Enhancing universal health coverage: Piloting of innovative tools for the Evaluation of the P4H Network (P4H)
The P4H Network(P4H) aims to expand healthcare access, reduce financial burdens, and protect against catastrophic health costs. Its main strategy is the development, improvement and maintenance of sustainable systems for Universal Health Coverage (UHC). To measure and communicate its impact, hera was contracted to develop a comprehensive Monitoring and Evaluation framework and tools.
The P4H Network is the global network for social health protection and health financing. To ensure accountability, assess P4H's added value, and communicate achievements at global and country levels, components for a monitoring and evaluation (M&E) framework had been developed under the oversight of an internal M&E Working Group. To finalize this framework and pilot key tools, GIZ enlisted the expertise of hera between June and November 2023. As part of this work, hera piloted the innovative Critical Milestone Timelines tool, an adapted version of Critical Incident Timelines.
hera initially proposed two possible versions for the M&E framework: one based on OECD-DAC Evaluation Criteria and one using the structure of P4H’s results framework. After consultation with the M&E Working Group, the OECD-DAC-based structure was chosen for easier accessibility.
The hera team proposed document reviews, stakeholder consultations and the regular social media analysis as data collection methods for monitoring progress. For the purpose of evaluations, semi-structured interviews with country and global level stakeholders, document reviews, a social media scan and country case studies using the critical milestones timeline tool were suggested as data collection methods.
A pilot phase was conducted in Chad (onsite) and Côte d'Ivoire (online) to test the annual monitoring surveys at global level and the critical milestone timeline tool at country level. Results informed refinements to indicators, evaluation questions, and tools. The final M&E framework and pilot findings were presented at the P4H Steering Group meeting in November 2023 in Paris. The feedback from the meeting informed the preparation of the final deliverables including a matrix of monitoring and evaluation indicators and further recommendations for the P4H Network.
As a result of this assignment, a revised M&E framework and tools are available for the P4H Network to inform and guide their efforts in enhancing universal healthcare access, mitigating financial hardship, and minimise risks linked to catastrophic health expenditures. This will be an important contribution to achieving the SDG principle of leaving no one behind.
Piloting of the Critical milestone timeline tool for the assessment of complex health system changes
A methodological approach combining the use of the Critical Milestone Timeline tool and key informant interviews was tested in Chad (on-site) and Cote d'Ivoire (online). The approach was found to be promising for evaluating P4H’s contributions to complex health system changes in countries. It allowed to illustrate the relationship between P4H’s activities and its outcomes, offering a comprehensive visualization of the enabling and hindering factors in the two piloting countries.
The tool was conducted in four steps:
Initial timeline creation: An indicative timeline is designed based on document reviews of annual reports and other relevant documents.
Consultation with P4H country focal person (P4H-CFP): An online interview with the CFP helps review and complement the timeline and identify key informants from various sectors.
Stakeholder interviews: Key informant interviews (KIIs) with stakeholders, including CSOs, academia, private sector, P4H member representatives, donors, government focal points, and relevant ministries, are conducted to gather insights.
Timeline revision: The timeline is updated based on KII feedback, highlighting factors that impacted outputs and outcomes, thus showing the relationship among these factors over time.