Advances in monitoring and evaluation in low- and middle-income countries

Data to inform and improve health care systems in low- and middle-income countries (LMICs) has been facilitated by the development of monitoring and evaluation (M&E) systems. The drivers of change in M&E systems over the last 50 years have included a series of health concerns that have animated global donors (e.g., family planning, vaccination campaigns, and HIV/AIDS); the data requirements of donors; improved national economies enabling LMICs to invest more in M&E systems; and rapid advances in digital technologies. Progress has included the training and expansion of an M&E workforce, the creation of systems for data collection and use, and processes for assessing and ensuring data quality. Controversies have included the development of disease-specific systems that do not coordinate with each other, and a growing burden on health care deliverers to collect data for a proliferating number of health and process indicators. Digital technologies offer the promise of real time data and quick adaptation but also raise ethical and privacy concerns. The desire for speed can cast large-scale evaluations, considered by some to be the gold standard, in an unfavorable light as slow and expensive. Accordingly, there is a growing demand for speedy evaluations that rely on routine health information systems and privately collected "big data" from electronic health records and social media.