Counting What Truly Counts: Translating Data into Impact and Legacy
Numbers matter in health development—but only when they reflect lives changed, systems strengthened, and legacies sustained. Monitoring & Evaluation (M&E) must move beyond counting to meaning.
In the health development space, numbers often dominate in project reports: The number of health workers trained, commodities distributed, facilities visited, clients on ART, Viral Load samples collected, adolescent at OTZ meetings, facilities renovated, machines installed etc. Health intervention programs are almost always about numbers.
While these figures are important, especially for tracking project performance, they do not tell the whole story. For newcomers in the health development space, monitoring and evaluation (M & E) often appears like a glorified counting process. However, M & E counts what truly counts: lives changed, systems strengthened, legacies built, and impacts sustained.
The sudden shrink in funding options for global health projects has posed a big challenge to organizations. Funders now demand more of impacts than just data and this reinforces the demand for robust M & E systems. It has gone beyond generating data just for compliance purposes. The demand now is for systems that transform project activities into concrete evidence; evidence into knowledge, knowledge into learning, and learning into lasting impact.
This paradigm shift is critical for donor-dependent countries like Nigeria. Whether the project is for Health Systems Strengthening, HIV and AIDS, Malaria, Health Workforce Training, Health Commodities Logistics, or Laboratory Systems Strengthening, the role of M & E remains the same: To ensure the impact of projects does not end at the end of a project lifecycle.
At Health Systems Consult Ltd. (HSCL), the M & E unit bears this responsibility. Beyond project monitoring, the unit supports HSCL’s vision of becoming a leading firm providing sustainable development solutions in Africa. M & E is HSCL’s strategic tool for sustainability, innovation, and trust-building.
Over the last 15 years, HSCL has implemented more than 345 health development projects. But how well has the M & E unit sustained these projects?
Beyond Policy Counting: Lessons from the HSCL’s HSS Model
In Nigeria, health systems strengthening is robust in policy framework designs but poor in sustained implementation. For instance, not many people even know that Nigeria has a dedicated health fund called the Basic Healthcare Provision Fund (BHCPF).
An M & E system interested only in numbers may end up counting how many of such policies there are, or how many BHCPF facilities are supported per state. But the focus should be in the number of resilient systems created, increase in domestic resource mobilization, the indicators for improved governance, enhanced accountability, and the improvement in community ownership of these facilities.
Many communities do not even know that their health facilities are BHCPF supported. They are unaware of the services they should be receiving, and as such, they are not receiving the required quality of care the facility is designed to give. As a result, the M & E system is likely to miss the impact of these facilities on the people as well as their sustainability.
A good M&E system can show state-level health budgets statistics. It can also show the impact of upgrades on primary health centers using parameters such as reduced maternal mortality and improved patient trust in public facilities. This evidence converts reforms from mere abstractions to legacies that outlive project cycles.
A strong M & E system will reveal that community governance structures have been strengthened and that community ownership and accountability of health systems has increased, thereby translating policies and numbers into confirming concrete changes.
Beyond the Numbers: Unpacking the HSCL HIV RADET File
Health and development Programs generally thrive on numbers—numbers of facilities supported, of people tested for HIV, of people initiated on ART, and of people retained on ART, the viral load sample collection rate, the CD4 Counts report, the number of adolescents enrolled in OTZ, the number of pregnant women who attended ANC and were tested, the partners elicited and tested etc.
The numbers seem unending and the responsibility to report across different platforms and sometimes on high frequency reporting rates appear to drown the real work and mask every work of M & E into just a game of numbers. However, there is more to these numbers. Behind these numbers are real human beings, a story changed!
The beauty of a good M & E system is in the continuity tracking. It is not just the number of clients tested and initiated on ART, but the retention process, the adherence, and the clinical monitoring for viral suppression. M & E sees through that with the numbers!
The M & E system follows the clients on a program through the continuum of care, blow alarms when a client is lost to follow-up, and sounds the gong, especially when innovations like the DSD models and community-based refills makes a difference.
The HSCL ACE 3 RADET File does not just show the numbers; it shows the how, when, why and what’s next on the numbers. Rather than build a system that simply reports numbers, M & E unit empowers the system to show the impact on the numbers.
In this moment when project funding is scarce, projects can only gain the trust of funders and governments by demonstrating that the numbers reported are real, sustainable, and worth scaling up. Until this is done, HIV programs risk drowning in endless numbers reporting. The lesson is the same: without deeper measurements, numbers mislead.
From Training Certificates to Changed Practice
In health development, M & E systems should measure wholesomely indices to reflect impact, namely: health seeking behaviours, healthy lifestyle adoption rates, improved care-seeking patterns, and reduction in incidence rate. These are indicators of real community transformation and impact—measures of improved health security.
M & E systems should go beyond counting the number of training participants to measuring application of knowledge gained through such training, the retention of knowledge gained from the training and its impact on service delivery for healthcare providers.
If M & E measures only the number of healthcare providers trained, or the number of training participant eligible to be given a certificate, then the project is as good as dead.
A robust M & E system should show that after the project or training has ended, the trained healthcare providers are still applying the skills learnt. There would be no need for fresh training for healthcare providers on handwashing in 2025 if the system monitored the impact of similar training in 2019. When the M & E system focuses on measuring real impacts, investments on projects become systemic.
With the recent funding cuts, especially from the U.S government, the health and development landscape in Nigeria and many parts of the world faces harsh times. It has become the survival of the fittest. If funders must be convinced that there are positive returns on their investments, M & E systems must be responsive enough to give details on the process and sustainability milestones of such projects. M & E should be able to tell the story of change and improvement in health outcomes from these projects.
When M & E counts what truly counts, it stops being a mere compliance tool and becomes a functional engine room for projects. It ensures that when the funding ends, the impact does not.
