Monitoring and evaluation of a large-scale community-based program: recommendations for overcoming barriers to structured implementation.

Accountability for the use of limited health resources requires quality information for ongoing monitoring of program effectiveness. We outline the challenges involved in the monitoring and evaluation of a large-scale community nurse home visiting program. Efforts to establish and maintain rigorous assessment were impaired by interrelated difficulties, impacting on the quality of information collected. The consequences and outcomes of these challenges are discussed. Recommendations to facilitate the monitoring and evaluation of community-based programs are made. Successful program monitoring and evaluation, guided by these recommendations, will support the ongoing review of program activities and evidence-based decision making to inform current operation and future planning.