Digital Health Monitoring, Learning and Evaluation

The importance of digital health learning, monitoring and evaluation cannot be overemphasized. Research participants discussed the rationale behind conducting monitoring and evaluation (M&E) for all DH interventions. They also analysed systemic setbacks related to monitoring and evaluation strategies in Nigeria. The major problem is that some key stakeholders in the DH ecosystem often have different M&E needs, and in their efforts to appraise DH action plans and performance of projects, they apply basic M&E methodologies such as:

• Indicators–which defines key performance areas for digital health projects.
• Measures–which defines criteria for measuring the baseline and target of indicators.
• Governance–which defines the acceptable and effective structures for improving DH governance and process of implementing DH projects.

The digital health monitoring and evaluation action plan in Nigeria includes: (i) inputs (ii) processes (iii) outputs (iv) outcomes, and (v) impacts. Inputs in the digital health context refer to efforts directed towards identifying indicators for DH output and outcome, setting timeframes for monitoring and evaluating DH projects, ascertaining baseline and target measures for indicators, and establishing a robust governance framework for monitoring and evaluating DH services. Simply put, measure for digital health M&E outcome asks questions such as:

• What can health systems achieve or change by using innovative management strategies—such as DH tools?
• How will a DH action plan transform the health system and care services?

Further, output measures refer to some analytical tools that help DH facilitators and health administrators to provide comprehensive outlines on how DH interventions can be achieved, including what the planned activities and deliverables could be. But the implementation of digital health M&E in Nigeria has been problematic and there is urgent need to combine timelines for both DH implementation and M&E. This requires DH facilitators to design M&E plans with full understanding and consideration for implementation stages stated in the maturity toolkit. Thus, stakeholders in the DH ecosystem should always identify the most effective DH strategy and align project with the maturity toolkit. They should also have clear definitions of the maturity and evaluation stages—including appropriate claims (Abejirinde et al., 2018; Omole et al., 2018).