Assessing the performance of the results-based monitoring tool and its influence on program performance in Uganda’s national HIV response

Abstract

Background: Uganda continues to face a significant HIV burden, with 4.9% prevalence and 37,000 new infections annually. To strengthen monitoring, accountability, and decision-making, the Uganda AIDS Commission (UAC) introduced the Result-Based Monitoring (RBM) Tool. While the tool provides a structured framework for performance tracking, challenges such as incomplete reporting, limited flexibility, and uneven staff capacity affect its optimal use. Objectives: This study evaluated the RBM Tool’s performance and its influence on performance monitoring and decision-making. It specifically examined trends in activity completion rates and data completeness, stakeholder perspectives, implementation challenges, and enabling factors for tool optimization. Methods: A process evaluation using an explanatory sequential mixed-methods approach was applied. Secondary data (n = 370 activity records, 2022–2024) from UAC database were analyzed using descriptive statistics and trend analysis. Qualitative data were collected through 16 key informant interviews with UAC staff (n = 10) and Self-Coordinating Entities (n = 6), and analyzed thematically using NVivo 15. Results: Activity completion averaged 82.7%, with stable annual performance scores (84.2% in 2022, 81.8% in 2023, 82.1% in 2024). Data completeness improved after 2022, yet over half of submissions in 2023–2024 remained incomplete. Stakeholders emphasized the tool’s value in standardizing reporting, aligning planning with national priorities, and fostering accountability. However, they cited constraints in capturing process-based achievements, limited narrative space, and capacity gaps among SCEs. Enabling factors included peer learning, quarterly feedback loops, financial facilitation, and a user-friendly interface. Conclusions: The RBM Tool has reinforced structured performance monitoring and accountability in Uganda’s HIV response but requires technical refinements, sustained capacity building, and integration with national digital systems to maximize effectiveness, adaptability, and sustainability.