Challenges in Monitoring and Evaluation During Health Emergencies

When a health emergency strikes, responders face immediate pressure to save lives, deliver essential services, and manage overwhelming demands. But equally important is the ability to track what’s working, identify gaps, and improve responses in real-time and for future events. This is where monitoring and evaluation (M&E) becomes critical-yet it’s precisely where disaster settings create unique and formidable obstacles.

Why monitoring and evaluation matters during health emergencies 🔗

Effective M&E during health emergencies serves as the backbone for evidence-based decision-making. Research on disaster response shows that evaluating a health department’s response to emergencies can reveal what supports or hinders the successful delivery of health services. Without proper M&E systems, responders operate in the dark, potentially repeating the same mistakes from previous disasters.

The consequences of inadequate M&E are well-documented. After the public health responses to Hurricanes Katrina, Gustav, and Ike in the United States, the same failures that were documented reappeared during the H1N1 pandemic response years later. This pattern demonstrates how failing to act on lessons from past emergencies leaves health systems vulnerable to recurring problems.

Resource constraints: the primary barrier 🔗

Health emergencies create extreme pressure on available resources. Personnel who would typically conduct evaluations are instead consumed by immediate response duties-treating patients, coordinating logistics, and managing communications. This leaves little capacity for systematic data collection and analysis.

Limited funding and competing priorities 🔗

Funding for M&E often takes a backseat to direct response activities during emergencies. Studies on public health emergency preparedness indicate that funding streams are typically siloed with respect to priorities, focused on singular diseases or planning functions, which hampers collaboration across sectors. When budgets tighten during crises, M&E activities are frequently the first to be cut despite their long-term value.

Additionally, legislation and funding often reflect the most recent past events, creating a reactive approach that focuses on the last disaster rather than building comprehensive systems for future emergencies.

Shortage of skilled personnel 🔗

Conducting quality M&E requires specific analytical skills that many frontline health workers lack. Due to the infrequent nature of large-scale disasters, personnel have limited opportunities to practice the documentation and assessment procedures needed during actual emergencies. This skills gap results in evaluation reports that lack depth and fail to capture the nuanced lessons that could improve future responses.

Embedded training-where M&E procedures are practiced during routine operations-has emerged as one solution. Some health departments use annual activities like influenza vaccination campaigns to train staff in mass response procedures, including documentation protocols.

Time pressures during active response 🔗

In the immediate aftermath of a disaster, there’s an inherent tension between providing care and documenting it. Yet assessments conducted right after an emergency are more likely to capture accurate information that would otherwise be lost over time. External partnerships with academic institutions or neighboring health departments can help alleviate this burden by providing personnel with the time and expertise to document responses properly.

Ensuring data quality and accessibility 🔗

Even when resources are available, disrupted infrastructure during emergencies creates significant barriers to collecting and transmitting reliable data. Roads may be impassable, communication networks damaged, and facilities destroyed-all of which impede traditional data collection methods.

Infrastructure damage and data gaps 🔗

Health emergencies often occur in settings where normal operations are severely compromised. The World Health Organization notes that nearly a quarter of the global population lives in settings affected by conflict, displacement, and natural disasters. In these environments, weak health systems make it difficult to deliver basic services-let alone maintain robust data collection systems.

Traditional methods like transport surveys and manual registration at relief centers are often inadequate. While important for record-keeping, these approaches are slow and may exclude the most vulnerable groups who are unreachable through conventional means.

Mobile technology as a solution 🔗

Research on mobile phone data demonstrates significant potential for improving the quality, quantity, and timing of information needed for disaster management. SMS-based surveys have proven particularly valuable because they work across all phone types-basic, feature, and smartphones-making them accessible in low-resource settings.

During the 2014 Ebola outbreak, the World Food Programme deployed monthly SMS surveys across Sierra Leone, Guinea, and Liberia to collect reports on food shortages and prices. Similarly, the RapidPro open-source SMS system enabled rapid assessment of Ebola prevention supplies in schools, allowing quick responses to identified shortages.

However, mobile technology has limitations. Disasters can damage phone networks, while power outages limit users’ ability to charge devices. Mobile network coverage also tends to be weaker in rural areas, making it difficult to track population movements away from urban centers. Additionally, phone ownership rates remain uncertain in many countries and may skew away from women, the poor, rural populations, and elderly individuals who are often most affected by disasters.

Digital health technologies and telemedicine 🔗

Digital health technologies have expanded data collection possibilities during emergencies. Telehealth platforms allow remote patient monitoring and specialist consultations, while mobile apps enable crowdsourced data collection from affected populations. These tools can help overcome geographic barriers and supplement traditional surveillance systems when infrastructure is compromised.

Crowdsourcing approaches engage distributed citizens as sensors, using mobile applications to report conditions on the ground. This method has been applied to disease control strategies and emergency management during the COVID-19 pandemic, providing real-time information that traditional systems would struggle to capture.

Stakeholder engagement and cultural sensitivity 🔗

Effective M&E cannot happen in isolation. It requires meaningful collaboration with local communities and adaptation to cultural contexts. Without this engagement, data collection may be incomplete, irrelevant, or even harmful to the populations it aims to serve.

The importance of community involvement 🔗

Research on community engagement in humanitarian settings emphasizes that involving affected populations and local communities fosters trust, enhances research designs, and creates channels for information distribution. Local partners understand cultural and historical contexts better than external actors, and their involvement enhances the quality and relevance of M&E activities.

Community involvement is not just ethically required-it’s practical. Studies show that research implementation and adoption of findings after completion depends heavily on whether affected communities were meaningfully engaged throughout the process. This becomes even more critical when working with populations experiencing trauma from humanitarian disasters.

Cultural considerations in data collection 🔗

Cultural factors significantly influence how disasters are experienced, how coping mechanisms develop, and how external aid and support are received. Mental health services and health assessments that ignore cultural values, beliefs, and practices are less likely to be effective or accepted by affected communities.

The U.S. Department of Health and Human Services provides guidance on delivering culturally and linguistically appropriate services during emergencies, recognizing that underserved populations face disproportionate disaster impacts. Effective M&E must account for how cultural dynamics affect data accessibility, willingness to participate in assessments, and interpretation of findings.

Building trust through culturally sensitive approaches 🔗

Successful M&E requires communication strategies that resonate with diverse communities. This means going beyond simply translating materials into local languages-it requires understanding how different communities process information, make decisions, and relate to authority figures.

Recent frameworks emphasize humanistic communication in disaster contexts-approaches that support personal connections, collaborative decision-making, and mutual responsibility. This perspective recognizes that meaningful engagement cannot treat communities as passive data sources but must involve them as active participants in co-designing evaluation activities.

Moving forward: practical solutions 🔗

Addressing these challenges requires multi-faceted approaches. Health departments can create organizational cultures where personnel feel safe reporting errors, leading to more accurate documentation. Standardizing evaluation report formats and terminology enables different agencies to learn from each other’s experiences.

Leadership plays a crucial role. Leaders who foster cooperation, value staff input, and provide constructive feedback create environments where quality improvement-including M&E-can flourish. Shared decision-making structures help personnel feel ownership over evaluation processes, increasing motivation and commitment to implementation.

Technology offers partial solutions but requires careful implementation. Mobile data collection tools must be appropriate to local contexts and accessible to vulnerable populations. Privacy safeguards need development and integration with formal response planning.

The path to better disaster M&E 🔗

Improving M&E during health emergencies is not optional-it’s essential for breaking cycles of repeated failures and building genuinely resilient health systems. This requires sustained investment in training, technology, and community partnerships before disasters strike, not just reactive measures during crises.

The good news is that practical solutions exist. Mobile technologies, community engagement strategies, and organizational culture changes have all demonstrated effectiveness when properly implemented. The challenge lies in prioritizing these investments and building the systems needed to deploy them rapidly when emergencies occur.

What do you think? How might health systems in your region better prepare their M&E capabilities before the next emergency strikes? What role could local communities play in making disaster data collection more effective and culturally appropriate?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC5492906/
2. https://www.ncbi.nlm.nih.gov/books/NBK563994/
3. https://www.who.int/tools/refugee-and-migrant-health-toolkit/module-1/tool-3
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7127132/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC3168875/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC10001761/
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC10470624/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC9371955/
9. https://thinkculturalhealth.hhs.gov/education/disaster-and-emergency
10. https://knowledge.aidr.org.au/resources/ajem-january-2025-embedding-humanity-in-building-sustainable-community-disaster-resilience-in-australia-a-humanistic-communication-perspective/