Mitigation of HIV/AIDS at the District Level: The Case for the Collection of Local Indicators & the Development of DEMMIS Peter Badcock-Walters Mobile Task Team on Impact of HIV/AIDS on Education (MTT) HEARD, University of KwaZulu Natal Centre for AIDS Research Conference: The Geography of AIDS 27 May 2004

The Developing Environment HIV/AIDS impact is variable across societies, sectors and areas and shows evidence of ‘hot spots’; Effective response requires a decentralised strategy and empowerment of local decision- making; Operational experience suggests that HIV/AIDS response and delivery at sub-national levels is constrained by lack of data and indicator-based decision support systems; National level MIS can provide the ‘big picture’ but often cannot provide the sub-regional data required to guide, support and monitor response;

Prevalence rates Ante Natal Clinics Schools HIV Prev. as %

The Developing Environment Deepening the critical knowledge base for AIDS impact assessment and mitigation will require functional sectoral data collection and analysis; Such systems and capacity function to some degree in education but are less evident in health and almost non-existent in social welfare; Development of new indicators, methods and models is the critical challenge, at both the national and district levels; Examples of countries where multi-sector development activity and HIV/AIDS impact mitigation are coordinated are almost unknown at this stage.

Key Issues All social sector ministries should routinely generate ‘early warning’ indicators of system malfunction/failure, and HIV/AIDS impact; Widespread MIS collapse due in part to lack of management demand for decision support; Problem in education may be dwarfed by that in health, social welfare and related ministries; Repeated failure of national MIS affirms need to consider district level development to support local system management and delivery; The AIDS era presents a unique opportunity to motivate multi-sectoral innovation, particularly if centered on OVC and development reporting.

HIV/AIDS Impact on Education The primary impact of HIV/AIDS is to explode the scale of existing systemic and management problems in education; It will directly and indirectly affect: –Labour attrition, recruitment & training –Access, enrolment & gender equity –Increase orphaning & drop out rates –Reduce household/school fee income –Learner transition, graduation rates & quality –Some geographic areas more than others Most education systems are somewhat dysfunctional, and HIV/AIDS makes these problems worse.

EMIS & System Management Conventional EMIS at best capture annual ‘snapshots’ of the system and may take 2 or 3 years to analyse and disseminate data; Few EMIS systematically deliver timeous or reliable data or provide basic decision support information; This compounds the difficulty of deciding where ‘normal’ dysfunction stops and HIV/AIDS erosion starts – and masks it; Result is failure to provide reliable evidence of HIV/AIDS impact or even ‘regular’ system performance/crisis (fuelling data scepticism).

Education MIS: The Need There is a clear need to develop new and/or supplementary EMIS able to stimulate management demand and: 1.capture/monitor key indicators of system input, performance & output more regularly and efficiently 2.Link these indicators to HIV/AIDS impact and provide ‘early warning’ measurement/monitoring This implies EMIS reform and/or the development of supplementary systems; Should not duplicate EMIS but be located at the point of delivery to empower managers to mitigate local HIV/AIDS impact; A key feature should be the capacity to capture monthly (or at least quarterly) time-series data.

The Response A decentralised District Education Management and Monitoring Information System (DEMMIS) has been developed to test viability of monthly data capture; The pilot system has been designed to capture key indicators of HIV/AIDS impact on a monthly basis, to guide response at the school, circuit and district levels; Indicators must be simple and easily extracted from the routine (?) school reporting system; The data captured reinforces school, circuit and district management systems and supplements annual EMIS data with time-series and trends.

The System The DEMMIS system captures monthly statistics on teachers, learners, support staff and school governing bodies; Provides time-series data on enrolment, absenteeism, attrition, contact time, drop-out, pregnancy, orphaning and fees – all by gender and grade; Copy to school, one to the Circuit and District; Indicators of HIV/AIDS impact can be quickly and easily derived from these; Linked to a District Managers Resource Kit with FactSheets and Management Response Checklist………

Annual School Survey (EMIS) (reported 2 to 3 years in arrears) +3% -12% -24% +20% +27%

EMIS Data: Mortality due to Illness

DEMMIS - Change in Enrolment Figures by Month: 72 Schools Decline of 2.3% Annualised -2.8% 2001: -2.6% (32 schools)

Enrolment Change by Gender: 72 Schools Drop in Enrolment Annualised: Female learners: -3% Male learners: -1.4%

Pupils leaving the System, all Schools, 2002

Pupil Attrition

“New” Orphans Orphans as a % of enrolment: 2001: 1.5% 2002: 2.3%

Sample of 32 schools

Teacher “loss” Teacher Loss: 2001: 5% 2002: 5%

Reason for Teacher Loss

Absenteeism Teachers: Illness – 72% Unknown Reasons – 26% Pupils: Illness – 40% Unknown Reasons – 55% Compassionate Reasons – 2% Pregnancy – 1 %

Rates of Absenteeism

Loss of Contact Time Loss of time: 2001: 7% 2002: 7.6%

Schools with Orphans in Relation to Clinics Schools, with no orphans Schools, with orphans Clinics

Incidence of Orphans As % of enrolment Less than 1% Between 1 and 2% +2% to 6%

The Lessons The pilot confirmed that a time series of monthly returns – by age, grade and gender – can provide unprecedented insights into impact and trends; Shows trends previously unseen in annual school census data and analysis; Confirms HIV/AIDS is exacerbating existing levels of system dysfunction; Impact appears lower than some projections – perhaps due to sample – but confirms upward trends; Demonstrates that communities are responding to OVC impact through fee exemptions;

The Lessons Suggests that if unchecked, trends point to large- scale systemic crises over time; Provides the opportunity to ground assumptions and future research in local data; Confirms that it is possible to identify and collect school-level indicators and analyse these at the district level; Proves viability of systematising routine data/indicator collection to inform local level management response; Provides basis for regular monitoring and ‘early warning’ of HIV/AIDS impact.

Future Development Pilot results suggest that DEMMIS provides an effective, complementary method of collecting and analysing key HIV/AIDS indicators; It should be seen as an adjunct to EMIS with the capacity to link annual data with monthly time series and verify the reliability of conventional EMIS; It is likely that DEMMIS will be regulated and taken to scale in KwaZulu Natal, and is being piloted/developed in Zimbabwe, Zambia, Kenya, Ghana, Uganda, Botswana and Namibia.

Mitigation of HIV/AIDS at the District Level: The Case for the Collection of Local Indicators & the Development of DEMMIS Contact