1. HIV/AIDS Results Monitoring and Evaluation Systems Measuring the Multi-Sector Response

2. The Power of Measuring Results If you do not measure results, you can not tell success from failure If you can not see success, you can not reward it If you can not reward success, you are probably rewarding failure What gets measured gets done What gets measured gets done

3. The Power of Measuring Results Continued…. If you can not see success, you can not learn from it If you can not recognize failure, you can not correct it If you can demonstrate results, you can win public support

4. Why Should Various Sectors Support the National HIV/AIDS Response? Public sector institutions (line ministries, Sub-national ministries and local government) need to mainstream HIV into their operations HIV mainstreaming has two components: Internal mainstreaming which implies ALL public sector institutions include HIV workplace programmes in their annual work plans External mainstreaming implies that public sector institutions contribute to the goals of the National HIV/AIDS Strategy through their own programs and efforts

5. Monitoring and Evaluating the National HIV/AIDS Multi-Sector Response 2 What are the key goals of a national response Identify sector Outcomes\ Contributing to the National Goals 3 4 5 6 7 Evaluate latest trends and drivers of the Epidemic and contribution from each sector 1 Identify set of key results indicators for each sector outcome Track ( monitor) results indicators and resources used with verifiable data( this is done for each program Use monitoring data to assess and improve progress of policy and program implementation

6. Evaluate latest trends and drivers of the Epidemic and contribution from each sector 1 Start with a clear articulation of the present status of the epidemic: 1.What type of epidemic is evident in the country? 2.Where have the last 1000 or 100 or 10 infections come from? 3.Which are the most at-risk groups?

7. National HIV/AIDS Strategy with Agreed Sector Goals 2 Now that we have a clear articulation of the present status of the epidemic and significant HIV/AIDS problems facing citizens What Does Success Look Like for a National Program? What are the Key Goals The Country is Striving to Achieve? What are the KEY sectors and ministries that are best able to support a national response based upon the groups MOST affected?

8. 3 Identify sector Outcomes Contributing to the National HIV/AIDS Goals 1.What population groups or sub-groups are most likely to be affected by the epidemic? ( the target groups) 2.Identify the sectors that can contribute to supporting these groups with prevention, treatment or care programs? ( e.g. Ministry of Youth or Social Affairs for orphans) 3.For the relevant sectors, identify key outcomes (goals) that would be supported by sector programs and initiatives 4.Be able to show a line of sight to a national goal

9. RESULTS PLANNING Programming Strategy Aligning Sector Outcomes to National Goals Source: Kusek&Rist, 2004. Outcomes Outputs Activities Inputs Goal (Long- term Impacts) Reduction in incidence of HIV/AIDS in young men and women aged 15-19 Increased use of services to support young people, (e.g. testing, counseling, educational) changes in behavior towards later sexual debut and fewer partners Increased coverage of VCT services, more incentive programs Hire more counselors, build more service centers, target more schools, Teachers, money, counselors, testers

10. Zanzibar Latest epidemiology 0.87% ANC prevalence 0.9% F and 0.2% M prevalence in 2002 population- based survey (5:1 female to male ratio of infection) 26.8% prevalence amongst IDUs in 2006 Drivers of epidemic Thought to include sex work, MSM activity, IDUs, heterosexual transmission Low availability of condoms

11. Zanzibar – higher risk behaviours amongst IDUs and CSWs IDUs 46% of IDUs share needles 9.1% of IDUs practicing flash blood practices Only 30% of IDUs report water cleaning of injecting paraphernalia before needle sharing, 76.9% female and 70.5% male IDUs reported sex with two or more one sexual partners (compared with 0.9% females and 18.4% males in the general population) 34.0% male substance users indicated a preference for anal sex (with a male or female) 16.3% IDUs have participated in group sex CSWs 19% of CSWs practiced dry sex 28% of male and female CSWs reported anal sex 39% CSWs did not use a condom

12. Zanzibar National HIV Strategic Plan Sector Outcomes for General Population

13. 4 Identify Set of Key Performance Indicators for Each Sector Outcome Indicators translate sector outcomes to measures that help track achievement Indicators help to answer two questions: 1. How will we know success or achievement when we see it? 2. Are we moving toward achieving our desired outcomes? Example: Goal: More young people need to more aware the causes of AIDS. Indicator: % of most at risk people who correctly identify ways of preventing sexual transmission of HIV)

14. 5 Specify how Indicators will be Monitored After the expected results, outcomes and indicators have been identified the HIV/AIDS Mulit-Sectoral planning process continues by considering how data will be collected, processed, analyzed and reported, including surveillance data

15. Measuring Indicators Requires Good Data and a Strategy Conversation with concerned individuals Consider cost, time, and expertise requirements Community Interviews Field visits Reviews of official records (MIS and admin data) Participant Observation Focus Group Interviews Key informant interviews Direct observation Questionnaires One-Time Survey Panel Surveys Census Impact Evaluation Field experiments Informal/Less Structured MethodsMore Structured/Formal Methods Source: J. Kusek and R. Rist, 2004.

16. When Dealing with Data ….. …. Be Realistic

17. 6 How Will Data Be Used To Improve Decision Making Telling success from failure Rewarding success, not failure Learning from what works and what does not Correcting problems during implementation and Demonstrating results, to win public support

19. Work Group Exercise Two case studies: Afriland and Jameria Read each case and address the following questions 1) From the situational analysis, identify the key sectors that should be involved in responding to the HIV/AIDS crisis 2) For each sector, what do you think are likely outcomes these sectors should achieve to contribute to the national response? 3) What might be a few indictors that each sector could track to help assess whether progress was being made, or not? 4) For these indictors, what types of data are needed, and how might the data be collected?