February 4-6 2002 Dakar, Senegal STRENGTHENING MONITORING and EVALUATION of NATIONAL AIDS PROGRAMMES in the CONTEXT of the EXPANDED RESPONSE February 4-6 2002 Dakar, Senegal

Monitoring AND Evaluation Monitoring: What are we doing? Tracking inputs and outputs to assess whether program are performing according to plans (e.g. people trained, condoms distributed) Evaluation: What have we achieved? Assessment of impact of the programme on behaviour or health outcome (e.g. condom use at last risky sex, HIV incidence) Surveillance: monitoring disease Spread of HIV/STD (e.g. HIV prevalence among pregnant women)

A FRAMEWORK for Monitoring and Evaluation Input Process Output Outcome Impact People money equipment policies etc. Services Service use Knowledge HIV/STI transmission Reduced HIV impact Training Logistics Management IEC/BCC etc. Behaviour; Safer practices (population level)

DATA COLLECTION for Monitoring and Evaluation Input Process Output Outcome Impact HIV/STI surveillance Household Surveys Facility surveys Programme Monitoring

INITIATIVES for Monitoring and Evaluation Input Process Output Outcome Impact Household Surveys Facility surveys Programme Monitoring HIV/STI surveillance Multi-sectoral AIDS (MAP) program Monitoring and Evaluation Second generation surveillance USAID / CDC Expanded response Monitoring and Evaluation United Nations General Assembly Special Session (UNGASS) Monitoring and Evaluation

Senegal Jamaica Thailand Uganda MONITORING and EVALUATION at the NATIONAL LEVEL: NATIONAL SUCCESS STORIES Uganda Senegal Jamaica Thailand

behaviour be attributed to interventions / programs? Did the National Response Make the Difference? Input Process Output Outcome Impact 1 HIV prevalence changing! 2 Can the changes in HIV prevalence be attributed to changes in behaviour?? 3 Can the changes in behaviour be attributed to interventions / programs?

The components of AIDS programmes Input Process Output Outcome Impact IEC programs: knowledge, attitudes Condom promotion and distribution School programs: adolescent KAP Targeted interventions (e.g. CSW, IDU) Control of STDs Voluntary counselling and testing Reduction of mother-to-child transmission Blood safety, prevention nosocomial transmission Care & support programs (including ARV)

Global Initiative to Improve M&E of AIDS programs at the National Level Goal: To help countries develop sustainable and effective M&E systems Coordination: UNAIDS, WHO, USAID, CDC in collaboration with World Bank, European Commission, FHI, MEASURE and many others

Global Initiative to Improve M&E of AIDS programs at the National Level (2) Process: 1998 Review of existing practices, systems and instruments (13 countries); 1999-2000: four consensus-building / technical meetings with stakeholders 2000: Publication of UNAIDS guide (English) 2001: Publication of UNAIDS guide (French) Country workshops (Africa - 25 countries) April 2001 - Entebbe Feb 2002 - Senegal Apr 2002 - Kampala (training in M&E) Apr 2003 - Dakar Coordination: MERG, GAMET

Lesson Learned: 5 Elements of a Good Monitoring and Evaluation System Presence Monitoring and Evaluation unit Clear goals and objectives of the program A core set of indicators and targets A plan for data collection and analysis A plan for data dissemination

Monitoring and Evaluation Unit Not so good GOOD Established M&E unit within the NAC and MoH Specific expertise in or affiliated with the unit: (M&E, epi, behavioural, statistics, data dissemination) Budget (10% of the national AIDS budget with national contribution) Formalised links with the research institutions, leading NGOs and donors No functioning unit for M&E 1 or 2 persons responsible for the whole country Very limited resources for M&E No formalised links with technical and other resources

Clear goals and objectives Not so good GOOD Well-defined national programme goals and targets - M&E plan Regular reviews/evaluations of the progress of the implementation of the national programme plans Guidelines and guidance to districts and regions or provinces for M&E Guidelines for linking M&E to multiple sectors Co-ordination of national and donor M&E needs National strategic plan has no specific goals and objectives No system of ongoing assessment with programs reviews and built-in evaluation Limited coordination with districts and regions Limited coordination between sectors Donor-driven M&E system

A set of indicators (and targets) Not so good GOOD A set of priority indicators and additional indicators that cover programme monitoring, programme outcomes and impact - M&E plan Selection of indicators through process of involving multiple stakeholders and maintaining relevance and comparability Utilization of past and existing data collection efforts to assess national trends (e.g. DHS) No indicators or indicators that cannot be measured Indicators that cannot be compared with past indicators or with other countries Indicators are only used for donors and each donor has its own set of indicators Indicators are irrelevant to those who collect the data Each district or sector uses its own indicator

Data collection and analysis plan Not so good GOOD An overall national level data collection and analysis plan, linked to the national strategic plan A plan to collect data and analyse indicators at different levels of M&E (programme monitoring) Second generation surveillance, where behavioural data are linked to HIV/STI surveillance data M&E is an ad hoc activity without a plan, mostly driven by donors Data are collected but not analysed sufficiently / utilized There is no systematic monitoring of programme inputs and outputs

Data dissemination plan Not so good GOOD Overall national level data dissemination plan Well-disseminated informative annual report of the M&E unit Annual meetings to disseminate and discuss M&E and research findings with policy-makers and planners Clearinghouse / Resource centre at national level Dissemination is ad hoc and not planned or coordinated Annual surveillance report is much delayed not user friendly and not well disseminated Dissemination to the districts and regions is not done Dissemination activities are donor driven