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A. What is the Monitoring and Evaluation (M&E) Framework?
In 2023, a significant stride was made toward improving medicine access in the Philippines through a comprehensive Monitoring & Evaluation (M&E) Framework. This framework emerged from a Theory of Change Workshop, which brought together multiple stakeholders in a whole-of-government approach. The workshop's primary output was an outcomes framework that established clear causal links between strategies for medicine access and broader pharmaceutical goals. This was achieved by assigning measurable indicators to monitor the progress of initiatives set forth by the Department of Health - Pharmaceutical Division (DOH-PD) in partnership with the Asian Development Bank (ADB). Building on this foundation, the agency prioritized specific indicators for the pilot implementation of their M&E efforts.
The M&E Framework is structured around 62 key indicators (Figure 2.1), carefully distributed across the three pillars of medicine access: availability, accessibility, and the rational use of medicines (RUM). This robust framework is a comprehensive tool for tracking progress, identifying areas for improvement, and ultimately advancing the goal of universal access to essential medicines in the Philippines. As a subset of the broader 2023 M&E framework, the current framework provides a more granular focus on indicators directly related to the DOH-PD's initiatives.
B. What are the components of the M&E Framework?
The M&E Framework for medicine access was organized to align with the primary healthcare (PHC) Monitoring Conceptual Framework established by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) (2022). This alignment ensures that the framework is built upon globally and regionally recognized conceptual and monitoring frameworks for health systems strengthening, PHC, and Universal Health Care (UHC), making it an ideal foundation for assessing medicine access in the country.
The framework has two key components: interventions and indicators. The interventions outline the strategies and specific actions to improve medicine access. On the other hand, indicators are a set of carefully selected metrics designed to measure the progress and impact of the interventions. This section delves deeper into these components.
What are interventions?
What are interventions?
The M&E Framework is founded on 11 priority interventions (Table 2.1). Interventions are deliberate and planned activities to achieve intended outcomes and goals. These can be broadly categorized into strategies, which represent the overall focus of an initiative, and actions, which are the specific steps taken to implement these strategies (Center for Theory of Change, n.d.). The interventions are the activities that the indicators are designed to measure. More specifically, the DOH-PD carefully selected priority interventions from their existing policies, programs, and projects; these interventions also align with the strategic pillars of the PMP. This comprehensive selection process serves a dual purpose: it ensures that the indicators in the M&E Framework actively measure the agency's actual activities and align with their capabilities, while also informing and shaping the DOH-PD's future strategic direction. Importantly, each of the three pillars of medicine access has its own set of corresponding strategies and interventions, allowing for a targeted and holistic approach to improving medicine access across all dimensions.
What are indicators?
What are indicators?
In a Theory of Change, outcomes represent the anticipated changes resulting from specific interventions (Annie E. Casey Foundation, 2022). These outcomes are the target results that stakeholders aim to achieve through their planned strategies and actions. To effectively gauge progress towards these outcomes, indicators serve as essential measurement tools. Indicators are precisely defined variables that quantify or qualify the various aspects of the desired outcomes (Center for Theory of Change, n.d.). As part of the M&E Framework, they function as a comprehensive tracking system to monitor progress across different time horizons. Through indicators, we can better understand the interplay of systems for medicine access, compare them, and ultimately, improve them (Pencheon, 2017). This multi-layered approach to monitoring allows for a nuanced understanding of how interventions contribute to the intended outcomes, ultimate goals, and wider systemic impacts.
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