moderate the relationship between monitoring and evaluation practices and performance of County Maternal Health Programmes in Kenya. The study recommends investing in robust and dynamic technical coordination platforms that can sustain the agenda for change. and at all levels is necessary to ensure the sustainability of M&E reforms in the health sector.