Strengthening the Strategic Impact of Global Health Engagements through Assessment, Monitoring, and Evaluation
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This study employed a qualitative, cross-sectional, exploratory design guided by the Consolidated Framework for Implementation Research (CFIR 2.0). The research integrated two complementary data sources to provide top-down and bottom-up perspectives on AM&E. First, a systematic review of unclassified DoD policy documents, doctrine, and strategic guidance was conducted to assess the clarity, comprehensiveness, and supportiveness of existing AM&E frameworks. Second, reflexive thematic analysis was performed on semi-structured interviews with 27 GHE practitioners. Participants represented multiple ranks, roles, and military services across five Geographic Combatant Commands (GCCs) and enterprise-level positions. Data from both sources were synthesized using a joint display matrix to identify areas of alignment, divergence, and silence. Results
Global Health Engagement (GHE) is a vital instrument of the United States Department of Defense (DoD) strategy, utilized to build partner capacity, enhance regional stability, and ensure force readiness. In an era characterized by great power competition and an “America First” foreign policy paradigm, GHE must prove its value in measurable terms that link outcomes to lethality, readiness, and deterrence. However, the strategic promise of GHE is consistently undermined by a significant lack of consistent and standardized Assessment, Monitoring, and Evaluation (AM&E) practices. This systemic gap hinders the DoD's ability to assess outcomes, align tactical activities with strategic objectives, and justify multi-year funding. The purpose of this study was to explore the knowledge, skills, and operational realities of GHE practitioners while analyzing the prescriptiveness of current DoD policy to identify systemic barriers to effective AM&E implementation.Methods
The integrated findings revealed a profound structural disconnect. While strategic policy mandates robust evaluation, it fails to provide the methodological guidance or organizational stability required for tactical execution. The policy review demonstrated that AM&E expectations are widely articulated across the defense architecture but lack consistent operational guidance for health-specific engagements. Furthermore, formalized AM&E frameworks are primarily tied to Significant Security Cooperation Initiatives (SSCIs), leaving the vast majority of routine GHE activities operating through a policy loophole without dedicated assessment mandates or evaluation resources. Practitioner interviews revealed that while AM&E is widely recognized as important, it is inconsistently understood in practice, largely due to a systemic lack of formal AM&E training. Even when understood, implementation is constrained by limited organizational capacity, funding limitations, frequent personnel turnover, fragmented knowledge management systems, and a lack of dedicated AM&E personnel. Consequently, GHE practitioners frequently default to measuring superficial activity outputs rather than complex strategic effects. Discussion
To address these gaps and transition from theoretical frameworks to actionable defense policy, this study formulated targeted recommendations for policy reform and practitioner support. Policy recommendations include revising DoDI 2000.30 to establish a scalable, tiered AM&E requirement for all GHE activities based on funding and duration, thereby closing the SSCI loophole without overburdening the force. Additionally, institutional continuity and policy compliance could be significantly improved by establishing dedicated AM&E funding percentages across all authorities and resourcing dedicated evaluation billets. To support practitioners at the operational and tactical levels, the GHE enterprise should develop a standardized library of "off-the-shelf" planning playbooks and after-action reporting templates, scale offline-capable mobile data collection technology, and institute mandatory "just-in-time" AM&E pre-deployment briefings. Additionally, leveraging secure Artificial Intelligence (AI) may help address systemic knowledge management barriers by synthesizing fragmented data to support planning, AM&E, and enterprise-level reporting. Implementing these recmmendations will empower the DoD to accurately calculate the return on investment for health diplomacy and transform GHE into a strategically aligned, rigorously evaluated instrument of national security.
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