Participatory Monitoring and Evaluation of the COVID-19 Response in the Africa Region

Abstract

As the COVID-19 pandemic swept throughout the world, it created a demand for information to help understand the public health response and its effects. Limited capacity to see and interpret data—“sensemaking” with measures of progress—affects the use of data for quality improvement. The World Health Organization Regional Office for Africa (WHO AFRO) supported partners from the Member States in using a participatory monitoring and evaluation system to document and systematically reflect on the COVID-19 response at the country level. The WHO AFRO’s COVID-19 Response Monitoring and Evaluation (M&E) team captured and communicated response activities based on available reports from 35 of the 47 member countries. By reviewing reports and communications, the M&E team documented nearly 8,000 COVID-19 response activities during the study period (January 2020 through July 2021). A “sensemaking” protocol was used to support country partners in identifying factors associated with increases or decreases in both new cases and response activities. This report describes this participatory M&E approach and process of shared sensemaking. We illustrate with a country-level case study of the COVID-19 response in the Africa Region.

Kenya’s Experience: Factors Enabling and Impeding the COVID-19 Response

“…The fifth step in the response framework (following action/implementation) is participatory evaluation and sensemaking. Technical support in monitoring and evaluating the COVID-19 response in Kenya was provided by the M&E team based in the WHO Regional Office for Africa ( Phori et al, 2022 ). By reviewing documents and conducting key informant interviews, the WHO AFRO M&E team documented more than 470 COVID-19 response activities in Kenya during the study period (February 2020 through May 2021).…”

“…The WHO AFRO COVID-19 Response M&E System ( Phori et al, 2022 ) used the M&E system developed by the WHO Collaborating Centre for Community Health and Development at the University of Kansas ( Fawcett & Schultz, 2008 ). It was used to (a) capture or document COVID-19 response activities (i.e., by reviewing documents and reports provided by Kenya partners to identify activities; by describing who implemented the activity/change, what they did, toward what goal, with whom, and how many were affected/reached by the activity/change); (b) code activities using established definitions and scoring instructions (e.g., development activities, community/system changes); (c) characterize attributes of activities (e.g., where it occurred, type of COVID-19 response pillar addressed); and (d) communicate findings through graph displays, sensemaking dialogues, presentations, and reports.…”

“…The “sensemaking” protocol developed by the WHO CC ( Fawcett & Schultz, 2008 ; Phori et al, 2022 ) was used to systematically reflect on patterns in the data. This sensemaking protocol guided Kenya partners in using questions to pay particular attention to (a) what they are seeing in the data (i.e., in the pattern of increases or decreases in new cases, displayed in Figure 1 , or in COVID-19 response activities over time, displayed in Figure 2 ); (b) what it means (e.g., what factors may be contributing to increases or decreases); and (c) implications for adjustment (e.g., expanding partnerships for fuller implementation).…”

“…This was lifted on June 7, 2020. However, in response to the third wave of COVID-19, there was a cessation of movement in and out of five counties deemed disease-infected areas of Nairobi, Kajiado, Machakos, The "sensemaking" protocol developed by the WHO CC (Fawcett & Schultz, 2008;Phori et al, 2022) was used to systematically reflect on patterns in the data. This sensemaking protocol guided Kenya partners in using questions to pay particular attention to (a) what they are seeing in the data (i.e., in the pattern of increases or decreases in new cases, displayed in Figure 1, or in COVID-19 response activities over time, displayed in Our goal was to assemble data regarding new cases (see Figure 1) and response activities (see Figure 2), to examine and reflect on patterns in the data during the study period, and to identify factors that may have facilitated or impeded the implementation and efficacy of the planned response.…”

Equity Lens Protocol: Reflecting on Harms From the COVID-19 Response and Mitigation Strategies Implemented in a Local Public Health System

“…This protocol is based on a Guidance document (PAHO, 2020) designed to assess and plan for an equitable response to COVID-19. The Equity Lens Protocol was implemented with partners in a public health system (the co-authors), appreciating that “sensemaking” is best done by those engaged in the work (Phori et al, 2022).…”