Institutionalisation of Monitoring and Evaluation Systems and Programmatic Performance of Public Health NGOs in Nigeria: A Cross-sectional Analytical Study

Background: This study examined the influence of M&E systems on the programmatic performance of public health NGOs in Nigeria, with the overall aim of assessing how the design, implementation, quality, and challenges of M&E systems impact organisational performance. Grounded in results-based management and performance measurement theory, the study conceptualizes M&E systems as managerial control mechanisms influencing organisational outputs and adaptive capacity. Methods: A quantitative research design was adopted using a structured questionnaire administered through Kobo Collect to 249 respondents drawn from national and international public health NGOs. Data were analysed for descriptive statistics and inferential analyses using SPSS version 27. Results: Results revealed that M&E systems are widely institutionalised within Nigerian NGOs, with 94% of organisations having dedicated M&E units and over 80% adopting structured logical frameworks or theories of change for program planning. The findings further established a strong positive relationship between M&E design and programmatic performance (r = 0.747, p < 0.001), confirming that effective M&E structures enhance program effectiveness. A moderate, significant correlation (r = 0.608, p < 0.001) was found between M&E quality and organisational performance. Multiple regression analysis showed that M&E design significantly predicted performance (β = 0.61, p < 0.001), explaining 55.8% of variance (R² = 0.558), while implementation challenges were not statistically significant predictors (p = 0.054). Regression results further showed that sex, organisational role, and NGO type significantly predicted perceived performance, with national NGOs and senior staff reporting lower ratings than international NGOs and operational staff. Conclusions: The study concluded that effective M&E systems serve as vital management tools that drive efficiency, innovation, and strategic learning within public health NGOs. It recommends strengthening technical capacity, aligning donor reporting frameworks with learning objectives, and leveraging digital technologies to enhance data quality and timeliness. The study contributes to knowledge by repositioning M&E from a donor compliance requirement to a strategic business management function essential for improving accountability, sustainability, and organisational performance in the Nigerian NGO sector.