Community-Based Monitoring

What is it?

Who uses it?

Why use it?

When to use it?

How to use it:

The Monitoring Curve can be used to follow any activity or service to external users. However it is more effective for following up MCH/PHC activities such as immunization, under-five clinics, prenatal clinics, family planning (some methods/services), etc.

Example: Prenatal care

2. Define the target population.

For monitoring different indicators of program coverage on one graph, the target population (denominator) of the different indicators must be the same.

Example: For prenatal care, the target population is the number of women having delivered during the observed period (3 or 6 months).

3. Define the indicators.

Every Monitoring Curve is composed of five indicators, selected on the basis of the following determinants:

• Availability of resources: percent of time during which the resources required to implement the intervention were available

  Example: percent of time without shortages of iron/folic acid and chloroquine

• Geographic accessibility of services: percent of the population living sufficiently close to have easy access to the service

  Example: percent of target population living less than 5 km from the health centre

• Utilization of services: percent of the target population utilizing the service at least once reflects the actual contact.

  Example: percent of population having made at least one prenatal visit during pregnancy

• Adequate coverage: the percent of the target population using a complete intervention reflects the compliance in the use of services.

  Example: percent of population having made at least three prenatal visits during pregnancy

• Effective coverage: the percent of the target population receiving services adhering to quality standards reflects the technical quality of services.

  Example: adequate coverage multiplied by a quality score for prenatal care

These five determinants make up a hierarchy in which each one influences the level of the following ones, ultimately limiting effective coverage. The five indicators can be combined in one graph.

4. Interpret the graph

A problem or "bottleneck" exists when the curve angles steeply to the left (lower percentage) between indicators. This indicates there has been a drop of coverage. For example, in the graph above, the monitoring session carried out in May 1989, in Seredou, Guinea, showed a drop in the coverage between utilization (58%) and adequate coverage (24%). This indicated that although 58% of women were using prenatal care at least once, only 24% received the necessary three prenatal consultations. Thus the use of the Monitoring Curve will help to monitor some proxy indicators of quality of care, alert us to the existence of problems, and pinpoint the problems.

Reference: The Bamako Initiative, Primary Health Care Experiences, R. Knippenberg et al., in Children in the Tropics, No. 184/185, 1990, and other references to the Bamako Initiative.