Monitoring and Evaluation for Health Resilience Programming in Fragile Settings: Lessons from DRSLP II, Somaliaf Sub-Saharan Africa
DOI:
https://doi.org/10.64229/qt2bgq78Keywords:
Monitoring and evaluation, Health systems resilience, Conflict-affected settingsAbstract
This study examines how conflict-sensitive and context-specific monitoring and evaluation (M&E) approaches can enhance health system resilience in fragile environments, drawing on experience from Somalia and regional capacity-building initiatives in Eastern Africa. A synthesis of two primary evidence sources was undertaken: (1) implementation experience from the African Development Bank-financed Drought Resilience and Sustainable Livelihoods Programme II (DRSLP II) in Somalia, which reached approximately 1.5 million people and four million livestock; and (2) a regional training manual developed to guide the design and operation of monitoring systems in fragile contexts. A comparative analytical framework assessed four dimensions: relevance to local conditions, operational feasibility, adaptability in insecure settings, and alignment with donor and government reporting requirements. Four notable innovations were identified: the development of contextualised indicator frameworks that bridge local and international standards; participatory validation processes that improved data credibility; rapid assessment tools suited for high-risk areas; and structured feedback loops that supported timely programme adjustments. Under DRSLP II, year-round access to multi-use water increased from 0% to 40%, 118 km of rural roads were rehabilitated, and 40 women-led Village Savings and Loan Associations were established__illustrating how robust M&E can support resilience outcomes. Context-sensitive M&E systems can inform and support material improvement of infrastructure to national and international standards, improve data credibility and rapid assessment. Well designed and implemented M&E support rapid assessment and structured feedback loops. Evidence from DRSLP II, Somalia underscores that durable resilience requires not only sound technical tools but also inclusive processes that engage communities and implementing partners. Beyond well designed projects, meticulous M&E systems strengthens accountability, learning and adaptive planning in fragile health settings.
References
[1]Ebi KL, Vanos J, Baldwin JW, Bell JE, Hondula DM, Errett NA, et al. Extreme weather and climate change: Population health and health system implications. Annual Review of Public Health, 2021, 42, 293-315. DOI: 10.1146/annurev-publhealth-012420-105026
[2]Ebi K L, Bowen K. Extreme events as sources of health vulnerability: Drought as an example. Weather and Climate Extremes, 2016, 11, 95-102.
[3]Roos N, Kovats S, Hajat S, Filippi V, Chersich M, Luchters S, et al. Maternal and newborn health risks of climate change: A call for awareness and global action. Acta Obstetricia et Gynecologica Scandinavica, 2021, 100(4), 566-570. DOI: 10.1111/aogs.14124
[4]Lombe P, Carvalho E, Rosa-Santos P. Drought dynamics in Sub-Saharan Africa: Impacts and adaptation strategies. Sustainability, 2024, 16(22), 9902. DOI: 10.3390/su16229902
[5]Adaawen S, Rademacher-Schulz C, Schraven B, Segadlo N. Drought, migration, and conflict in Sub-Saharan Africa: What are the links and policy options? Current Directions in Water Scarcity Research, 2019, 2, 15-31. DOI: 10.1016/B978-0-12-814820-4.00002-X
[6]Akinyetun TS, Fatai-Abatan A, Ogunbodede N. Heated environment, armed people: Between “climate-change conflict” and “fragility conflict” in the Sahel. Journal of Asian and African Studies, 2024. DOI: 10.1177/00219096241285108
[7]Chigudu D. Peace and security, health and climate change in Sub-Saharan Africa. Journal of Law and Sustainable Development, 2024, 12(6), e3628. DOI: 10.55908/sdgs.v12i6.3628
[8]World Health Organization. Health systems resilience toolkit: A WHO global public health good to support building and strengthening of sustainable health systems resilience in countries with various contexts. 2022. Available from: https://www.who.int/publications/i/item/9789240048751 (accessed on December 06, 2025).
[9]Okafor AE. Influence of monitoring and evaluation system on the performance of projects. IJRDO Journal of Social Science and Humanities Research, 2021, 6(8), 34-49. DOI: 10.53555/sshr.v6i8.4535
[10]Zeynu T. The assessment of monitoring and evaluation practices in a technical-assistance programme and its contribution to government counterpart: The case of the Building Resilience in Ethiopia Technical Assistance Program (BRE-TA). Addis Ababa: St. Mary’s University, 2024. Available from: http://hdl.handle.net/123456789/8275 (accessed on December 06, 2025).
[11]Chachu DO. Implementation of a project-based comprehensive monitoring and evaluation strategy in Ghana and Côte d’Ivoire: Key lessons. African Evaluation Journal, 2019, 7(1), a387. DOI: 10.4102/aej.v7i1.387
[12]Endalamaw A, Khatri RB, Erku D, Zewdie A, Wolka E, Getahun F, et al. Monitoring and evaluation framework for Primary Health Care programmes and systems: A scoping review. 2024. DOI: 10.21203/rs.3.rs-4496607/v1
[13]Elkalmi RM. Transforming healthcare in Libya-the need for clinical practice guidelines in disease management. Journal of Pharmaceutical Policy and Practice, 2025, 18(1), 2565419. DOI: 10.1080/20523211.2025.2565419
[14]Federal Government of Somalia, Ministry of Environment and Climate Change. Somalia national climate change policy. Mogadishu: Government of Somalia. 2022.
[15]Lwanga-Ntale C, Owino BO. Understanding vulnerability and resilience in Somalia. Jàmbá: Journal of Disaster Risk Studies, 2020, 12(1), 856. DOI: 10.4102/jamba.v12i1.856
[16]Yusuf HA, Mohamed SA, Sharmake GB, Yakub BA, Naima IA. Public health impacts of drought in the horn of Africa: A review. Authorea. 2025. DOI: 10.22541/au.174556820.07640360/v1
[17]Abdi AM, Osman HM, Jama MA, Ibrahim ME. Building resilient primary health care in somalia: Integrating noncommunicable disease and mental health interventions for universal health coverage amidst fragility-a health systems analysis and prospective economic review. BMC Health Services Research, 2026. DOI: 10.1186/s12913-026-15003-1
[18]Sinshaw A. Monitoring and evaluation framework for Primary Health Care programmes and systems: A review. International Journal of Integrated Care, 2024, 24(4), 283-283. DOI: 10.5334/ijic.APIC3221
[19]Bogale B, Scambler S, Mohd Khairuddin ANM, Gallagher JE. Health system strengthening in fragile and conflict-affected states: A review of systematic reviews. PLoS One, 2024, 19(6), e0305234. DOI: 10.1371/journal.pone.0305234
[20]Truppa C, Yaacoub S, Valente M, Celentano G, Ragazzoni L, Saulnier D. Health systems resilience in fragile and conflict-affected settings: A systematic scoping review. Conflict and Health, 2024, 18(1), 2. DOI: 10.1186/s13031-023-00560-7
[21]Ahmed MM, Dirie NI, Mohamud AK, Elmi AH, Musa SS, Alhammadi OA, et al. Advancing digital healthcare in Somalia: A review of modern technologies and their implications. BMC Digit Health, 2024, 2, 49. DOI: 10.1186/s44247-024-00111-x
[22]Mohamed AA, George NS, Ali AY. Challenges and opportunities in utilizing secondary data for health research in Somalia: A focus on health management information systems (HMIS). Health, 2025, 17(8), 921-930. DOI: 10.4236/health.2025.178060
[23]African Development Bank (AfDB), IGAD. Drought Resilience and Sustainable Livelihoods Programme II (DRSLP II), Somalia: Project Completion Report 2020-2024. Abidjan: AfDB, 2024.
[24]Makokha B. Training manual on monitoring systems: 2nd regional workshop on monitoring & evaluation. ICGLR, 2017.
[25]Aranda E, Arif Z, Innocenti C, Wahid SS. TCharacterizing the implementation of performance management interventions in a primary health care system: A case study of the Salud Mesoamerica Initiative in El Salvador. Health Policy and Planning, 2023, 38(5), 579-592. DOI: 10.1093/heapol/czad020
[26]Bingham AJ. From data management to actionable findings: A five-phase process of qualitative data analysis. International Journal of Qualitative Methods, 2023, 22, 16094069231183620. DOI: 10.1177/16094069231183620
[27]Mpofu M, Semo BW, Grignon J, Lebelonyane R, Ludick S, Matshediso E, et al. Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: Lessons learned from an M&E task-shifting initiative in Botswana. BMC Public Health, 2014, 14, 1032. DOI: 10.1186/1471-2458-14-1032
[28]Bogale B, Scambler S, Mohd Khairuddin AN, Gallagher JE. Health system strengthening in fragile and conflict-affected states: A review of systematic reviews. PLoS One, 2024, 19(6), e0305234. DOI: 10.1371/journal.pone.0305234
[29]Elsey H, Abboah-Offei M, Vidyasagaran AL, Anaseba D, Wallace L, Nwameme A, et al. Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: A history and systematic review of what works, for whom and why. Frontiers in Public Health, 2023, 11, 1105495. DOI: 10.3389/fpubh.2023.1105495
[30]Munatsi R. Using rapid evidence-synthesis platforms to institutionalise evidence-informed decision-making in low-resourced health systems. Johannesburg: University of Johannesburg. 2024.
[31]Ahmed MM, Dirie NI, Mohamud AK, Elmi AH, Musa SS, Alhammadi OAS, et al. Advancing digital healthcare in Somalia: a review of modern technologies and their implications. BMC Digital Health, 2024, 2(1), 49. DOI: 10.1186/s44247-024-00111-x
[32]Nikoloski Z, Mohamoud MM, Mossialos E. Universal health coverage in fragile and conflict-affected States: Insights from Somalia. International Journal for Equity in Health, 2025, 24(1), 125. DOI: 10.1186/s12939-025-02486-3
[33]Kadir A, Stevens AJ, Takahashi EA, Lal S. Child public health indicators for fragile, conflict-affected, and vulnerable settings: A scoping review. PLOS Glob Public Health, 2025, 5(3), e0003843. DOI: 10.1371/journal.pgph.0003843
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Copyright (c) 2026 Bonface Makokha, Richard W. Okwara (Author)
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