national m&e planning and lessons learned. what’s m&e? let’s keep our definition...
TRANSCRIPT
NATIONAL M&E PLANNINGAND LESSONS LEARNED
WHAT’S M&E?
Let’s keep our definition practical – are we:
Doing the right thing?
Doing it right?
Doing enough of it?
DOING THE RIGHT THING
Addressing major drivers of transmission with proven approaches
HIV TRANSMISSION AND PREVENTION PRIORITIES IN NIGERIA
Infections from high risk partnerships
Resources for high risk interventions
Sources: USAID, 2004
DOING IT RIGHT
Making sure we retain the key elements of effectiveness
.
3
11
49
56
0.5
0.3
0 10 20 30 40 50 60 70 80 90 100
Free needles
Free STI treatment
Free condoms
HIV counselling
IEC materials
Methadone detoxification
Percent
Just one person!
IDU IN YUNNAN, CHINA CAN’TINJECT SAFELY WITH A PAMPHLET
Sources: UK-China AIDS Programme, 2003, MAP, 2004
DOING ENOUGH OF IT
Achieving high coverage – small behavioural change on large scale better than large behaviour change on small scale
HAD HIV TEST, ZAMBIA, 1998-2000
0%
5%
10%
15%
Male Female
1998 2000
HAD HIV TEST, KNOW RESULT, ZAMBIA, 1998-2000
0%
5%
10%
15%
Male Female
1998 2000
WHAT DO WE NEED TO ANSWERTHESE 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
DO WE HAVE COMPREHENSIVEM&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?
WHY DO WE NEED COMPREHENSIVEM&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
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
A TALE OF THREE EPIDEMICS
0
510
1520
2530
3540
45
1986 1988 1990 1992 1994 1996 1998 2000 2002
Manzini
Kampala
Dakar
WHY DO WE NEED STRENGTHENED BEHAVIOURAL SURVEILLANCE?
Without strengthened behavioural surveillance, we don’t know what behaviours are responsible for changes in HIV prevalence
Sources: Cassall et al, 2005
BEHAVIOURAL AND HIV TRENDS IN UGANDA
0
10
20
30
40
1989
1995
1989 35 16 15
1995 15 6 3
Men with one or more "casual" partners in
past year
Women with one of more "casual" partners
in past year
Men with three or more "non-regular" partners
in the past year0
5
10
15
20
1991 15
2003 4.1
Adult HIV prevalence
WHY DO WE NEED STRENGTHENEDBIO-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
WHY DO WE NEEDSTRENGTHENED RESEARCH?
There are some major research issues that surveillance alone can’t answer – we need more and better research
WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (1)
To know how interventions may be influencing HIV trends
TRENDS IN HIV PREVALENCEAND CONDOM SALES IN UGANDA
0%
5%
10%
15%
20%
25%
30%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
% HIV
in pr
egna
nt wo
men
0
5
10
15
20
25
cond
oms d
istrib
uted i
n mi
llions
condoms distributed ANC 15-19 ANC 20-24
TRENDS IN HIV PREVALENCE AND VCT IN UGANDA
0%
5%
10%
15%
20%
25%
30%
1990 1991 1992 1993 1994 1995 1996 1997 1998
% HV
in pr
egna
nt wo
men
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
clien
ts tes
ted
Annual tested cumulative tested ANC 15-19 ANC 20-24
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?
WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (3)
For accountability to our communities, governments and development partners
WHY DO WE NEED PROGRAM ACTIVITY MONITORING? (4)
To monitor performance and justify who we are giving funds to and why
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?
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)
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)
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)
We must realize none of us can have responsible, defensible grant-making without functioning program monitoring systems
WHAT MUST WE DO? (2)
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)
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?