There is an increasing need to bridge the gap between learning effective Monitoring & Evaluation strategies and implementing them especially in Low and Middle Income Countries (LMICs) facing a shortage of resources and challenging healthcare systems. When public health programs are being implemented, evaluation studies of effectiveness are needed. Evaluation studies of effectiveness should aim to demonstrate impact, both benefits and potential harms, and to understand the strategies used in achieving said impact.
Just as Yamey (2012) pointed out: a major reason for slow progress in developing countries was the “know-do gap”. Many of the people in LMICs face socioeconomic and political instability. Stemming from deep-seated issues, they have been unable to evolve technologies appropriate to their own resources and have been dependent on external institutions to transfer technical know-how. This usually means that research and development is directed towards solutions for Global North’s problems and these are then used as frameworks to be used in meeting the needs of the Global South.
Evidence-based approach drawn from high-quality research is widely acknowledged as a vital element that supports effective implementation. However, even with enough evidence, the evidence does not push itself into practice spontaneously. This often requires advocacy, stakeholder engagement, technical assistance and other efforts to promote its use (Hoke ; Wilcher, 2014).
The obstacles to knowledge uptake may be grouped into three interacting spheres: Demand, Supply and Socio-cultural factors. On the demand-side, policymakers need evidence from research that determines which options are quick and cost-effective. Demand-side issues include a lack of awareness of existing or relevant research and limited interest in using the research knowledge. On the supply-side, researchers are concerned on how to improve dissemination of knowledge and the acceptability to policymakers. However, the supply and demand interaction does not take place in a vacuum but within socio-cultural environments and around events that shape the opportunities for research use (Stone, 2001). The socio-cultural sphere is probably the most important factor that can mitigate the uptake of evidence.
Most LMICs struggle with performance tracking of public health interventions and this contributes to the curtailed progress in development (The World Bank, 2013). The know-do gap regarding strategies in evaluating programs and projects in LMICs may be addressed by the following solution options:
1) Monitoring, Evaluation and Implementation Science technology from High Income Countries (HICs) may be transferred to LMICs by direct training to increase local capacity and to engage national governments in the development of indicators and implementation plans that are tailored to the specific needs of the country. The LMICs will benefit from external assistance in the development of its own monitoring and evaluation plan for enhancing its capacities to maximize use of resources and knowledge and relating it with international expertise and experiences.
The need for better dialogue, partnerships and collaboration is a recurring theme of need on evidence-based policy and practice. This becomes a key factor in successful knowledge translation and considers the receiver’s inherent capacity and guides it to wade through issues that are unique to its setting (Stone, 2001).
With tailor-fit strategies, the developed monitoring and evaluation system will be the source of information to guide national policy, providing evidence on the effectiveness of such strategies in LMICs and may be introduced to other countries with similar settings but may not always be replicable due to diversity in obstacles per setting.
2) The second solution greatly depends on the World Health Organization (WHO) playing a vital role in directing and coordinating international health. By releasing a standard set of indicators, such as the 100 Core Indicators by WHO, that could be used across countries. However, this poses a problem in countries without the inherent capacity to execute monitoring and evaluation strategies recommended by WHO.
The standard set ensures that comparability between nations is valid and may spur a competitive spirit to improve for the next evaluation during benchmarking events. In addition to this, developing a web-based monitoring and evaluation platform as the ground for countries to exchange information will be useful. The existence of web-based platform is ideal in timely reporting of potential failures, which allows prompt actions to mitigate the problem (Sanga et al., 2013). With the use of a standard set of indicators, comparability between countries is assured.
3) Status quo. This solution does not incur any additional costs to the existing system however, does not contribute to closing the know-do gap in monitoring, evaluation and implementation science.
As seen in the table below, the second option covers all the criteria for decision-making; however, the first option presents the best solution to facilitate smoother knowledge translation by enhancing local capacity of LMICs under the guidance of HICs. By considering the LMICs’ capacity and unique obstacles, tailor fitting of monitoring and evaluation strategies addresses the need to bridge the ‘know-do’ gap.
In conclusion, in order to bridge the ‘know-do gap’, uptake may be affected by demand and/or supply but it is significant to take into account the social, economic and political factors. Introducing and implementing technology from Global North on to Global South can be difficult to execute with identified inherent complexities in public health, limited government capacity, inadequate spread of knowledge/strategies and lack of political will and decision making. The assistance provided for by external institutions will allow the development of its own strategies and tailor-fitting it to answer the country’s unique needs. Provided guidance will ensure validity of the strategies, enhancing local capacity will allow a smoother knowledge uptake and sustainability in Low and Middle Income Countries.