1. NATIONAL M&E PLANNING AND LESSONS LEARNED

2. WHAT’S M&E?  Let’s keep our definition practical – are we:  Doing the right thing?  Doing it right?  Doing enough of it?

3. DOING THE RIGHT THING  Addressing major drivers of transmission with proven approaches

4. HIV TRANSMISSION AND PREVENTION PRIORITIES IN NIGERIA Infections from high risk partnerships Resources for high risk interventions Sources: USAID, 2004

5. DOING IT RIGHT  Making sure we retain the key elements of effectiveness

6. . 3 11 49 56 0.5 0.3 0102030405060708090100 Free needles Free STI treatment Free condoms HIV counselling IEC materials Methadone detoxification Percent Just one person! IDU IN YUNNAN, CHINA CAN’T INJECT SAFELY WITH A PAMPHLET Sources: UK-China AIDS Programme, 2003, MAP, 2004

7. DOING ENOUGH OF IT  Achieving high coverage – small behavioural change on large scale better than large behaviour change on small scale

8. HAD HIV TEST, ZAMBIA, 1998-2000

9. HAD HIV TEST, KNOW RESULT, ZAMBIA, 1998-2000

10. WHAT DO WE NEED TO ANSWER THESE QUESTIONS?  We need comprehensive M&E systems  What does comprehensive mean?  It means:  Overall guiding flowchart and data base  Bio-surveillance  Behavioural/facility surveillance  Research  Program monitoring  Using data to improve programs

11. DO WE HAVE COMPREHENSIVE M&E SYSTEMS?  No – we have bits and pieces  We have some biological and behavioural surveillance and some research  We have very little linked bio-behavioural surveillance or program activity monitoring  Do any of us have an overall guiding flowchart, specifying exactly where and how everything flows into our data base?

12. WHY DO WE NEED COMPREHENSIVE M&E SYSTEMS?  Without comprehensive systems, we can’t get a complete picture of the HIV epidemic and our responses  We can’t answer the big questions – what’s really working and why?  And without program monitoring, we do not have the information we need to be responsible, informed donors

13. WHY DO WE NEED STRENGTHENED BIOLOGICAL SURVEILLANCE?  Without strengthened biological surveillance, we don’t know how high the epidemic is, whether it is growing or declining and who it is affecting

14. A TALE OF THREE EPIDEMICS Manzini Kampala Dakar

15. WHY DO WE NEED STRENGTHENED BEHAVIOURAL SURVEILLANCE?  Without strengthened behavioural surveillance, we don’t know what behaviours are responsible for changes in HIV prevalence

16. Sources: Cassall et al, 2005 BEHAVIOURAL AND HIV TRENDS IN UGANDA

17. WHY DO WE NEED STRENGTHENED BIO-BEHAVIOURAL SURVEILLANCE?  And without strengthened bio-behavioural surveillance, we have limited insight into major risk factors  In Kenya’s bio-behavioural DHS+, the following factors were associated with higher HIV prevalence  Uncircumcised men  More sexual partners  More income  More education

18. WHY DO WE NEED STRENGTHENED RESEARCH?  There are some major research issues that surveillance alone can’t answer – we need more and better research

19. WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (1)  To know how interventions may be influencing HIV trends

22. WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (2)  To know whether our services are reaching people who need them - - how many orphans in Swaziland are receiving AIDS care?

23. WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (3)  For accountability to our communities, governments and development partners

24. WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (4)  To monitor performance and justify who we are giving funds to and why

25. WHY DON’T WE HAVE FUNCTIONING M&E SYSTEMS? (1)  We have divorced M&E from the big questions  M&E isn’t auditing. It must address the vital, burning issues. Where’s the AIDS epidemic going? What’s really working in AIDS prevention and care?

26.  There are no incentives to have working M&E systems  Except for the Global Fund, we get our money with or without functioning M&E systems WHY DON’T WE HAVE FUNCTIONING M&E SYSTEMS? (2)

27.  What are there incentives for?  There are incentives to have complicated M&E plans. There are no incentives to actually implement these plans  We’ve become dreamers, designing houses we’ve no intention of building WHY DON’T WE HAVE FUNCTIONING M&E SYSTEMS? (3)

28.  We must have incentives not for plans but for data products  Let’s not talk about plans or indicators any more – let’s talk about actual, completed products  And let’s have incentives for actual products that come from functioning M&E systems WHAT MUST WE DO? (1)

29.  We must realize none of us can have responsible, defensible grant-making without functioning program monitoring systems WHAT MUST WE DO? (2)

30.  To move from designing houses we can never build to actually building houses, we must make the plans so simple that we can afford to build and maintain them  Simplicity is everything. We have more indicators and try to collect far more data than we can use. The more complex a M&E system, the more likely it is to fail WHAT MUST WE DO? (3)

31.  Program monitoring starts by defining the essential services we will provide, developing a simple, standardized, structured form to capture these services, training and motivating implementing partners to use the form and developing simple procedures to ensure program data flows reliably from level to level WHERE DO WE START?