Abstract: This study assesses extent to which stakeholders’ participation influence in the implementation of effective monitoring and evaluation systems in health institutions and hindrance towards having effective monitoring and evaluation systems. Stakeholder’s participation is around involvement in effective M&E systems, extent of participation, stakeholder’s involvement in development projects, external stakeholder’s involvement and stakeholder’s involvement in M&E committees. At the County level, hospitals, health facilities and dispensaries stakeholder’s participation are at the frontline in ensuring the implementation of effective M&E are achieved thus impact to the health sector. The findings showed that stakeholder’s play a critical role in monitoring and evaluation systems and there is need to have stakeholders participate in all stages of implementation. Through effective stakeholder engagement, stakeholders can provide direct input in evaluation systems by providing feedback and findings of the M&E activities. However, unavailability of M&E committees is a major challenge that hampers smooth decision making in monitoring performance and identifying gaps and challenges.