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Analysis Strategic Review of Child Health

Framework and strategy for integrated monitoring and evaluation of child health programmes for responsive programming, accountability, and impact

BMJ 2018; 362 doi: (Published 30 July 2018) Cite this as: BMJ 2018;362:k2785

Strategic review of child health

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  1. Theresa Diaz, coordinator1,
  2. Kumanan Rasanathan, chief2,
  3. Emmanuel Meribole, director3,
  4. Isabella Maina, head4,
  5. Humphreys Nsona, programme manager5,
  6. Kyaw Myint Aung, chief of health6,
  7. Bennett Nemser, senior consultant1,
  8. Kathryn Patricia O’Neill, coordinator7
  1. 1Epidemiology and Monitoring and Evaluation Team, Maternal Newborn and Child Adolescent Health Department, World Health Organization, Geneva, Switzerland
  2. 2Knowledge Management and Implementation Research Unit, Health Section, Unicef, New York, USA
  3. 3Monitoring and Evaluation, Nigeria Ministry of Health, Abuja, Nigeria
  4. 4Health Sector Monitoring and Evaluation Unit-MOH;,Nairobi, Kenya
  5. 5Integrated Management of Childhood Illnesses, Ministry of Health, Malawi
  6. 6Unicef, Malawi Lilongwe, Malawi
  7. 7Global Platform on Measurement and Accountability, Department of Information, Evidence and Research, Health Systems and Innovation, World Health Organization, Geneva, Switzerland
  1. Correspondence to: T Diaz tdiaz{at}

Stronger governance and leadership is needed to implement and maintain integrated reporting systems, say Theresa Diaz and colleagues

Monitoring and evaluation of health systems, programmes, and interventions is critical to assess progress, identify problems, and facilitate change to improve service delivery and reach the desired outcomes.123 Funders increasingly demand monitoring and evaluation so that they can determine whether a programme achieves its intended outcomes.

As the recognition and importance of monitoring and evaluation has grown so has the push towards integration of health services. For the sustainable development goals adopted by countries at the United Nations in 2015, the global health policy pendulum is swinging towards the need for “integration” of health service delivery to achieve universal health coverage (which is one of the sustainable development health targets).4 However, less attention has been paid to the consequent need for monitoring and evaluation systems to be integrated, through design and implementation that allows the measurement and analysis of multiple outputs and outcomes in a single report.

An integrated strategy for management of childhood illness has been in place for 20 years. The Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization and Unicef in 1995. Its aim was to reduce child mortality and improve child health in countries with a mortality rate in the under 5s of >40/1000. It tackles multiple child illnesses through integrated delivery of preventive and curative services.5 More than 100 countries have adopted the IMCI strategy for their health programmes and systems. Its three components—improving health worker skills, strengthening health systems, and improving family and community practices—have been adopted to a varying extent.6 However, there have been challenges to creating and sustaining a monitoring and evaluation system to support the programme.

Here we describe the challenges created …

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