By: Keren Dunaway

In 2023, Via Libre and the LAC Platform carry out an assessment of Community-Led Monitoring (CLM) initiatives across three Latin American countries: El Salvador, Costa Rica, and Paraguay. This evaluation was part of a broader effort to increase community engagement and ensure that health services effectively address the needs of key and vulnerable populations. 

Conducted in two distinct phases, the project first involved a virtual training course on CLM, targeting seven Country Coordinating Mechanisms (CCMs) in the region. The second phase focused on a detailed national assessment of existing CLM data within the CCMs of El Salvador, Costa Rica, and Paraguay. 

CLM, as outlined in the “Community-Led Monitoring for CCM – Training Guide,” is an accountability mechanism that uses an independently planned and structured process designed and led by equipped, trained and paid members of community-based organizations in affected communities. It refers to models or mechanisms by which service users and local communities continuously collect, analyze, and use information to improve the accessibility, quality, and impact of services. By placing communities at the center of this process, CLM ensures that the voices of those most affected by health disparities are heard and acted upon. 

The assessment aimed to achieve three primary objectives: (1) Identify the types of data collected, the entities responsible, and the diseases targeted, including HIV, tuberculosis, and malaria, (2) analyze factors that hinder the effective use of CLM data by CCMs and propose solutions to overcome these challenges and (3) develop guidelines to adapt existing CLM frameworks to better support CCM decision-making and grant tracking, ensuring that these processes are tailored to the unique needs of each country. 

Findings revealed varying levels of CLM implementation across the three countries, with Paraguay leading in progress, followed by El Salvador and Costa Rica. Despite the progress, there is a generalized confusion among community representatives and other stakeholders about the CLM approach with other strategic monitoring activities, monitoring and evaluation programs, advocacy efforts, accompaniment of vulnerable populations, timely and unstructured follow-up of service delivery, or studies conducted with KPs. This did not apply to Paraguay where community representatives have shown a deeper understanding of CLM. 

There is considerable interest in the region to include CLM strategies in new funding requests to the Global Fund; however, there is a need to improve the technical capacity of organizations and communities to plan, train, operationalize and implement CLM initiatives. 

Factors that contributing to the limited use of CLM data include the fact that the approach is new and certain confusion with other monitoring and follow-up activities. In some countries, experiences are not systematized, and where they are, their use for advocacy is limited.   

Tracking into the results on CLM implementation is an important tool for stakeholders to build on the successes and lessons learned from these three countries. By addressing the identified challenges and leveraging the growing interest in CLM, the region can make significant strides toward more effective and inclusive health service delivery.