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Application, Lessons, and Recommendations from a Retrospective Case Study Approach in Côte d’Ivoire & Nigeria

Technical Brief: Measurement of M&E System Strengthening. Application, Lessons, and Recommendations from a Retrospective Case Study Approach in Côte d’Ivoire and NigeriaMeasurement of M&E System Strengthening: Application, Lessons, and Recommendations from a Retrospective Case Study Approach in Côte d’Ivoire and Nigeria

A case study to document monitoring and evaluation (M&E) systems strengthening in Côte d’Ivoire and Nigeria sought to (1) document the M&E system strengthening interventions and investment from 2007 to 2012 and (2) identify M&E system strengthening progress and the need for future interventions.

The purpose of this technical brief is to highlight the methods applied to assess M&E system strengthening, share lessons learned, and provide recommendations for improving approaches to measure M&E system strengthening.

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Case Study Series: Community-Based Information Systems

MEASURE Evaluation, with support from the United States Agency for International Development, conducted case studies to understand and document how community-based information systems are designed, implemented, and used by program staff and government counterparts. Case studies in Kenya, Tanzania, and Zambia provide an opportunity to identify key lessons learned – including successes, challenges, and opportunities for improvement – that will inform community-based programs globally.

The case studies focus on OVC programs because such programs rely heavily on community workers and community-based organizations to implement activities and monitor program progress. However, case study findings are relevant to other community-based programs that support prevention efforts and ensure continuity of care through nutrition, home based care, and general community health programs that are at the forefront of AIDS-free generation efforts.

The case study series includes the case study overview and three separate case studies for each country. Each element of the series can be downloaded as a stand-alone document.

Case Study Series Overview

Kenya

Tanzania

Zambia

Mapping Community-Based Global Health Programs

Mapping Community-Based Global Health Programs: A Reference Guide for Community-Based PractitionersMapping Community-Based Global Health Programs: A Reference Guide for Community-Based Practitioners

As visual displays, maps showing community resources and health services serve as focal points for communities to discuss program needs and gaps with themselves and with other stakeholders.  As such, they can serve as powerful evaluation and advocacy tools supporting improved targeting of services and better health outcomes.

Across the global health community, mapping efforts are incorporating community knowledge, detailing where services are available, outbreaks occurring, and where treatment is been provided.  Using maps to visual displays this information can empower communities and program planners with using this information to support the effectively deliver health services to those who need them.

This document serves as a guidance framework for those aiming to use maps to support community-based programs.  We identify key questions to ask when planning a mapping effort, review necessary resources, and outline the four main stages of the mapping process:

1. Community engagement
2. Data collection
3. Visualization
4. Analysis and Information use

While each community based project is different, and will require its own tailored approach, this guidance framework is designed to help program managers walk through the process of incorporating maps for M&E of global health programs.

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Case Study Measures M&E Systems Strengthening in Côte d’Ivoire & Nigeria

Technical Brief: Findings from the Case Study to Measure M&E Systems Strengthening in Côte d’Ivoire and NigeriaFindings from the Case Study to Measure M&E Systems Strengthening in Côte d’Ivoire and Nigeria

A case study to document monitoring and evaluation (M&E) systems strengthening in Côte d’Ivoire and Nigeria sought to (1) document the M&E system strengthening interventions and investment from 2007 to 2012 and (2) identify M&E system strengthening progress and the need for future interventions.

Analysis of the qualitative findings focused on providing understanding in four key areas: (1) national commitment to HIV M&E system strengthening, (2) performance of the HIV M&E system, (3) national capacity to strengthen the HIV M&E system, and (4) integration of HIV M&E systems with national health information systems. A summary of conclusions is provided.

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Collecting PEPFAR Level 2 Monitoring, Evaluation, and Reporting Indicators: Supplement to OVC Survey Tools

Collecting PEPFAR Level 2 Monitoring, Evaluation, and Reporting (MER) Indicators: A Supplement to the Orphans and Vulnerable Children Survey Tool KitCollecting PEPFAR Level 2 Monitoring, Evaluation, and Reporting (MER) Indicators: A Supplement to the Orphans and Vulnerable Children Survey Tool Kit

This document was prepared by MEASURE Evaluation at the request of the PEPFAR OVC Technical Working Group and reflects a legislative mandate to monitor and evaluate programs funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

As part of its new monitoring, evaluation, and reporting (MER) guidance,  launched a set of outcome indicators for PEPFAR OVC programs. These outcome indicators reflect internationally-accepted developmental milestones and collectively measure holistic wellbeing for children and their families over time. Indicators track the ways OVC programs gain from and contribute to the broader HIV and child protection response. These outcome indicators are designated as “level 2”, meaning that PEPFAR requires countries to collect Level 2 indicators biennially. These indicators are held in country to be used to inform program planning and review, both by country and visiting headquarters staff.

The purpose of this document is to provide U.S. government staff and others with a high-level understanding of outcomes monitoring and approaches to outcomes monitoring to enable effective procurement of data collection services for these new outcome indicators.

Two appropriate methods for outcomes monitoring are briefly described: cluster sample surveys and Lot Quality Assurance Sampling (LQAS) surveys. Like evaluation, outcomes monitoring should be carried out by a group that is independent and external to program delivery. The methodology for outcomes monitoring must be documented in a data collection protocol. Unlike evaluation, outcomes monitoring protocol may be exempt from full ethical review. However, protocols should be submitted to an ethics review board to certify and document exemption. A data collection tool and analysis guidance is provided.

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Measuring National HIV M&E System Strengthening in Côte d’Ivoire

A Case Study to Measure National HIV Monitoring and Evaluation System Strengthening: Côte d’IvoireA Case Study to Measure National HIV Monitoring and Evaluation System Strengthening: Côte d’Ivoire

This Côte d’Ivoire study uses interviews with stakeholders and key informants and other evidence to verify real change in routine health information system strengthening through indicator and data collection tool harmonization, development of an electronic patient record system, and improvement in data quality through the collection, collation, and reporting data cycle. The study also shows that although much has been accomplished, considerations for future monitoring and evaluation (M&E) system strengthening assessment and implementation should account for a systems thinking approach to strengthen a country-led M&E system.

Future interventions also will need to collaboratively and actively identify the work of each national agency and development partner to build partnerships that use substantive, productive feedback on what is and is not working.

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Mozambique Community Care Program Assessment

Mozambique Program Assessment: Community Care for Vulnerable Children in an Integrated Vulnerable Children and Home-Based Care Program Mozambique Program Assessment: Community Care for Vulnerable Children in an Integrated Vulnerable Children and Home-Based Care Program

In Mozambique, the Community Care Program (Programa de Cuidados Comunitários, or PCC in Portuguese) is a five-year project (2010-2015) that seeks to strengthen the response to HIV and AIDS, specifically support to orphans and vulnerable children (OVC) and home-based care (HBC) service provision for people living with HIV and AIDS (PLHIV), in seven focus provinces through a network of community-based organizations (CBOs). Prior to PCC, OVC support and HBC had usually been provided by different activistas (community workers) and/or different CBOs, even when the same household had both HBC clients and OVC.

PCC integrated OVC support with HBC service provision: a single activista would provide integrated support to all people living with HIV (PLHIV), OVC, and pre/post-partum women living in the household through HBC, as well as supporting households that may have only one beneficiary type (e.g., households with vulnerable children and no HBC client). Integration of services and service providers involved devising a schedule of visits based on those needing more frequent care and those needing less frequent care (“intensive” versus “maintenance” stages of care).

Stakeholders expected that this integrated approach would offer a more efficient model of service provision. The U.S. Agency for International Development (USAID) in Mozambique asked MEASURE Evaluation to assess the integrated model to better understand what integration of HBC and OVC services means for OVC beneficiaries.The assessment outlined in this report found consensus regarding the value of having one activista provide services to all clients in one household for the efficiencies it offers, including offering holistic support to households, the potential for cost savings, and the integrated activista’s ability to reach OVC that may not have been previously reached.

Access the report in English or Portuguese.

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