Primer on Monitoring and Evaluation

The 3 Pillars of Monitoring and Evaluation  Identifying the Performance Indicators  Collecting information using appropriate M&E tools and methods Household surveys Facility Surveys HMIS Quantifiable Supervisory Checklists  Using M & E results for program decisions

Coverage for Routine Immunization Very Low Initial Reach : <20%

Coverage for Routine Immunization Failure to sustain coverage after initial reach

Coverage for Maternal Health Very Low Initial Reach : <35% for AN care

Inequities in Under-five Mortality Rates DHS 2003

Under-five Mortality – Absolute Difference between low and high Nigeria has highest difference in the Region

All performance indicators should have Base-line and Targets – NHSDP has them Should provide data at the required frequency and with adequate disaggregation Should be able to identify sub groups that are missing out services (Equity) Principles of M &E

Should use 3 rd party assessments for Evaluations 1.Independence 2.Less distraction for the program manager Clearly defined responsibilities for analysis and use of data Availability of dedicated staff and Systems/protocols for reviewing and using data Robust enough to meet the data requirements of RBF /CCT/Contracting which require more precision in measuring results Principles of M &E

Where does Nigeria Stand now?

Reduction in Under 5mortality Rates; Maternal Mortality Ratios and HIV prevalence among Year population Level I Health Impact Level 2 Program Outcomes Level 3 Service Delivery outputs Level 4 Institutional Processes Level 5 Inputs 1.Wards meeting the Staffing requirements to deliver minimum package of services (%) 2.Health Personnel receiving competency based training (Number) 3.Health Facilities Renovated/ Rehabilitated (Number) 4.Health Centers receiving supplies of Essential Medicines for ward Minimum Health Package (%) 1.Wards meeting the Staffing requirements to deliver minimum package of services (%) 2.Health Personnel receiving competency based training (Number) 3.Health Facilities Renovated/ Rehabilitated (Number) 4.Health Centers receiving supplies of Essential Medicines for ward Minimum Health Package (%) 1.Increase in Federal and State Budgets allocated for health sector (%) 2.Improved retention of Human Resources for Health (%) 3.Public health facilities having active committees (at least 4 meetings per year) that include community representatives (%) 4.Increase in State HMIS reports meeting minimum quality standards (Number 1.Increase in Federal and State Budgets allocated for health sector (%) 2.Improved retention of Human Resources for Health (%) 3.Public health facilities having active committees (at least 4 meetings per year) that include community representatives (%) 4.Increase in State HMIS reports meeting minimum quality standards (Number 1.Increase in Children months fully immunized (%) 2.Increase in women receiving IPT for malaria during pregnancy (%) 3.Increase in births attended by Skilled providers (%) 4.Improved TB case detection rates (%) 5.Reduction in unmet need for FP services (%) 1.Increase in Children months fully immunized (%) 2.Increase in women receiving IPT for malaria during pregnancy (%) 3.Increase in births attended by Skilled providers (%) 4.Improved TB case detection rates (%) 5.Reduction in unmet need for FP services (%) 1.Increase in children under five sleeping under an ITN during the previous night (%) 2.Enhanced condom use at last high risk sex (%) 3.Improved TB Cure rates (%) 4.Increase in contraceptiv e prevalence rates (%) 1.Increase in children under five sleeping under an ITN during the previous night (%) 2.Enhanced condom use at last high risk sex (%) 3.Improved TB Cure rates (%) 4.Increase in contraceptiv e prevalence rates (%) The NSHDP Results Framework in Place

 Collecting data on NSHDP performance indicators using appropriate M&E tools and methods Household surveys:  DHS being done once in 5 years – Possibility of Mini DHS in between DHS rounds?  MICs proposed once every 3 years  LQAS being used for Malaria + Program – Scope for using in other programs, but requires capacity building at sub national level  Urgent need for more frequent surveys providing disaggregated data for States/LGAs

 Collecting data on NHSDP performance indicators using appropriate M&E tools and methods Facility Surveys:  Being done under the Malaria Program  Need to develop design, pilot and implement Quantifiable Supervision Checklists:  Not being done  Will be required with improved results focus  Need to design, pilot and implement HMIS:  In place  Quality, coverage and timely reporting remain a concern  Requires systems for validation of data

 Using M&E results for program decisions Lot more work still needs to be done  Developing simple tools for annual State/LGA performance ranking  Capacity building at District and LGA levels on decentralized data analysis  Ensuring robust M&E for RBF/Performance Contracting initiatives

Proposed Organization of Session: Day 3  Quiz : What we know about M&E  A brief primer on Monitoring and Evaluation  Presentations on different M&E tools and approaches Day 4  Introduction to New M&E tools : LQAS  Case Study  Discussion on next Steps on Development of State Results chains and specific actions for putting in place M&E systems for disaggregated data generation and use

Distribution of States by Scores Achieved using Self Administered Questionnaire