Proving It With Less: Sustaining M&E and Quality Improvement When Technical Budgets Are Cut First

The quarterly report an M&E officer is preparing this week may be the document that decides whether their own post survives the year. That is the strange position measurement now occupies. The budget line that funds it is among the first to be cut, yet its output has quietly become the thing a programme's future funding turns on.

This is not a coincidence of bad timing. It is a structural feature of how the new funding era works, and understanding it changes what an M&E or quality-improvement lead should do next. The instinct under budget pressure is to treat measurement as overhead and trim it. The reality is closer to the opposite: in a world of co-investment and value-for-money scrutiny, the evidence a programme can produce about itself is becoming its most valuable asset.

Getting this right means seeing why measurement is cut first, understanding what funders actually buy now, protecting the few things worth measuring, improving services without a budget for it, and turning all of it into the case that keeps the money coming.

Why the first budget cut lands on measurement, and why that is backwards

When budgets contract, the functions that do not directly deliver a service tend to go first. The current US posture makes this explicit, moving to rapidly reduce funding for activities other than health commodities and frontline health workers. Monitoring and evaluation, technical assistance, and data systems sit squarely in that category. On a spreadsheet, they look like the safest things to cut, because nobody misses a report the way they miss a medicine.

The problem is that this reasoning is running exactly backwards for the environment it operates in. Development assistance for health peaked at US$80.3 billion in 2021, fell to $49.6 billion in 2024, and is expected to drop to $38.4 billion in 2025, a level last seen in 2009, with continued stagnation forecast through 2030. Less money, chasing the same disease burden, means every remaining dollar is scrutinised harder. The instrument that shows where a dollar produces the most health is not a luxury in that world. It is the thing that decides which programmes survive the squeeze.

So the paradox stands: the technical function most likely to be cut is the one whose value is rising fastest. An M&E lead's task is not to defend measurement as it was resourced before, but to reshape it into something lean enough to survive the cut and sharp enough to justify keeping.

What funders now buy: evidence of value for money

The new funding relationship is transactional in a way the old one was not. When a government co-invests its own constrained budget and a bilateral agreement is built around a path to self-reliance, the funder is no longer buying activity. It is buying outcomes per dollar, and it wants to see the evidence before it commits. Measurement is how a programme makes that sale.

This changes what belongs in a report. Co-financing arrangements, drawing on models like Gavi's, increasingly pair a donor-government agreement to jointly fund a programme with the government assuming a rising share over time, and build in a mutual monitoring mechanism with both health and finance ministries as co-signatories. A finance ministry reads evidence differently from a disease programme. It wants unit costs, trends, and a defensible link between spending and result. The reporting that satisfies it looks less like an activity log and more like an investment case.

There is a long-standing gap this exposes. For all the attention paid to tracking how much donor money flows to a country, what happens once the money arrives has historically been far less clear. The programmes that can close that gap for a funder, showing not just that money was spent but what it bought and how efficiently, hold an advantage that has nothing to do with the size of their M&E budget and everything to do with its focus.

Sustaining M&E on a shrinking budget: what to protect, what to let go

A shrinking budget forces a question most M&E systems never ask themselves: which of these numbers actually changes a decision? Protect the small set of indicators that drive management action and prove outcomes. Let go of the data collected only because it was always collected. Most systems over-measure, and a funding shock is a blunt but effective forcing function to measure what matters.

In practice, the indicators worth defending are the ones tied to outcomes and cost. What did it cost to achieve a result, how has that cost moved over time, and is the service reaching the people it is meant to reach. Around that core, a great deal of routine reporting can be thinned without losing anything a decision depends on. The test for each indicator is simple and unsentimental: if this number moved, would anyone do anything differently? If not, it is a candidate to drop.

The second move is structural. Vertical M&E systems that run parallel to the national one are expensive to maintain and, because they operate independently of the national health system, tend to increase inefficiency and complicate effective management. Folding measurement into the national health information system, rather than running a separate donor-shaped apparatus alongside it, is often both the cheaper option and the more sustainable one. The data a programme needs and the data the country needs are usually closer than parallel systems assume.

Continuous quality improvement without a budget line

Quality improvement is frequently the first thing cut and the easiest to sustain without dedicated funding, because at its core it uses staff and data a programme already has. A continuous quality improvement loop is a disciplined habit rather than a project: review the data you already collect, identify one thing to change, test the change, and check whether it worked. None of those steps requires a new budget line.

What it requires instead is rhythm. A facility team that meets regularly to look at its own numbers, choose a single improvement, and return the following month to see whether it moved is running a quality-improvement system, whatever it is called. This is also precisely the kind of evidence the new funders reward, because it demonstrates a service getting measurably better over time, which is exactly the trajectory a value-for-money case needs to show. Improvement and evidence turn out to be the same activity viewed from two angles.

The discipline matters more than the tooling. Sophisticated platforms help when they exist, but the loop works on paper registers and a monthly meeting. The programmes that keep improving through the squeeze are rarely the ones with the best software. They are the ones that kept the habit of looking honestly at their own results and acting on what they saw.

Turning measurement into your funding case

The final move is to stop treating M&E output as a report filed and start treating it as an argument made. A co-investment negotiation is won or lost on a programme's ability to state, with evidence, what it delivers per unit of spending and how that has improved. The M&E function that survives the budget cut is the one repositioned from a compliance cost into the source of that argument.

Assembling the case is largely a matter of framing evidence a programme should already hold. The cost to achieve a defined outcome, the trend in that cost as processes improved, the coverage reached among the intended population, and the plan to sustain it all as domestic financing rises. This is the language of the accountability and co-financing standards now shaping external funding, which increasingly reward context-specific, evidence-based design with regular reviews, feedback loops, and evaluation used to fine-tune investment over time. A programme that can show it works this way is describing itself in the exact terms a modern funder uses to decide.

Seen this way, the measurement budget is not overhead at all. It is the production cost of the single most important document a programme will put in front of a funder. Cutting it to the bone to save money, and losing the ability to prove value in the process, is the most expensive economy a programme can make.

Frequently Asked Questions

Why cut M&E if funders want evidence? Because measurement does not directly deliver a service, it often looks like the safest budget line to trim under pressure. That reasoning misreads the environment. As funding shrinks and shifts to co-investment, the evidence a programme produces about its own value increasingly decides whether it keeps its funding, which makes M&E more important as budgets fall, not less.

What is value for money in health programmes? It is the relationship between what a programme spends and the health outcomes it achieves, expressed in a way a funder can compare and trust. In practice it means unit costs per outcome, trends showing efficiency improving over time, and evidence that services reach the intended population, rather than a list of activities completed.

How do we do M&E with less money? Protect the small set of indicators that drive decisions and prove outcomes, and drop data collected only out of habit. Fold measurement into the national health information system rather than running a parallel one, and lean on continuous quality-improvement loops that use existing staff and data instead of a dedicated budget.

What is a mutual monitoring mechanism? In co-financing arrangements, it is an agreed system through which a government and a funder jointly track progress against commitments, often with both health and finance ministries as signatories. It formalises shared accountability and gives both sides a common, evidence-based view of whether the programme is delivering what was promised.

Key Takeaways

The programmes that hold their funding through this transition are not the ones with the largest M&E budgets. They are the ones that measured the right things and used the evidence to make their case. In a leaner funding era, measurement stops being overhead and becomes the argument for survival.

• Measurement is cut first and matters most. As funding shrinks and turns transactional, the evidence a programme produces about its own value is what decides who keeps their funding.
• Funders now buy outcomes per dollar. Reporting should read like an investment case, with unit costs, trends, and coverage, not an activity log.
• Measure what changes a decision. Protect the indicators tied to outcomes and cost, drop the rest, and fold M&E into the national system rather than a parallel one.
• Improvement needs discipline, not budget. Continuous quality-improvement loops run on existing staff and data, and they produce exactly the evidence funders reward.
• Reposition M&E as a funding asset. The measurement budget is the production cost of the most important document a programme will show a funder.

Building the evidence base that wins co-investment, while running measurement on a tighter budget than before, is a genuine technical challenge, and it is rarely the thing a stretched programme team has spare capacity for. This is the work ChainOptix's Technical Services are built for: health systems strengthening, data systems, and monitoring and evaluation that turn a programme's results into its case for funding. If your team is rethinking how it measures and proves impact, we would welcome the conversation.