Possibility of the optimum monitoring and evaluation (M&E) production frontier for risk-informed health governance in disaster-prone districts of West Bengal, India

An efficient M&E system in public healthcare is crucial for achieving universal health coverage in low- and middle-income countries, especially when the need for service remains unmet due to the exposure of the population to disaster risks and uncertainties. Current research has conducted exploratory and predictive analyses to estimate the determinants of sustainable M&E solutions for ensuring uninterrupted access during and after disasters. The aim was to estimate the efficiency of reaching a higher M&E production frontier via the Cobb‒Douglas model and stochastic frontier model as the basic theoretical and empirical frameworks. The research followed a deductive approach and used a stratified purposive sampling method to collect data from different layers of health and disaster governance in a flood-prone rural setting in the Malda, South 24 Parganas and Purulia districts in West Bengal, India. The present mixed-method study revealed multiple challenges in healthcare seeking during disasters and how a well-structured M&E system can increase system readiness to combat these challenges. The stochastic frontier model estimated the highest M&E frontier producing the most attainable M&E effectiveness through horizontal convergence between departments, enhanced coordination, the availability of frontline health workers at health centers, the adoption of learned innovation and the outsourcing of the evaluation component to external evaluators to improve M&E process quality. Although the study has several limitations, it shows the potential to increase technical and allocative efficiency through building skills in innovative techniques and applying them in process implementation. In the future, research on strategy improvement followed by real-world evidence-based policy advocacy is needed to increase the impact of M&E on access to healthcare services.