Monitoring systems for public health program and policy implementation in community settings: features and suggested...

Monitoring systems are important for evaluating key outcome measures, identifying opportunities for improvement, and informing public health investment. While disease surveillance systems are highly developed and widely used, monitoring systems for the implementation of public health programs and policies in community settings are less established. To address this gap, this review aimed to: 1) describe the scope of the literature on implementation monitoring systems and their operational features; and 2) synthesise this literature to produce features and suggested actions for system design.

A systematic search of five databases and grey literature sources was conducted to identify systems, frameworks, or guidance for monitoring the implementation of public health programs or policies in community settings. Studies focused on clinical healthcare, or disease surveillance were excluded. Two authors independently screened titles, abstracts, and full texts for eligibility. Included documents were then categorised by 'Case' (one or more documents exploring the same monitoring system, framework, or topic). For Research Aim 1, characteristic data for each Case were extracted and narratively summarised. For Research Aim 2, Best Fit Framework Synthesis was employed using an a priori framework informed by disease surveillance models. Full text of included documents were coded, and the framework iteratively modified, to develop a new framework with key features and suggested actions relevant to implementation monitoring systems in community settings.

Ninety-seven documents were identified, describing 75 distinct real-world implementation monitoring Cases. Aim 1: Most Cases were intended for use in high-income countries (64%) and focused on monitoring programs (81%) rather than policy. The most common topic areas related to nutrition (36%) and reproductive, HIV, and sexual health (28%). Primary responsibility for monitoring systems was most often held by national-level agencies (43%). Aim 2: Synthesis led to 13 key features of monitoring systems, with corresponding suggested actions across five broad Action Areas: 1) planning and preparation; 2) data collection activities; 3) system appraisal; 4) partner engagement, and 5) system revision.

Findings emphasise that monitoring systems require attention across multiple Action Areas, including planning and resourcing, data collection, partner engagement, and system improvements (through both proactive appraisals and real-time response). This manuscript offers a foundational framework to guide policymakers and practitioners in monitoring the implementation of community-based public health policy or programs.