Assessing monitoring and evaluation practices for disability-inclusive health services in selected health facilities in Kampala city

Abstract

Background Monitoring and evaluation (M&E) systems are crucial for ensuring accountability and informing evidence-based decision-making in health programs. In Uganda, however, routine health information systems seldom collect disability-disaggregated data or assess the accessibility and preparedness of services for persons with disabilities. This shortfall weakens the country’s commitments to inclusive health as outlined in the Sustainable Development Goals (SDGs), the Convention on the Rights of Persons with Disabilities (CRPD), and national policy frameworks. Objective: To assess monitoring and evaluation (M&E) practices for disability-inclusive health services at selected health facilities in Kampala City. Methods: A qualitative case study design was employed, guided by the Performance of Routine Information System Management (PRISM) framework. Data collection involved 25 key informant interviews (KIIs), three focus group discussions (FGDs), and a targeted review of relevant documents. Thematic analysis was utilized to identify patterns across the technical, organizational, and behavioral dimensions of Monitoring and Evaluation (M&E) practices. Findings: This study concludes that although some disability-related data, primarily informal notes concerning physical impairments, observable function limitations, and service utilization by individuals with disabilities, are collected at the facility level, such data are neither systematically analyzed nor utilized to inform planning or service enhancement. Routine Health Management Information System (HMIS) tools lack standardized indicators that are sensitive to disability, and mechanisms for feedback between health facilities and district and national levels remain inadequate. Furthermore, Organizations of Persons with Disabilities (OPDs) are often excluded from monitoring and evaluation (M&E) processes, thereby restricting opportunities for participatory accountability and responsiveness. Conclusion: Enhancing disability-inclusive M&E involves adding disability indicators to HMIS tools, increasing staff capacity for inclusive data collection and utilization, and creating mechanisms for OPD involvement. These actions are essential for advancing equity, accountability, and inclusive health services in urban Uganda.