title: 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.
abstract: BACKGROUND
  The demand for quality data and the interest in health information systems has increased due to the need for country-level progress reporting towards attainment of the United Nations Millennium Development Goals and global health initiatives. To improve monitoring and evaluation (M&E) of health programs in Botswana, 51 recent university graduates with no experience in M&E were recruited and provided with on-the-job training and mentoring to develop a new cadre of health worker: the district M&E officer. Three years after establishment of the cadre, an assessment was conducted to document achievements and lessons learnt.
  
  
  METHODS
  This qualitative assessment included in-depth interviews at the national level (n = 12) with officers from government institutions, donor agencies, and technical organizations; and six focus group discussions separately with district M&E officers, district managers, and program officers coordinating different district health programs.
  
  
  RESULTS
  Reported achievements of the cadre included improved health worker capacity to monitor and evaluate programs within the districts; improved data quality, management, and reporting; increased use of health data for disease surveillance, operational research, and planning purposes; and increased availability of time for nurses and other health workers to concentrate on core clinical duties. Lessons learnt from the assessment included: the importance of clarifying roles for newly established cadres, aligning resources and equipment to expectations, importance of stakeholder collaboration in implementation of sustainable programs, and ensuring retention of new cadres.
  
  
  CONCLUSIONS
  The development of a dedicated M&E cadre at the district level contributed positively to health information systems in Botswana by helping build M&E capacity and improving data quality, management, and data use. This assessment has shown that such cadres can be developed sustainably if the initiative is country-led, focusing on recruitment and capacity-development of local counterparts, with a clear government retention plan.
authors.forename: Mulamuli
authors.initials: M
authors.lastname: Mpofu
authors.forename: Bazghina-Werq
authors.initials: BW
authors.lastname: Semo
authors.forename: Jessica
authors.initials: J
authors.lastname: Grignon
authors.forename: Refeletswe
authors.initials: R
authors.lastname: Lebelonyane
authors.forename: Steven
authors.initials: S
authors.lastname: Ludick
authors.forename: Ellah
authors.initials: E
authors.lastname: Matshediso
authors.forename: Baraedi
authors.initials: B
authors.lastname: Sento
authors.affiliation: International Training and Education Centre for Health (I-TECH), P,O, Box AC46 ACH, Riverwalk, Gaborone, Botswana. ledikwe@u.washington.edu.
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Ledikwe
mesh_terms: D001902:Botswana; D003906:Developing Countries; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D011203:Poverty; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012107:Research Design