M&E-The Ethiopian Experience MERG Meeting Geneva,Switzerland Oct. 25-26,2004 Dr. Wuleta Lemma, CDC/Tulane/WB M&E and Surveillance Advisor, HAPCO/MoH

Outline Background M&E---Case Study After Bangkok New Development

Status of HIV/AIDS

Background-Ethiopia People living with HIV/AIDS ……..…………….….. 1.5 million Estimated percent of adults (15–49) infected with HIV ….. 4.4% Rural = 2.6%; Urban = 12.6% Cumulative deaths due to AIDS ………………..…... > 1 million Children infected and living with HIV ………………... 96,000 Cumulative number of children orphaned by AIDS …... 540, 000 Number of pregnant women living with HIV …………. 130,000 Number of PLWHA needing ART ……………………. 245,000 UNAIDS estimated, by the end of 1999, about 3 million people to be living with HIV/AIDS in Ethiopia. Though Ethiopia constitutes only 1% of the world’s population, it contributes about 9% of the world’s HIV/AIDS case burden. Estimated percent of adults aged 15 to 49 infected with HIV was 10.7%. There have been over a million cumulative deaths due to AIDS with 280,000 occurring in 1999 alone. UNAIDS estimated 150,000 children to be currently living with HIV and an astounding 1.2 million children to have been orphaned by AIDS.

Weighted urban HIV prevalence: 12.5%

: 2.8% (2004) 2004 prevalence range: 1.0% - 5.2% Assumed start of rural HIV epidemic: 1984

No. HIV-pos, 2003: Female: 810,000 Male: 650,000 Total: 1.5 million

M&E-The Ethiopia experience

Challenges to “One M&E System” No M&E unit at the national level Indicators not harmonized- Everybody have their own – Ministries, Donors, CSO etc No unified data collection formats- Organizations have their own different formats for similar indicators- “Same person ” at lower fills it all !!!! Different report-Information Flow Limited not unified capacity building plan -- including training and human capacity at all levels to role out a national M&E system Non existence of an integrated data base (including HMIS) Surveillance more developed than Program Monitoring Limited Budget for M&E Non-existent and disjointed Evaluation plan Infrastructure (road, telecommunication, networking, etc) varies from region to region

M&E-2003-present M&E Department at national ( 5 Staff ), Regional HAPCOs and district focal persons. M&E team includes MoH Secured budget (MAP,GF, PEPFAR and Others) Comprehensive training plan for all regions developed – ToT manual to follow Equipment (Computers & accessories) for all regional M&E Departments and all new ART sites- Take advantage of Woreda net National M&E Framework (with indicators, methods of data collection, Information flow, who collects what etc) after extensive consultation published in December 2003 and distributed to all Regions, NGOs, FBOs & Donors

M&E 2003-present National M&E Operational Plan with detail M&E Formats for all program activities Assessment of National Financial Monitoring System of NHAPCO Harmonization of GF requirement with national Indicators Consolidated Surveillance and M&E resource mapping for MoH completed Expanded Surveillance : 66 sites for 2003, almost twice the number sampled in 2001 (34 sentinel surveillance sites in 2001) first BSS done/report distributed nationwide (>27,000 sample) BBS-2 starting

After Bangkok

University Students 2003/4 (1996 ET) M&E data collected 2 University Students/ Region plus ~2 per District (606 district) Most regions completed Information includes at Federal level --Sector Ministries, Bilateral, Multilateral and NGOs

Example-Forms

M&E Operational Manual-12 modules-meeting in Nov, 2004 (>150 people) Module 01 Education Module 02 Drug Administration and Control Authority (DACA) Module 03 Ethiopian Red Cross Society (ERCS) Module 04 FMoH, RHBS, WHOs and Facilities (Health) Module 05 Other Government Offices Module 06 Bilateral and Multilateral Organizations Module 07 Civil Societies (NGOs, FBOs, CBOs, POs, etc.) Module 08 Kebele HIV/AIDS Committee?? Module 09 Woreda HIV/AIDS Committee?? Module 10 Zonal HIV/AIDS Committee?? Module 11 Regional HAPCO Module 12 National HAPCO

Other-Opportunity/Challenge Ethiopia approved for the largest GF (GF2+GF4 > $600M, PEPFAR around 50M/year) ~10-12% for M&E(inc. HMIS) and Surveillance/year FMoH- HMIS (HMIS and M&E Advisory Committee formed-Work stared) LMIS Lab Information system Patient monitoring system M&E National/Regional ToT training Training on Medical Record

The Network Model Formal Health System Levels Service Components ART Specialty care Acute Illness Care HIV Counseling and Testing Pain Management Tertiary Referral Hospitals ( 5) C O M U N I T Y Regional / Zonal Hospital Uniformed Services District Hospital District Hospital District Hospital Health Center HIV counseling and testing, PMTCT, OI treatment and prophylaxis, TB dx , ART follow up, nutrition counseling and support, psychosocial support [ pain management] Health Center Health Center Health Center Transporters CSW Health Posts HEP: basic general health care CHWs Basic care, including pain and symptom relief Home based Care

New Development/Strategies HAPCO to Report to MoH Implication on M&E not clear (assumed not much as the National M&E Framework was accepted in SPM) Implication on structure not clear Health Extension Workers (23,000 to be deployed in 5 years). 2005 M&E training planned Performance based District Block grants

Thanks!!! A small section of Mosi-oa-tunya (also called Victoria Falls) in June at high water, from the Zambian Perspective. A mile along the precipice, a 100 meter cascade, 1.5 million gallons per second, awe-inspiring.