Participatory Monitoring and Evaluation Process and Performance of Maternal and Child Health Programs in Nairobi City County, Kenya

Abstract

Maternal and child health (MCH) outcomes in Nairobi City County persist with extremely structural and programmatic challenges especially in the urban informal settlements where there are significant health inequities. This study focuses on the impact of participatory monitoring and evaluation (PM&E) processes (participatory planning, data collection and data analysis, and utilization of findings) on the performance of MCH programs. The research addresses a critical lack of empirical evidence on how multi-stage participation of stakeholders bolsters accountability, contextual appropriateness and sustainability in urban health interventions. An explanatory sequential mixed-methods approach was used in which a census approach was undertaken of 114 respondents from 36 MCH programs, comprising of program managers, frontline health workers, and community-based actors. Quantitative data were gathered by structure Likert-scale questionnaires with complementary semi-structured interviews in order to produce qualitative data. Data analysis included descriptive statistics, Pearson correlation, and simple and multiple linear regression analysis, where the test hypotheses were below a =0.05 level of significance. Qualitative data was thematically analyzed to add meaning to the quantitative data. The results show that there is a statistically significant and positive influence of all four PM&E components on the performance of MCH programs. Participatory planning (r = 0.775), data collection (r = 0.772), data analysis (r = 0.792) and utilization of findings (r = 0.810) had a good association with key performance indicators, such as coverage of antenatal care, skilled birth attendance, immunization uptake and outcomes of maternal and child mortality (p < 0.05). Collectively, PM&E processes accounted for 61.6% of the variance of MCH program performance (R2 = 0.674). The study concludes by stating that integrated participatory monitoring and evaluation helps substantially to improve the effectiveness of maternal and child health programs. The findings provide solid evidence for informing policies and practices such as strengthening stakeholder ownership, enhancing evidence-based decision-making and support the development of sustainable and context-related MCH programming in complex urban settings.