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Measuring Outcomes among Children in Adverse Situations Indicators and Survey Tools

Measuring Outcomes among Children in Adverse Situations Indicators and Survey ToolsHousehold surveys, such as the Demographic and Health Survey and the Multiple Indicator Cluster Survey, provide useful data on the vulnerabilities faced by children in the general population, but they often miss children who may be exposed to extreme adversity, such as children of female sex workers (FSWs), street children, and children working in mines. Globally, there are limited data on children living outside of traditional households, such as those living in the context of sex work or mining, or outside the care and protection of a primary caregiver, such as those living on the streets (Clay, et al., 2012). Service delivery organizations supporting these children also rarely share information and best practices in order to measure outcomes and performance.

Although research has shed some light on the vulnerabilities and needs of children living in such adverse situations, until now, no standardized indicators have been released to guide practitioners in measuring the extent of their risk to HIV. The goal of the Children in Adverse Situations Indicators and Survey Tools—available at—is to answer the following question: “What improvements in well-being outcomes can be attributed to programs supporting children of FSWs, street children, and children working in mines?” The indicators and tools were specifically developed to expand the evidence base required by child welfare systems and programs in low- and middle-income countries to systematically reduce the vulnerability of these specific populations.

The Children in Adverse Situations Indicators and Survey Tools help countries or organizations assess and strengthen their information base on well-being outcomes of children in these populations. This suite consists of a holistic set of standardized outcome indicators and corresponding survey tools that have been deemed essential to ensuring more effective sharing of outcome data both in and between countries and programs and to expanding the evidence base of these invisible children to better understand their needs.

Implementing Event-Based Surveillance in Burkina Faso: Using the “One Health” Approach

Implementing Event-Based Surveillance in Burkina Faso: Using the “One Health” ApproachRecent outbreaks of Middle East respiratory syndrome, avian influenza, and Ebola virus disease have put local, national, regional, and global focus on the ability of countries to effectively detect and respond to emergent public health issues. Many of the outbreaks have involved zoonotic diseases: those that spread between animals and humans.

These outbreaks led countries to develop new intervention strategies through the Global Health Security Agenda (GHSA) launched in 2014. The GHSA aims to strengthen both the global capacity and nations’ capacity to prevent, detect, and respond to threats from infectious diseases, facilitated by a multilateral and multisectoral approach. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—has been working in Burkina Faso since March 2018 in partnership with the Ministry of Animal and Fisheries Resources (MRAH); the Ministry of Health (MS); and the Ministry of the Environment, Green Economy and Climate Change (MEEVCC) to strengthen the country’s ability to detect and respond to diseases with epidemic and epizootic potential using a “One Health” approach. One Health is a collaborative, multisectoral, transdisciplinary approach that works at the local, regional, national and global levels to monitor and control public health threats and to learn how diseases spread among people, animals, and their shared environment (One Health).

In Burkina Faso, each of the ministries responsible for human and animal health and the environment has a system of disease monitoring. At the Ministry of Health, the integrated disease surveillance and response (IDSR) system ensures the surveillance of diseases, including those with epidemic potential. At MRAH, surveillance of and response to animal diseases are coordinated by the Epidemiological Surveillance Network of Animal Diseases (RESUREP). MEEVCC does not have a surveillance system, but for the purpose of monitoring animals in parks and protected areas, ecological monitoring forms have been implemented to collect information on wild animals, including about their health.

Starting in 2017, MEASURE Evaluation joined other partners in assisting Burkina Faso to enhance its surveillance system as part of the project’s overarching objective to support the government in strengthening its health information system (HIS). MEASURE Evaluation’s specific objectives for HIS strengthening are: (1) to aid the government in strengthening its early-warning system by developing a community-level EBS system for diseases with epidemic and epizootic potential; (2) to strengthen the collection, analysis, and use of routine health data; (3) to strengthen the country’s capacity to manage the HIS; and (4) to develop an electronic platform to aid in the identification, notification, and follow-up of all diseases under surveillance by the Ministry of Animal Resources and the Ministry of Health.

MEASURE Evaluation has assisted at the national level in developing a One Health approach to event-based surveillance (EBS) that is suited to the Burkina Faso context. To test this approach, the Center-South Region was chosen as the intervention zone. This region has three provinces: Zoundwéogo, Nahouri, and Bazèga. Nahouri, whose capital is Po, was chosen to pilot EBS activities using the One Health approach.

This report shares more on the One Health approach in Burkina Faso.

Data Quality Assessment (DQA) for HIV Program Indicators in Burundi: Final Report

Data Quality Assessment (DQA) for HIV Program Indicators in Burundi: Final ReportThe Office of HIV/AIDS at the U.S. Agency for International Development (USAID) has allocated resources to address the data quality of HIV and AIDS indicators through the MEASURE Evaluation project. The Programme National de Lutte Contre le SIDA et les Infections Sexuellement Transmissibles (PNLS/IST) (National HIV/AIDS Control Program in Burundi) and other donors and partners have also contributed resources to assessing and improving data quality for HIV in Burundi. A joint effort was made to plan and implement a joint data quality assessment (DQA) of 80 percent of the patients active on treatment in Burundi. This report summarizes the findings of the DQA and provides recommendations for follow-up.

The primary objective of the DQA was to investigate data quality issues concerning the number of people currently receiving antiretroviral therapy (ART) at a sample of health facilities representing 80 percent of patients actively on treatment in Burundi. The activity aimed to improve the accuracy and reliability of future data submissions to PEFPAR and the Ministry of Health (MOH). The assessment follows a pilot test in November 2018 to validate new assessment tools and methods. The assessment aimed to validate reported values for priority indicators at 147 sites, including sites supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

In addition, the assessment aimed to validate a proposed methodology for evaluating the quality of data in source documents, and program quality indicators. The so-called Lot Quality Assurance Sampling (LQAS) Triage System is a methodology to sample patient records within health facilities to gauge the completeness of the data, as well as the coherence of data between different data sources.

This report presents the findings of the assessment, which include systematic data quality problems affecting “Currently on ART” (TX_CURR), “Newly initiated on ART” (TX_NEW), and “Percentage of Viral Load Suppressed” (TX_PVLS). The report provides recommendations for actions that can be undertaken independently to improve data quality.

Implementing the Monitoring and Evaluation Capacity Assessment Toolkit in Central America: Adjustments and Lessons Learned

Implementing the Monitoring and Evaluation Capacity Assessment Toolkit in Central America: Adjustments and Lessons LearnedWorldwide, the use of health system data to guide decisions on how resources are allocated is rising rapidly. Ministries of health and national health programs are seeking ways to ensure that the quality of health system data is reliable. As a result, data collection, collation, reporting, and use are increasingly scrutinized, and efforts to strengthen health information systems (HIS) must focus on improved health program monitoring and evaluation (M&E). To help meet this need, MEASURE Evaluation and its Kenya associate award, MEASURE Evaluation PIMA (both funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief), developed the Monitoring and Evaluation Capacity Assessment Toolkit (MECAT).

The MECAT was used in Kenya to set baselines for beneficiary national programs and 17 target counties. Since then, it has been adapted for use in other countries to help health management and development professionals make decisions, monitor progress, and design capacity-building interventions for sustained HIS improvements. Recently the toolkit was implemented in four Central American countries—Guatemala, Honduras, Panama, and El Salvador—to assess each country’s capacity for M&E of HIV programs. This brief shares more.

Access MECAT resources at

Successful Support for Better HIV Data

Successful Support for Better HIV DataA major objective of MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), has been to improve health information systems, and the data they contain, to contribute to control of the HIV epidemic in the countries where the project works.

PEPFAR is focused on data-driven decision making to ensure that programs addressing the epidemic are deployed where they are most needed and that they have measurable impact. The Data for Accountability, Transparency and Impact (DATIM) software system was developed to organize HIV data from monitoring, evaluation, and reporting (MER) of programs; Site Improvement through Monitoring System (SIMS) assessments; Evaluation Standards of Practice; Surveys, Surveillance, Research, and Evaluations (SRE) activities; and expenditure analyses.

MEASURE Evaluation has advanced this crucial PEPFAR aim in two primary ways: (1) supporting DATIM implementation, management, and capacity building; and (2) increasing the capacity of country health information systems (HIS) and their enabling environments (governance, management, skills, etc.) at global, regional, and country levels, especially in PEPFAR countries. This brief shares more.

GEND_GBV Rapid Data Quality Review

tl-19-28.JPGTo improve data quality of GEND_GBV—the PEPFAR monitoring, evaluation, and reporting (MER) indicator that captures the number of individuals who received post-violence clinical care services based on the minimum package—USAID engaged MEASURE Evaluation to identify gaps in indicator understanding, recording, and reporting. Together, USAID and MEASURE Evaluation developed and piloted a GEND_GBV Rapid Data Quality Review Tool.

This tool and resource collection is designed to identify data collection and reporting gaps to improve GEND_GBV data quality and should be used by implementing partners (IPs), PEPFAR country teams, and/or USAID/Washington.

Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Final Report

Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Final ReportThis evaluation—conducted by MEASURE Evaluation, a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—aimed to understand how orphans and vulnerable children (OVC) programming by the Government of Botswana (GOB) and the PEPFAR-funded Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) project prepares older youth to be healthy, productive young adults. It examined the effect of services on the educational, economic, and health outcomes of older youth graduating from the programs.

This mixed-methods evaluation was a one-time quasi-experimental study, with the intervention group receiving services from the BCCOVC project and the GOB and a comparison group receiving services from the GOB only. The primary outcomes were as follows:

  • Youth who sat for and passed the Botswana General Certificate of Secondary Education exam (i.e., received a score of 36 points or higher) in 2018
  • Youth who had basic financial literacy
  • Youth who had an HIV test in the past 12 months and knew their test results

The BCCOVC project had mixed success in improving HIV and health, economic strengthening, and education outcomes. It had some effect on HIV/health and economic strengthening outcomes but none on education outcomes. Qualitative data revealed youth perspectives around accessing HIV testing and treatment, awareness of gender-based violence, the importance of education, and economic challenges and aspirations. HIV-positive respondents reported that teen clubs provided support and improved adherence.

Adolescent OVC are an important population to support as they transition to adulthood, and additional research is needed to understand how services reach them.

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