Monitoring and Evaluation for Health Resilience Programming in Fragile Settings: Lessons from DRSLP II, Somaliaf Sub-Saharan Africa

This study examines how conflict-sensitive and context-specific monitoring and evaluation (M&E) approaches can enhance health system resilience in fragile environments, drawing on experience from Somalia and regional capacity-building initiatives in Eastern Africa. A synthesis of two primary evidence sources was undertaken: (1) implementation experience from the African Development Bank-financed Drought Resilience and Sustainable Livelihoods Programme II (DRSLP II) in Somalia, which reached approximately 1.5 million people and four million livestock; and (2) a regional training manual developed to guide the design and operation of monitoring systems in fragile contexts. A comparative analytical framework assessed four dimensions: relevance to local conditions, operational feasibility, adaptability in insecure settings, and alignment with donor and government reporting requirements. Four notable innovations were identified: the development of contextualised indicator frameworks that bridge local and international standards; participatory validation processes that improved data credibility; rapid assessment tools suited for high-risk areas; and structured feedback loops that supported timely programme adjustments. Under DRSLP II, year-round access to multi-use water increased from 0% to 40%, 118 km of rural roads were rehabilitated, and 40 women-led Village Savings and Loan Associations were established__illustrating how robust M&E can support resilience outcomes. Context-sensitive M&E systems can inform and support material improvement of infrastructure to national and international standards, improve data credibility and rapid assessment. Well designed and implemented M&E support rapid assessment and structured feedback loops. Evidence from DRSLP II, Somalia underscores that durable resilience requires not only sound technical tools but also inclusive processes that engage communities and implementing partners. Beyond well designed projects, meticulous M&E systems strengthens accountability, learning and adaptive planning in fragile health settings.