Assessment of the monitoring and evaluation system of a population-based program: Theory-driven evaluation approach

•The top-down approach to M&E systems is often a result of authority or use of grants to induce compliance.•Inviting collaboration to build M&E does not secure buy-in of the lower-level agencies.•Managerial policies, trust, and communication are the heavy influencers of performance.•A bilateral adaptive strategy is critical for the successful development and implementation of the M&E system and program. The purpose of this study was to assess the performance of a monitoring and evaluation system (M&E) for a population-based program and to identify factors influencing its performance. The state health department provided a grant, guide, and training for health districts to implement the program and report quarterly and annually to the M&E. Some health districts did not meet this requirement. We also found that the M&E did not adequately capture the actual work of the districts in communities as related to the work plan. We identified several factors that negatively affected the performances of the M&E. For example, the state and health districts did not have a shared vision on how to develop and implement the program, and what to report to the M&E. We proposed strategies that could improve the timeliness and content of reports to the M&E, as well as its utilization in the future.