CDC Mozambique Transition Monitoring Approach 8 th Annual Track 1 meeting, August 12, 2010 Charity Alfredo CDC-Mozambique

Track 1.0 Program in Mozambique Two international Partners through Track 1.0 Program (EGPAF and Columbia University) ― Working in 7 of the 11 provinces in Mozambique ― Supporting more than 100 ART sites in Mozambique Represents 53% of total USG-supported sites Represents 46% of all ART sites in country ― Receiving approximately $57M (COP 10) ― As of 31 Mar 10, supporting more than 78,000 persons on ART Represents more than 60% of USG-support for patients on treatment Represents 43% of all patients on ART in Mozambique

Types of Support Provided through Track 1.0 Partners Clinical Services ― Direct Salaries ― Commodities/Equipment ― Supervision/Technical Assistance/Mentoring/Training Infrastructure ― Renovation/rehabilitation ― Laboratory Logistics Monitoring and Evaluation/Information Systems ― Printing of paper tools ― Development and Support of Electronic Systems ― Human and Technical Resources (Data Entry, Management and Analysis) ― Supervision, Data Quality Assurance

How will Transition work? Current model ― International partner receives funding ― Directly hires/procures staff, materials, equipment ― Sub-contracts to Provincial/District for specific roles/services Future model (during/post-transition) ― Government of Mozambique receives direct funding (e.g. CoAg with MOH Provincial Directorate) Specific roles/tasks defined ― Local NGO/International partner with role defined as TA provider Current implementation emphasis is placed on different aspects of this transition e.g. service delivery versus management

M&E Challenges of Transitioning Track 1.0 programs 1. Transition of M&E: How to transition management for tracking, accountability, reporting and evidence-based program oversight from international NGO to MOH and other local partners to ensure continued provision of quality services and program data? 2. M&E of Transition: How to monitor and evaluate the transition process for optimal success? ― How do we know if we are succeeding in transition Local government ownership, Capacity has been built ― How do we know the extent to which the quality of service provision is adversely affected by transition and what do we do about it?

Monitoring and Evaluation (M&E) of Transition Key Domains ― Human Resources Management ― Clinical Outcomes ― Supervision/Quality and QI ― Pharmacy & Logistics ― Laboratory ― HMIS and M&E ― Community Involvement ― Financial Management Indicators ― Focus on Outcome and Output level indicators (use existing SAPR/APR indicators) ― Balance between Short-Term Monitoring of processes and Longer-Term Systems Strengthening ― Build on existing data collected in GOM (and USG) systems

M&E of Transition: Framework

M&E of Transition: Strategy Routine Self-Report from Funded Partners ― Data reported ~quarterly to allow USG/partner monitoring ― Includes international, local partner, GOM ― Target setting and results reporting at provincial level ― ~21 indicators currently not reported through SAPR/APR Financial, infrastructure, pharmacy/logistics, supervision, quality, Strategic Information External Assessment (baseline/annual) ― Increased objectivity/standardization of information collected (e.g. some questions can be “verified” on site) ― Standardized approach across partners/provinces ― Qualitative, contextual information complements quantitative data ― Allows for greater “dialogue” about actual processes of transition (e.g. what’s working well)

Routine Self-Report from Funded Partners Domain Indicator TypeIndicator Description Data source External assessment/ro utine report Freq of report/collecti on Quality and QIProcess % of supported sites to have bi-monthly clinical mentoring activitiesTBDBOTHAnnual Quality and QIProcess % of months in which there was at least one Provincial ART Committee meeting per monthTBDBOTHAnnual HR MgmtOutput (SS-HRH3) Number of health care workers being supported in a pre-service training institutionS/APRNo Quarterly/ Semi-Annually Clinical OutcomesOutcome % of eligible HIV-positive persons receiving cotrimoxazole prophylaxisS/APRNo Quarterly/ Semi-Annually LabOutput % of supported ART sites in province with access to CD4 testingS/APRYes Quarterly/ Semi-Annually Clinical OutcomesOutcome Percent of patients known to be alive and on treatment 12 months after initiation of antiretroviral therapyS/APRNo Quarterly/ Semi-Annually

Annual External Assessment DomainTypeIndicator descriptionData Source External/ routine Freq. of report HR MgmtProcess HR development plan developed, approved (by DPS and international partner), and disseminatedTBDBOTHAnnual Financial MgmtProcess % of supported districts that submit financial reports according to the time frame stipulated in the terms and conditions of the sub-agreement with the international partnerTBDYesQuarterly Pharmacy/ LogisticsProcess % of provincial warehouses visited (by DPS and/or partner) in which pharmacy storage conditions were assessed as satisfactory using standardized checklistTBDYesAnnual Pharmacy/ LogisticsProcess % of provincial warehouses visited (by DPS and/or partner) in which pharmacy storage conditions were assessed as satisfactory using standardized checklistTBDYesAnnual HMIS/M&EProcess % of supported districts where data are verified in at least one HIV-related service each year by a team of DPS and/or PartnerTBDYesAnnual HMIS/M&EProcess % of supported districts in which data verification occurred which achieved at least 75% consistencyTBDYesAnnual

Challenges Agreement from the government to report on indicators that fall outside of the routine government reporting system There is a need to introduce indicators that are not currently reported on ― To determine shift in ownership/responsibility ― To measure increasing capacity Discrepant USG and GOM fiscal cycles Determining attribution over time Determining readiness

Looking Ahead Present M&E plan and framework to the Ministry of Health ― Health information Management Unit within the MOH central ― Provincial health directorates ― Requirement to report on existing/new indicators ― Agreement on the frequency and timing of reporting, benchmarks and targets Plan for implementation of external assessment in the next 4- 8 weeks ― Tools development/adaptation, pilot and implementation Share lessons learned, Ongoing review and revision of M&E activities (USG, partner, GOM)

Obrigada Thank You