This case is about monitoring and evaluation (M&E) challenges in the Punjab Department of Health (DOH). Despite his substantial experience of working in senior managerial positions, Arif Nadeem, the department secretary, finds himself somewhat lost in the numerous department related reports and data sheets that keep on coming from various quarters. He feels under-informed and over-informed at the same time.

DOH regularly collects data on a range of indicators and there are multiple systems in place to collect the data from various health facilities. The following four systems are important. First, the District Health Information System (DHIS) collects data on around eighty indicators covering treatment and spread of communicable and non-communicable diseases, human resources, facility utilization, etc. Second, the M&E assistants (MEAs) inspect primary health care facilities and report on fourteen indicators covering the number of patients attended, staff presence, medicine availability, public opinion, etc. Third, the DOH field operatives visit health facilities and report on various aspects of functioning in monthly meetings of officials at the district level. Since 2011, they have been using simple smartphone based applications to enter data on site and transmit it to the points of analyses instantaneously. Fourth, progress on development projects is reported every month on prescribed pro forma covering physical progress as well as the amount spent. In addition, tertiary care hospitals report on various aspects of their functioning on need basis and receipt/expense statements are regularly prepared by the budget and accounts section in the department.

Often there is too much information to absorb. There is no effective system of filtering and processing information according to the needs of various managerial tiers. Arif realizes that he needs a dashboard that can provide just enough detail to various users. Arif and his team deliberate on the choice of indicators for the dashboard. There is substantial disagreement on what to include and what to leave. The disagreement partly emanates from a lack of clarity on the mandate of the department and its senior management. Farasat, a key team member, proposes eight key areas for the dashboard. He suggests displaying these eight areas on the main screen and creating links to detailed district, tehsil and facility-wise data on selected indicators.