Ghs Monitoring & Evaluation Plan 2010-2013
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GHS MONITORING AND EVALUATION PLAN 2010-2013
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Monitoring and Evaluation Plan
GHANA HEALTH SERVICE
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jkl b t i dfghjkl GHS MONITORING AND EVALUATION PLAN 2010-2013
ACKNOWLEDGEMENT
The Development of this Monitoring and Evaluation Plan has been made possible
with the support of all the divisions within the Ghana Health Service. Key individuals
who contributed to the write up and technical review have been recognized in the
document. The Ghana Health Service is most grateful to all who took time of their
busy schedule to contribute their technical expertise to the development of this
document.
We are also very grateful to the Medical Sciences for Health who provided funding
for the writers workshop, the technical review meetings and the printing of this
document through the TB CARE 1 Project.
We humbly acknowledge the contributions of all other individuals who may have
contributed to the development of this document but have not been mentioned by
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GHS MONITORING AND EVALUATION PLAN 2010-2013
FOREWORD
The Ghana Health Service has over the years been implementing different
programme of Work and have been reporting on its performance. There is an
elaborate system to ensure that the Ghana Health Service accounts for its
stewardship. The processes involved in doing this are in various documents. This
effort to document these monitoring and evaluation processes in one document is
one of the important steps in the overall attempt to improve the monitoring and
evaluation within the service and ensure accountability within the service.
It is hoped that this document will provide direction for Districts, Regions, Divisions
and Programs to better monitor and evaluate the implementation of their programme
of work.
Thank You
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LIST OF TABLES
Table 1: Participants at Writers Meeting
Table 2: Participants at Document Finalization Meeting
Table 3: Monitoring and Evaluation Calender
Table 4: Roles and Responsibilities of Divisions
Table 5: Stakeholders in the Health Sector
Table 6: Timeline for Data Submission
Table 7: Financial Reporting Framework
Table 8: M&E Activities
Table 9: Budget for M&E
LIST OF FIGURES
Fig 1: Institutional Monitoring and Evaluation Framework
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List of Acronyms
ACT Artemesinin Combination Therapy AFP Acute Flaccid Paralysis AIDS Acquired Immunodeficiency Syndrome ANC Ante Natal Care ART Anti-Retroviral Therapy ARV Anti-RetroviralBCG Bacillus Calmette-Gurin Vaccine
BMC Budget Management Centers CEmONC Comprehensive Emergency Obstetrics and Neonatal Care CHAG Christian Health Association of GhanaCHIM Centre for Health Information ManagementCHO Community Health OfficersCHPS Community-based Health Planning and ServicesCHW Community Health WorkersCSO Civil Society OrganizationCYP Couple Years of ProtectionDA District AssemblyDDHS Director of District Health ServicesD-G Director GeneralDHIMS District Health Information SystemsDHMT District Health Management TeamDHS Demographic and Household SurveyEmONC Emergency Obstetrics and Neonatal CareEPC Environmental Protection CouncilEPI Expanded Programme on Immunization
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LDP Leadership Development ProgrammeLI Legislative InstrumentMDG Millennium Development GoalsMICS Multi-Indicator Cluster SurveyMLGRD Ministry of Local Government and Rural DevelopmentMOFEP Ministry of Finance and Economic PlanningMOH Ministry of HealthMOWAC Min istry of Women and Childrens Affairs M&E Monitoring and Evaluation
NACP National AIDS Control ProgrammeNCD Non-Communicable DiseaseNDPC National Development Planning CommissionNGOs Non-Governmental OrganizationOPD Out-Patient DepartmentOPV Oral Polio VaccineNMCP National Malaria Control Programme
NTP National Tuberculosis Control ProgrammePHD Public Health DivisionPNC Post Natal CarePOW Programme of WorkPPME Policy Planning Monitoring and Evaluation DivisionPPP Public Private PartnershipsRDHS Regional Director of Health Services
RDT Rapid Diagnostic TestSBS Sector Budget SupportSD Skilled DeliverySP Sulfadoxine Pyrimethamine
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Table of Contents
LIST OF TABLES ................................................................................................................................. 4
1. INTRODUCTION ............................................................................................................................... 9
1.1. BACKGROUND ......................................................................................................................... 9
1.2. RATIONALE .............................................................................................................................. 9
1.3. PROCESS OF DEVELOPING THE M&E PLAN ........................................................................... 10
2. SITUATIONAL ANALYSIS ................................................................................................................ 12
2.1 SWOT Analysis of the GHS Monitoring and Evaluation System .................................................. 12
2.1.1. Strengths ....................................................................................................................... 12
2.1.2. Weaknesses................................................................................................................... 13
2.1.3. Opportunities ................................................................................................................ 14
2.1.4. Threats .......................................................................................................................... 14
3. PROGRAM DESCRIPTION AND FRAMEWORK ............................................................................... 15
4. INSTITUTIONAL ARRANGEMENT ................................................................................................... 39
4.1. MANDATE OF THE GHANA HEALTH SERVICE ........................................................................ 39
4 2 M&E MANDATE AND FUNCTIONS OF DIVISIONS 43
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8.3. USE OF DATA FOR DECISION-MAKING .................................................................................. 57
8.4. PLAN FOR EVALUTAION ........................................................................................................ 58
9. QUALITY ASSURANCE .................................................................................................................... 59
9.1. Ensuring Data Quality ........................................................................................................... 59
9.2. Improving the quality of data collection ............................................................................... 59
9.3. Standard Operating Procedures ........................................................................................... 60
9.4. Improving Timeliness, Completeness and Accuracy of Transmitted data ............................ 60
9.5. Data Quality Audit ................................................................................................................. 61
9.6. Feedback Processes .............................................................................................................. 61
9.7. Documentation ..................................................................................................................... 62
10. REPORTS .................................................................................................................................... 63
10.1. REPORTING MILESTONES .................................................................................................. 63
10.2. PROGRAMMES/PROJECT MONITORING ........................................................................... 63
10.3. FINANCIAL REPORTS ......................................................................................................... 63
10.4. FINANCIAL AUDIT REPORTS .............................................................................................. 64
10 5 GHANA HEALTH SERVICE REPORT 64
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1. INTRODUCTION1.1. BACKGROUND
The Ghana Health Service (GHS) annual program of work (POW) are developedfrom the Health Sector Medium-Term Development Plan (HSMTDP) - 2010-2013and they mirror the government s development agenda for the medium term and arealigned with the national objective of attaining middle income status by 2015. TheHSMTDP 2010- 2013 builds on the general principle of providing affordable primaryhealth care (PHC) that is both cost-effective and ensures equitable access tohealthcare for all people living in Ghana. The HSMTDP has been synchronized withthe third 5-year POW which is truncated to allow for consistency in the developmentand provision of health services.
The HSMTDP 2010 - 2013, was developed through an elaborate consultativeprocess involving key stakeholders including development partners, and non-governmental actors in Ghanas health industry. It is based on the broad guidelinesof the National Development Planning Commission (NDPC). The consultationprocess was further enhanced by a series of key stakeholder consultations at thenational, regional and district levels involving development partners, health sectorNGOs, health workers and other sector collaborators such as the Ministry of LocalGovernment and Rural Development (MLGRD), Ministry of Women and Childrens
Affairs (MOWAC) and Environmental Protection Council (EPC).
The GHS which is the largest service agency of the Ministry of Health (MoH) willcontribute significantly to the achievement of the sector indicators. GHS providespublic health and clinical services at both primary and secondary levels The
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and targets. It will also make an allowance for identifying challenges toimplementation for timely and appropriate remedial measures to be taken. The GHSM&E plan will also delineate the roles of Divisions and Programmes in the M&Eprocess and guide overall stakeholder involvement in measuring health sectorperformance.
1.3. PROCESS OF DEVEL OPI NG THE M & E PLANThe M&E plan is built on existing M&E arrangements and processes in the healthsector. The indicators and milestones for assessing the performance of the Serviceare derived from sector wide indicators which were developed through elaborateconsultations with stakeholders facilitated by the Ministry of Health. Indicators andtargets from other strategic documents and some existing M&E plans were alsoadopted.
The process of developing the sector wide indicators began with internalconsultations at agency level. Following these, submissions were made to theMinistry of Health accentuating the need to either modify the tools for assessment ormodify targets, indicators, or milestones. These submissions were consolidated andcirculated widely to stakeholders for consideration and comments. Additionalcontributions were received from other stakeholders, particularly the health sectordevelopment partners.
The Divisions within the Service provided the targets for the various indicators asdefined under the Health Sector objectives.
The development of the GHS M&E plan began with a zero draft prepared by the
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9 Dr. Paul Ntodi Regional Hospital Medical Director Western Region10 Ms. Mabel Segbafah Health Educator - GHS11 Dr. Beatrice Heymann M & E Specialist - GHS12 Mr. Isaac Akumah Administrator, PPME13 Mr. Francis Victor Ekey Ag. Deputy Director, Planning - HRDD14 Dr. Cynthia Bannerman Ag. Director, Institutional Care Division15 Dr. Felix Afutu TB Control Program Officer16 Ms. Hilda Smith MSH TB Project Officer
17 Mr. Prince Asante Health Service Administrator18 Mrs. Esi Amanful Nutritionist GHS/HQ19 Mr. Daniel Darko Head, Centre for Health Information Management
20 Mr. Daniel Osei Ag. Director, Policy Planning Monitoring & EvaluationDivision - GHS
21 Dr. Edward Antwi Deputy Director, Public Health Greater Accra Region22 Dr. John Eleezar Deputy Director, Public Health Central Region
23 Dr. Alex Nazzar Public Health Specialist - GHS
24Dr. Constance Bart-Plange
Program Manager, National Malaria ControlProgramme (NMCP)
25 Dr. Daniel Asare Regional Hospital Medical Director Eastern Region26 Mr. Daniel Degbotse M & E Specialist - MOH27 Mr. Ransford Akorli Deputy Chief Accountant - GHS28 Dr. Kyei-Farried Deputy Director, Disease Control
29 Mrs. Ramatu UdeUmanta Ag. Director, Finance Division - GHS30 Mr. Bernard Asamany Ag. Deputy Director, Procurement and Logistics - GHS
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2. SITUATIONAL ANALYSIS
Monitoring and Evaluation within the GHS depends largely upon monthly routineservice data generated from all districts and sub-districts. In Ghana, almost all theyearly health sector reviews and the aide memoires have called for an improvementin the existing health information system for better decision-making and supportingthe health system to deliver on key interventions and to achieve set objectives withinthe PoW and the MDGs.
Apart from these routine data, the health sector also collaborates with stakeholderssuch as the Ghana Statistical Service (GSS) and research institutions to undertakeperiodic health surveys and sentinel studies including the Demographic andHousehold Survey (DHS) and the Multi-indicator Cluster Survey (MICS). Suchsurveys provide the health sector with additional information for monitoring andevaluation that contributes to policy-making and re-strategizing.
The Health Sector, in an attempt to improve access to an integrated service datadeveloped and successfully deployed the DHIMS software in 2008 within the healthsector. This was to help district, regional and national managers to improve on thecollation and analyses of routine service data.
Service registers are provided at service delivery points in all health facilities toaccumulate client demographic and healthcare information. This informationconstitutes the primary data sources for monitoring and evaluation within the service.Standard forms are used to manually summarize data from these service registers
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Inadequate monitoring of M&E plans at all levels Very little commitment to M&E processes Weak process monitoring. M&E not included in planning at all levels Lack of a platform to link service parameters to governance parameters Lack of two-way accountability at all levels No sector goals for M&E system Weak feedback mechanisms and use of data to revise planning and
implementation activities2.1.3. Opportunities
Health Training Institutions available to deepen understanding on M & EGlobal interest for results tracking and data management.Increasing availability of ICT solutions.
2.1.4. ThreatsPolitical influence and governments prioritiesGlobal economic instabilityDonor driven parallel M&E systems
To address these gaps strategies will be developed to address issues relating toHealth Workforce, resource management and Leadership and governance .
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3. PROGRAM DESCRIPTION AND FRAMEWORKHO1: Bridging equ i t y gaps in access to health care and nutrition services, and ensure sustainable
financing arrangements that protect the poor Strategies Priority action Activity Division
ResponsibleOutput Indicator Outcome
IndictorImpactIndicator
1.1Strengthen districthealth system with aparticular emphasis onprimary health care
1.1.1Improve coverageof PHC servicesat sub-districtlevel throughcommunity healthsystems
Review of theCHPS strategy
PPMED-GHS
Number of newfunctional zones
Percentage ofOPD casesseen andtreated byCHOs.
Outpatientsvisits per capita
Proportion of
Cases ofvaccinepreventablediseasesseen.
New functionalCHPS zonesoperationalised
DistrictHealthManagementTeams /RegionalHealthManagementTeams
Provideaccommodation,transportation andservice deliverykits
DistrictHealthManagementTeams /RegionalHealthManagementTeams
Number of functionalCHPS zones withService delivery kitsavailable.
1.1.2 Leadershipcapacitydevelopment ofdistrict and sub-district teams
Train sub-districtteams to supportapproved serviceproviders in thesub-district
HRD-GHS Number of sub-districtteams trained underLDP
MaternalMortalityratio
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StrengthenDHMTs anddevelop theDistrict Health
Departments tooperate inaccordance withLI 1961
HRD-GHS Number of DHMTstrained under LDP
funds obtainedfrom non-traditional(GOG) sources
1.2 Develop sustainablefinancing strategies thatprotect the poor andvulnerable
1.2.1 Developcomprehensivehealth financingframework
Develop anational healthfinancing strategy
Office of DG Team in place;Documents forfinancing strategyprepared.
Percentage ofOPD visits byinsured clients.
Percentage ofindigentsregisteredunder the NHIA
Update andinstitutionalizeNational Health
Accounts
GHS-DG Team in place;Number of fieldworkand analysis on NHA
undertaken by team
Provideleadership andsupport for thereview andpassage of theNHIS bill,including definitionof the "indigent"
GHS- DG Number of peoplecaptured underrevised definition ofpoor and indigent
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HO1: Bridging equity gaps in access to health care and nutrition services, and ensure sustainablefinancing arrangements that protect the poor
Strategies Priority action Activity DivisionResponsible
OutputIndicators
OutcomeIndicators
ImpactIndicators
1.3 Increaseavailability andefficiency ofhumanresources
1.3.1 Revise andimplement theHuman ResourceStrategy
Develop a newHR strategy
HRD-GHS New strategydocumentavailable
Nurse percapita ratio.
Doctor percapita ratio
Medical Assistant percapita ratio
Midwife percapita ratio
Reviewestablishments,staffing normsand develop andimplementdeployment plan
HRD-GHS
Agree andimplementincentivepackage topublic healthsector workers inunder-servedareas
HRD-GHS Number of staffin deprivedareas benefittingfrom Incentivepackage agreedupon.
Number of
residentcommunitynurses(CHO)
Proportion ofdoctorsworking indeprived areas .
Infantmortality rate
Under fivemortality rate
Maternalmortalityratio
HO2: Strengthen governance and improve the efficiency and effectiveness of the health
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systemStrategies Priority action Activity Division
ResponsibleOutputIndicators
OutcomeIndicators
ImpactIndicators
2.1 Developcapacity toenhance theperformance ofthe nationalhealth system
2.1.1 Leadership andmanagementdevelopment at alllevels
Design andimplement in-service trainingprogramme inleadership andmanagement forall managers inthe health sector
HRD -GHS Number ofseniormanagers(National,Regional andDistrict) trainedin Leadershipandmanagement
Number offunctionalmanagementteams in place
2.1.2 Performancecontracting
Review andrefine the system
for performancecontracting withinthe sector.
Training on newperformancecontract forms
Performancecontract too besigned betweenmanagers and
staff
DG-GHS Newperformance
contract formfinalized
Proportion ofsenior membersin the servicewho havesignedperformancecontracts by firstquarter.
Percentage ofmanagers whoassess theperformance oftheir staff usingthe contract atmidyear.
2.1.3 Enforce adherenceto sound publicfinancialmanagementpractices
Review andimplement publicfinancialmanagementstrengtheningplan
Finance/Internal Audit
Completed plan.
Functional auditresponse teamin place
Number offinancial issuesfrom GHSbrought beforethe Public
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Build Capacityfor resourcetracking
Number of stafftrained inresource
tracking
AccountsCommittee
PercentageDistribution offunds by levelswithin thehealth sector.
Percentage offunds used forintendedactivities ,
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HO2: Strengthen governance and improve the efficiency and effectiveness of thehealth system
Strategies Priority action Activity DivisionResponsible OutputIndicators OutcomeIndicators ImpactIndicators2.3 Strengthen
inter-sectoralcollaborationand public-privatepartnerships
2.3.1 Improve partnershipfor health byengaging the privatesector.
Implement theprivate sectorpolicy
GHS-DG Number ofPPP meetingsheld Number of
private publicpartnerships(MOUs)establishedwithin theservice.
Establish advisorycommittee onPPP
PPMED-GHS Advisorycommittee inplace
Promote inter-sectoral coordination
GHS to be part ofthe developmentof District
Assembliescompositeplanning
District HealthManagementTeams.
Number ofmeetings heldwith DA.
Number ofsocialservices sub-committeemeetingsattended byDDHS.
District planswith priorityHealthcomponentincluded
Percentage ofPriority healthprojects jointlyimplemented.
Infant mortalityrate
Maternalmortality ratio
Strengthen
FHD Number ofmeetings heldwith the
Nutritionalstatusindicators(
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Collaboration onschool healtheducationactivities at all
levels(healthylifestyles)
SHEPcoordinators
Number of
joint visitsundertaken
Wasting,stunting,underweightand obesity)
Collaborate withNationalCommission forCivic Education toengage in masspublic educationcampaigns topromote healthylifestyles in thepopulation
-Materialproduction-Advocacy for useof materials-Supportcampaigns
GHS- ICD/FHDHealth Promotionunit
Number andtypes ofhealtheducationmaterialsproduced forNCCE.Number ofadvocacy and
trainingsessions heldbetween GHSand NCCE.
Number ofJoint masscampaignsundertaken
Publicawarenessindicators.
Behaviourchange
indicators
HO2: Strengthen governance and improve the efficiency and effectiveness of thehealth system
Strategies Priority action Activity DivisionResponsible OutputIndicators OutcomeIndicators ImpactIndicators2.4
Strengthensystems thatuse evidencefor policyformulation
2.4.1 Develop amonitoring andevaluation plan
Prepare andimplement anational M& Eframework for theGhana HealthService.
PPME-GHS GHS M&Eplandeveloped.
Number ofME Reports
Improvedperformance using therelevantindicators-quality
Infant mortalityrate
Under- fivemortality rate
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Number ofME Feedback
-coverage-Case fatality-evidencebased
decisions
MaternalMortality ratio
Establish districtleague table andreward system
Regional HealthManagementTeams
Number ofRegions withDistrict leaguetable andrewardsystem inplace
Dropoutrates(Immunization drop-outrateCure rate/casedetection rate
Workloadindicators(Number of
childrenimmunized/each communityhealth nurse)
2.4.2 Implement andcoordinate a nationalresearch agenda
Allocate dedicatedrecurrent budgetto health research
DG Percentage ofItem 3GOG/SBS inring-fencedbudgetallocated toresearch.
Proportion ofresearchagendabudget thatfunds areprovided for.
.
Number ofresearchpublications.
Proportion ofresearchrecommendations carried topolicy
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Number ofapprovedresearchgrants.
Disseminate thenational healthresearch agenda
HRU Number ofResearchagendadisseminationfora.
Proportion ofresearchproposalssubmitted tothe Ethicsreview boardthat is alignedwith thenationalresearchagenda.
Conduct
operationalresearch /clinicaltrials.
HRU Number of
reportsavailable
Number of
policydecisions takenbased onresearchfindings
Strengthen healthinformationmanagement
Implement theDHIMS II
PPME Number ofdistricts/Headquartersdivisionstrained in theuse ofDHIMSII
Percentage ofdistricts usingDHIMS II.
Percentage ofDivisions,Programmes
anddepartmentssourcing datafrom DHIMSII
Morbidity andmortalityindicators.
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Percentage ofdistricts withevidence ofanalysis and
givingfeedback toreporting level
HO3: Improve access to quality maternal, neonatal, child andadolescent services
Strategies Priority actions Activities DivisionResponsible
OutputIndicators
OutcomeIndicators
ImpactIndicators
3.1 Reduce themajor causes
contributing tomaternal andneonataldeaths
3.1.1 Implement the MDG Acceleration
Framework Country Action Plan forimproved maternaland newborn care
Increase accessto modern FP
services
FHD Number offacilities
offering FPservices
ModernContraceptive
prevalence rate
Couple yearprotection
InstitutionalMaternal
mortality ratioIncreasecoverage ofskilled delivery
FHD Number ofmidwives perexpecteddeliveries.
Averagenumber of
ANC visits perregistrants
TotalDeliveries.
TotalstillbirthsTotal LiveBirths
Percentage of ANCRegistrants
Percentage of ANC clientsmaking 4+visits
Proportion ofregistrantsreceiving IPT1,IPT 2and IPT3
Tetanus toxoidcoverage rate
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Proportion ofstillbirths tototal deliveries
Proportion ofdeliveries byskilledattendants.
Proportion ofinstitutionalmaternaldeaths audited.
Finalize andimplement
recommendationsof the report onEmONCassessment
FHD National andRegional
EmONCReports
Percentage ofHealth Centres
providingBEmONC
Percentage ofDistrictHospitalsprovidingCEmONC
Institutionalmaternalmortality ratio
Strengthenimplementation ofLife Saving Skillsat district and sub-
district level andbuild RegionalResource Teams
FHD Percentage ofdistrict andsub-districtstaff trained in
LSS;
Proportion ofRegions withresourceteams
Total numberof vacuumdeliveriesperformed
Total numberof manualremovals ofplacenta done .
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HO 3: Improve access to quality maternal, neonatal, child andadolescent services
Strategies Priority actions Activities Division
Responsible
Output
Indicators
Outcome
Indicators
Impact
Indicators3.1 (cont) Reduce the majorcauses contributing tomaternal andneonatal deaths
Implement the MDG AccelerationFramework Country
Action Plan forimproved maternaland newborn care
Evaluate theimplementation ofthe free maternaldelivery
FHD Free maternaldeliveryevaluationreportavailable anddisseminated
Raise awarenesson socio-culturalbarriers to accessto maternal andnewborn care
GHS Improvedawareness
Improve access tosafe blood forexpectantmothers andnewborns
ICD Number ofNew bloodstoragefacilitiesprovided inhealthfacilities
Proportion ofrequestedblood forpregnantwomen thatare madeavailable
Totaltransfusionvolume
InstitutionalMaternalMortality Ratio.
3.2 Reduce the
major causescontributing tochild morbidityand deaths
3.2.1 Implement the Child
Health Policy andStrategy
Increase the
uptake of EPIservices
PHD Number of
EPI outreachpoints
Measles
coverage forunder one year
Percentage ofchildrenimmunized byage one forPenta 3.
InstitutionalInfant mortalityrate
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Percentage ofchildrenimmunized byage one for
Polio 3
Percentage ofchildrenimmunized byage one forBCG
Infant mortalityrate(DHS)
Train healthworkers in IMNCIthe use of ORSand Zinc to
manage diarrhoea
FHD Number ofHealthworkerstrained in
IMNCI.
Proportion offacilities withfunctional ORTcorners.
Diarrhoea casefatality rate
Train relevantCommunityHealth Workers(CHWs) onintegratedCommunity CaseManagement ofDiarrhoea/Pneum
onia/Malaria
FHD Number ofCHW TrainedandimplementingCCM
Number ofdistrictstrained inCommunityCaseManagementfor majorchildhoodkillers
Percentage ofdistricts
implementingcommunitycasemanagementfor childhoodkillers
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Scale up schoolhealthprogrammes
FHD Number ofSchoolsinspected
Number ofchildrenreferred.
Nutritionalstatus ofchildren
Child mortalityrate
3.3 Improveadolescenthealth
3.3.1 Implementadolescent healthpolicy and strategy
Implement priorityactivities underadolescent healthstrategy
FHD- AdolescentHealth
Number ofPriorityactivitiesimplemented
Percentage ofpregnantwomenattendingantenatal whoareadolescents
3.4 Improvenutritional
status ofwomen andchildren
3.4.1 Develop andimplement National
Nutrition Policy andStrategy
Develop NationalNutritional policy
and strategy
FHD- Nutrition Documentsfinalized and
disseminated
Proportion ofdistricts with
nutrition priorityinterventionsreflecting intheir actionplans
Scale-up essentialnutrition actionsfor women andchildren
FHD-Nutrition Essentialnutritionactions scaledup to cover 3regions
Percentage ofunder five whoare underweightpresenting atfacility and
outreach.
Malnutritionrates(DHS)
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HO 4: Intensify prevention and control of communicable and non-communicable diseases and promotehealthy lifestyles
Strategies Priority Action Activity DivisionResponsible
OutputIndicator
OutcomeIndicator
Impact Indicator
4.1 Improve uponprevention,detection andcasemanagement ofcommunicablediseases.
4.1.1 Prevention andcontrol ofcommunicablediseases
Perform routineimmunization as well asImplementsupplementaryimmunization activities.
Provide immunization forselected epidemic pronediseases.
PHD-EPI Number ofroutine EPIoutreachpoints
Number ofnewvaccinesintroduced
Non-AFP Poliorate.
Immunizationcoverage
PercentageFullyimmunized
Drop-out rateLeft out rate
Vaccinewastage rate AEFI
Vaccinepreventablemorbidities andmortalities
4.1.2 Prevention, detectionand management ofHIV/AIDS, TB andMalaria
Implement nationalstrategic plans to reducenew HIV infections
PHD-NACP Number ofpeopletested andcounseledfor HIV.
Number/Per centage
tested HIVpositive
Number/Per centage ofeligible HIVclients on
ARV
.Number/Percentage ofcases alive andon ART.
Number/Proportion of
children born toHIV positivemothers put on
ART who arenegative after18months,
Percentage ofyoung womenand men aged15-24 who areHIV infected.
Survival rate ofcases put on ART.
ART Resistancelevel
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Number ofHIV positivepregnantwomen put
on ART.Implement nationalstrategic plans toincrease TB casenotification and treatmentsuccess rate
PHD -NTP Numberof newandrelapsecases.
Number/Percentage of newandpreviousl
y treatedTBpatientsconfirmedMDR-TB.
Number/Percentage of totalTB caseswho arehealthworkers
-TB casenotificationrate
TB treatmentsuccess rate
Case Fatalityrate for
Tuberculosis
Incidence andmortalityrate(WHO
Annual report)
Expand coverage ofITN/Ms
PHD-NMCP Number ofITN hanged
Percentagechildren underfive years whosleep underITNs.
Percentage ofpregnant
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women whosleep underITNs
Number/Percentage ofHouseholdswith hangednets
Implement nationalstrategic plans to reducemalaria case fatalityamong pregnant womenand children
PHD-NMCP Number ofprescriberstrained inthe newmalariatreatmentprotocols
Percentage ofpatients treatedwith ACT
Maternalmortality ratio
Under fivemortality rate
4.1.3 Prevention, detectionand management ofdiseases of epidemicpotential and thosetargeted foreradication
Maintain status andvalidate eradication ofguinea worm and polio
PHD-NMCP Number ofcases ofguineawormreported.)
Number ofcases ofwild polioconfirmed.
Non-Polio AFPrate.
Percentage ofguinea wormcasescontained
Increase activities for thecontrol of onchocerciasis,lymphaticfilariasis,schistosomiasis,Buruli and elimination ofyaws and leprosy
PHD-NTDs Number ofreportedcases ofNTD.
Coverage ofmasstreatment
Prevalencerate of theNTDs
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for Oncho,shisto, LFand soilhelminthes.
Flyinfectivityrate for
Early detection and rapidresponse to epidemicprone diseases
PHD-DCD/DS
Number ofepidemicpronediseasesconfirmed.
Case fatalityrate ofdiseases
4.2 Improveprevention,
detection andmanagement ofnoncommunicablediseases
4.2.1 ImplementRegenerative Health
and NutritionProgramme
Establish network of
stakeholders and trainthem to implement RHNP
Promote healthy lifestyleawareness among thegeneral population
FHD-HealthPromotion
Unit
Number ofstakeholder
s trainedand able tocarry outtheir roles inthe nationalstrategy.
Number andtypes ofRHNPprogrammes held
Number ofstakeholders
with definedworkplacearrangementsfor promotingRHNP.
Measure ofawareness
Practice ofHealthylifestyle(DHS)
4.2.2 Scale up detectionand management ofnon-communicablediseases
Establish National NCDSteering committee anddefine its terms ofreference.
PHD-NCD Committeeestablishedand active
Minutes,reportsandguidelines
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Expand screeningprogrammes for selectednon-communicablediseases: hypertension,
diabetes, sickle cell andselected cancers.
PHD-NCDICD
Number ofpersonsscreenedand treated
for selectedNCDs
Proportion ofInstitutionaldeaths
Attributable to
NCDs
Increase effective clinicalmanagement of NCDs
ICD Number offacilitieswithEssentialequipment
Number ofhospitalteamstrained tomanagenon-communicablediseases.
Number offacilities thathaveinstitutionalizedcollecting ofdata on riskdeterminantfor NCDsfrom OPDclients(egBP, BMI)
Percentage ofOPD casesthat is due toNCDs
Case fatalityrate For NCDs
Prevalence ofNCDs
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HO5 Improve institutional care, including mental health service deliveryStrategies Priority actions Activities Division
ResponsibleOutput
IndicatorOutcomeIndicator
Impact Indicator
5.1 Increase
access toMental HealthServices
5.1.1 Ensure the passage
andoperationalization ofthe Mental Health
Act
Advocate for the
passage of the MentalHealth Bill
ICD-Mental
Health
Mental
Health Actavailableandoperational
Decentralized
mental healthservices.
Number oftreatmentcenters formental Health.
Availability ofresource-humanfinancial and
medicationNumber ofhuman rights-abuses(chaining andmechanicalrestraints )reported
Develop communitymental health strategy
ICD-MentalHealth
Communitymentalhealth
strategydeveloped
5.1.2 Establish mentalhealth services in allhealth facilities
Establish community andfacility-based mentalhealth services
ICD/MentalHealth
Proportionof DistrictHospitalswith mentalhealth units
Registered
cases.
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5.2 Enforcestandards,guidelines andprotocols toimprove thequality ofinstitutionalcare
5.2.1 Ensure availabilityand use of standardsand protocols
Review and developstandard protocols andguidelines for institutionalcare including referrals
ICD Number ofhealthinstitutionswithStandardprotocolsandguidelinesforinstitutionalcare.
Proportionofguidelineswithchecklistand job aids
Clientsatisfaction
Providersatisfaction.
Treatmentoutcomemeasures e.g.Disabilityprevention,Case fatalityrate.
Ensure theavailability ofequipment andinfrastructure
Develop and implementmedical equipmentreplacement plan
HASS Equipmentreplacementplan inplace andimplemented
Availabilitymeasure
HO5 Improve institutional care, including mental health service deliveryStrategies Priority actions Activities Division
ResponsibleOutput
IndicatorOutcomeIndicator
Impact Indicator
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5.3 Strengthen thesystemcapacity foremergencyresponse
5.3.1 Develop andstrengthenframework foremergency response
Develop and disseminatenational strategies andguidelines for responseto accidents and medicalemergencies
ICD Number offacilitieswithemergencyresponseset up
Proportion offacilitiesmeeting theminimumacceptablestandards
Promote local initiativesto further expandemergency transport forpregnant women,children and others
ICD/FHD Number ofdistricts withLocalinitiativesforemergencytransport inplacearound thecountry
Case fatalityrate
Maternalmortalityratio(Institutional)
5.3.2 Strengthen capacityof Accident &Emergencydepartments ofhealth facilities
Train emergency medicalteams for district,regional and tertiaryhospitals
ICD Number ofRegionalHospitalswith trainedEmergencymedicalteams.
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MONITORING AND EVALUATION FRAMEWORK OF GHANA HEALTH SERVICE
LOGICAL FRAMEWORK
Verifiable
indicators
Means of verification Assumptions
HEALTH
SECTOR
GOAL
To improve
access to
quality health
care
Maternal
Mortality ratio
Under-five
mortality rate
Neonatal
mortality rate.
Life expectancy
GDHS
MICS
An assumption is made that
improvement in access to
quality health care will reduce
mortality
PURPOSE1 Bridge equity
gaps in access
to health care
Number of CHPS
zones made
functional
Routine Service
reports
Provision of close to clients
service delivery using CHPS
will address the geographical
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the efficiency
and
effectiveness
of the health
system
management
Number offunctionalmanagementteams in place
service better at whatever
level they might be.
PURPOSE 3 Improve
access to
quality
maternal,
neonatal,
child andadolescent
health and
nutrition
services
Institutional
MaternalMortality Ratio.
Skilled deliverycoverage
Measlesvaccinationcoverage.
InstitutionalInfant mortalityrate
Infant mortalityRate
Percentage ofchildren underfive years whoare stunted
Routine Service
reports
DHS
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communicable
and non-communicable
diseases and
promote
healthy
lifestyles
PURPOSE 5 Improve
institutional
care, including
mental health
service
delivery
Number oftreatmentcenters formental Health.
Number ofdistrict Hospitalswith mental
health units
Bed occupancyrare
Average lengthof stay
Bed turn over
rate
BMC reports
BMC reports
Routine service
reports
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Fig 1.Levels of Monitoring in Ghana Health Service
4.2. M & E MANDATE AND FUNCTIONS OF DI VI SI ONS
Monitoring and Evaluation within the Divisions and Programs, is designed to provide managers
and stakeholders with the information necessary to guide the implementation of their action plans.It is therefore mandatory for all Districts, Regions, Programs and Divisions to include monitoringand evaluation activities in their respective action plans.
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Table 3: MONITORING AND EVALUATION CALENDAR Activities Time Frame Actors
1st Quarter 2nd Quarter 3 rd Quarter 4th Quarter
J a n
F e
b M a r
A p r
M a
y J u n
J u
l A u
g S e
p O c t
N o
v D e
c
Sub-district datavalidation meetings
Sub-district Teams
District datavalidation meetings
DHMT
Regional datavalidation meetings
RHMT
Supervision andMonitoring visits
DHMT,RHMT andIME-PPMED
Districtperformancereviews
Sub-District Teams,DHMT and RHMT
Regional Annualand Half yearperformancereviews
DHMT, RHMT ,GHSHeadquarters, MOHand DPs
National GHSHead-quarters
Annual and Halfyear Performancereviews
Divisions in GHS
Senior ManagersMeetings
GHS Headquarters,RHMTs,
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7. M&E ACTIVITIES
7.1. Roles and Responsibi l i t ies wi t hin GHSThe Divisions within the Ghana Health Service in implementing their mandate contributeto monitoring and evaluation process
Table 4 : Roles and Responsibilities of Divisions Category ofservice provision
Division Type of information Frequency
1. ClinicalCare
ICD Outpatient attendance Outpatient morbidity Inpatient admissions Inpatient deaths Death Audits Inpatient morbidity Inpatient mortality Differential use of services by
patient categories
Statement of In-Patient Admissions, Discharges andDeaths
Bed Occupancy Rates Surgical Operation Returns Total number of beds
Bed Turnover Rate Average length of stay Infection rate for caesarian
MonthlyMonthlyMonthlyMonthlyMonthlyMonthlyMonthlyMonthly
Monthly
MonthlyMonthlyMonthlyMonthlyMonthly
Monthly
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Institutional under fivemortality rate.
Underweight Stunting PMTCT Exclusive breastfeeding
coverage Assessment of facilities for
BFHI activities
Monthly
Monthly
Then Quarterly;Half year/Annual
Public Health PHD Immunization (specificallyMeasles and Penta-3 coverage)
Trend of other communicableand non communicablediseases.
Disease surveillance indicators(Timeliness, completeness,accuracy)
Monthly;
Monthly
Monthly
Then Quarterly;Halfyearly/Annually
PHD Trend on Diseases earmarkedfor eradication and orelimination.
Technical Support visits
Weekly
Quarterly
FHD Antenatal coverage Postnatal coverage IPT coverage Family planning coverage
Monthly,MonthlyMonthlyMonthly
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Revenue and expenditure dataFunds for Monthly Capitationsfor Primary care (NHIA)
Monthly
HASS State of public healthfacilities
State of Central &Regional Medical Stores
Equipment and logisticssituation of the public healthfacilities
Cost of replacingequipment
Equipment
Maintenance in the public healthfacilities
Planned preventivemaintenance activities
Status of projects underimplementation in the sector
Number of healthfacilities by level and location,including CHPS compounds and
Quarterly/Half-yearly/
Annually
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report (LMIS).
4. Percentage of facilities thatmaintain acceptable storageconditions (Warehousing)
5. Percentage availability ofTracer medicines (Product
Availability)
6. Percentage availability of non-medicine consumables(Product Availability)
7. Mean Absolute PercentageError (MAPE) betweenforecasted consumption and
Actual consumption(Forecasting)
8. Average percentage differencebetween consumption forecastsand actual consumption(Forecasting)
9. Percentage of stock wasteddue to expiration or damage(Warehousing and Inventorymanagement)
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RFQ
13. Average lead time from Awardof Contract to delivery(Procurement)
ICT
NCT
RFQ
14. Percentage of procurementexecuted through
ICT
NCT
RFQ
15. Percentage of staff trained inLogistics management (LMIS)
16. Percentage of Procurementand Supply Officers at post.
17. Percentage of procurementexecuted with PPA approval.
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Development Partners Provides technical assistance, financial
supportCivil Societies Advocacy for health, community and resource
mobilization community empowerment througheducation, demand accountability
Academia Support research, training, policy formulationand technical assistance
Faith based organization Support service delivery,
Private providers Support service delivery
7.4. M & E CONDI TIONS AND CAPACITI ES
7.4.1. CAPACITY FOR MONITORING AND EVALUATION
Traditionally, the GHS utilizes medium term plans (POW) drawn from the HSMTDP. Annual POW is also developed to guide the activities of the Service for each year. GHS
has personnel at all levels involved in the M&E process. However, the workloadespecially at sub-district, district and regional levels overwhelms staff strength andcapacities at these levels. The National level has an M&E unit within the PPMED but no
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Following on these, financial support will be required to resource the PPMED to
undertake regional monitoring and to equip the national, regional and all districts withmuch needed ICT infrastructure, internet access and anti-virus software to facilitate thefull adoption of the DHIMS 2 software.
7.4.2. TECHNICAL ASSISTANCE
GHS has completed the process of adopting the DHIMS 2 as the main software for datacollection and analysis; however some technical assistance is still required to addresspost implementation challenges. There has been some contact with the University ofOslo to this effect and as a result a memorandum of understanding has been signed tofacilitate the provision of Technical Assistance to continue the further improvement inDHIMS2 after it has been rolled out.
GHS will also require some technical assistance to evaluate the HSMTDP implementationat the end of 2013 to determine the scope of the Service activities and how these havecontributed to the overall reduction in morbidity and mortality in the Ghanaian population.
7.4.3. STORAGE OF INFORMATION
The kind of service data and information generated and stored varies among the different
levels within the Service. The category of M&E information that is stored also depends onthe level of the management centre managing the data as well as the sub-level at whichthe specific activity generating the data is being carried out. This in turn is dictated by the
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transmission of data by courier has adversely affected data completeness, quality, and
timeliness. It is hoped that the current HSMTDP will adequately address thesechallenges. The development and deployment of web-based software (DHIMS2) thatwould replace the existing data collecting software will enable collection of real-time datafrom the districts and improve timeliness.
7.4.4. EQUIPMENT AND LOGISTICS
To gain from the efficiency of real-time data collection requires that computers be placedwithin the consulting rooms of hospitals, and mobile devices like phones set-up within thesmaller health facilities and for other public health programmes. These systems willrequire internet access for efficient data transmission. Currently there is dire need forcomputers and accessories at all levels but more especially at the facilities and District
Health Directorates. For most districts there is a reliance largely on internet access viaUSB modems available on various mobile phone networks, raising issues withconnectivity and reliability.
Following these, there is recognition of the need to support facilities and districts withcomputers and reliable internet access. There will also be the need to support andresource the ICT department to maintain the existing computers and accessories in the
Service. Additionally the GHS needs to make investments in infrastructure and personnelto strengthen the capacity at its Center for Health Information Management (CHIM) to beable to maintain and run the proposed web-based data collection, analysis and reporting
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8. THE MONITORING AND EVALUATION PROCESS
8.1 COLLECTION, COLLA TION AND ANA LYSIS OF DATA
GHS should collect and collate routine data monthly from the districts. Send Reportsfrom CHPS zones, health centers and hospitals as well as private facilities to the districtsmonthly using the prescribed reporting forms. Ghana Health Service has been given themandate by the Ministry of Health to collect health service data from all facilities in the
district, including Private and CHAG facilities. This can be sent as a hard copy orelectronic using the DHIMS2. District validation teams should validate the reports before itis entered into the DHIMS2. The Districts should then enter the data into DHIMS2 tomake it available to the Regional level. Each unit at the district level should beresponsible for entering data from their service area. District Health Information Officerswill enter the data that do not have officers assigned. The Regional reports from theirrespective districts will be available to the National Level through the DHIMS2.
To augment the routine data collected, the health sector will work with some of itsstakeholders to undertake joint periodic health surveys such as the Demographic andHousehold Survey (DHS) and the Multi-indicator Cluster Survey (MICS). These surveyswill generate additional indicators for monitoring and evaluation.
8.2. REVIE W PROCESS I N TH E GHANA H EAL TH SERVI CE
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performance and to highlight their key challenges for discussion. This review should
culminate in a final district report based on the guidelines provided by the PPMED whichshould be submitted to the regional level.
The second level of collation and analysis should take place at the Regional level. Thismust be preceded by the regional performance hearing sessions, involving all DistrictHealth Directorates, district and regional hospitals, training institutions, CHAG facilities,Regional Health Directorates and other stakeholders at the regional level. National teams
attending these reviews should include health information officers, policy-makers, clinicaland public health specialists, health and development partners These reviews shouldculminate in a final regional report based on the guidelines provided by the PPMED. Thereport should be sent to the National level PPMED
At the National level, the first Senior Manage rs Meeting (SMM 1) should be organizedwithin the first quarter of the succeeding year and focused to reviewing Regional and
National Performances through a series of regional and divisional presentations. This willform the basis for preparing the GHS Annual Report. The National level PerformanceSessions should be attended by the GHS Council.
The GHS will make presentations on the performance of the year-under-review at theMoH- Inter-agency review and at the Health Summit. There will be an annualindependent performance review of the entire Health Sector by an independent team ofconsultants. This independent review should also include a review of the performance ofthe M&E System of the GHS.
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8.4. PLAN FOR EVALUTAIONEvaluation is at the heart of the decision-making process and determines the value of anintervention or programme, to inform its adoption, rejection or revision. Evaluation makesuse of assessment data in addition to many other data sources and measures how wellactivities have met expected objectives. The evaluation process provides valuableinformation for management and draws lessons for future actions.
At the end of the implementation of the HSMDP, the Ghana Health Service together withother agencies of the Ministry of Health will be involved at all levels to evaluate theperformance of the sector.
The following steps can be used at all levels in the service to evaluate programmeimplementation within the GHS
Identify and engage stakeholders Involve partners to work on the Logic Model for the evaluation
Define the outcome objectives and impact objectives
Gather credible data/evidence
Organize and interpret results and draw conclusions
Prepare and disseminate reports
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9. QUALITY ASSURANCE
9.1. Ensur ing Data Quality
Data veracity, put in a nutshell, its completeness, consistency, accuracy, integrity ispivotal to effective planning, implementation and improvement of health services as wellas programme evaluation. Authentic data informs enhanced patient care, better use of
health insurance, more appropriate and better defined priorities of the service.
Poor data quality is common in the health sector. The trail of upward reporting to eachlevel is beset with an array of data quality issues that range from inadequatedocumentation and storage, poor analysis and improper interpretation, poor presentationand non dissemination in many cases. The lack of integrity of data generated from thelower levels may well be in part the direct consequence of its low utilization in decision-
making in the service. These have been identified by a number of health sectorassessments in Ghana 1. It becomes tempting to blame the original source of data for anyand all errors that appear downstream. However, any efforts to improve data quality willonly be meaningful when these are part of an overarching quality culture that mustemanate from the apex of an organization. 2
Currently, existing GHS data quality audit activities conducted have been collected into a
useful data repository and these have been used to develop tools and training modules toensure correct and consistent data at every level in the Service. These activities areamong the nascent scheme the GHS is effecting to build a rigorous data quality
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compulsory participation of all service providers and supervisors. These activities will be
further augmented by institutions through monthly data validation sessions at all servicedelivery points before data reports are signed, stamped and forwarded by the officerdesignated for the purpose.
Where data is submitted upwards and to succeeding levels in hard copy, a hard copy ofthe original will be kept in the submitting institution s file. This will be well-labelled (dated,stamped, named, batched) and stored in an orderly fashion for easy retrieval. Where the
data are transmitted electronically using external storage devices (pen/flash drive, CD-Rom, external hard drive) the copy of the original should be filed properly in clearlyidentifiable folders with regular backup. Where data is transmitted by email, the originalemail should not be deleted.
9.3. Standard Operating Procedur esGHS has developed a set of Standard Operating Procedures (SOPs) to guide datamanagement. These SOPs for improving data quality are a set of written instructions thatdocument the routine or repetitive activities to be followed by the various levels datacollection and aggregation in the GHS. It will detail regularly recurring work processesthat are to be conducted for data collection, data processing, use and transmission. TheSOP will also facilitate the way activities are performed to enhance compliance andmaintain consistency with technical and quality guidelines for quality data. Training will beorganized at all levels in the service in the use of the SOPs for data management.
9.4. I mproving Ti meli ness, Completeness and Accuracy of Tr ansmit ted data
Data must be collected collated analyzed and delivered within an agreed period To
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Regions to GHS HeadquartersGHS
Headquarters monthly
25 of thefollowingmonth
GHS Headquarters to MOH MOH Quarterly
Two monthafter thequarter
Transmitted data must be complete. The reported data must include inputs from allreporting units, all required fields must have valid data, and the document must be signedstamped and dated by the officer responsible.
All data submitted must be consistent with what is on the original file at all times. Thedeployment of the internet based DHIMS2 will contribute significantly to improving thetimeliness of reporting...
9.5. Data Quali ty Audi t
GHS has initiated its process of periodic audit of reported data at point of data collectionor aggregation. The audit teams must be made up of personnel from a higher level (e.g.national to regional; regional to district, district to facilities). These teams should makescheduled visits to data aggregation levels or facilities and audit their reported data. Thisexercise will provide the platform for a more robust and rigorous data managementsystem that would identify strengths and gaps in data.
This exercise will also include a data verification process to track published data to the
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accuracy of the report and submit a quick report to the sender. This immediate feedback
to the sender offers the opportunity for quick updates for completeness and correction ofminor errors and it serves as a capacity building activity.. Written feedback should be based on more in-depth analysis of data from varioussources. This technique of feedback unearths data inconsistencies, enables analysis andcomparison of trends and performance with peers. The process should look at thestandards, the performance of the various districts and facilities and the gaps that are to
be filled.
A technical data quality team preparing the feedback reports is to pay attention to qualityissues including data completeness and correctness
Regular feedback on all reports submitted will be encouraged at performance review
meetings. These should give opportunity to carry out peer comparison, receiveexplanations and opportunities for learning.
9.7. Documentation
Any feedback given, whether in relation to completeness, accuracy, timeliness orconsistency should be filed. In addition, any suggestions made to guide the resolution ofobserved gaps in the report should be documented and filed.
Data already submitted should only be changed when there is enough documentation onth f h d th d t t itt d t ll l l t th ti Thi
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10. REPORTS
10.1. REPORTI NG M I LE STONES All Districts, regions and divisions are expected to provide quarterly updates on theirroutine activities and any new initiatives planned for the year. The half-year and annualreports will also be expected to be produced by all Divisions, Regions, Districts andHospitals.
10.2. PROGRAM M ES/PROJECT M ONI TORIN GRegions and Divisions implementing programs and/or projects are to provide quarterlyupdates using the project/programs monitoring matrix. The required information includesbudget execution regarding the project or program, and the status of implementation.
10.3. FI NANCI AL REPORTS All BMCs in the GHS are to submit monthly and quarterly updates on their revenue andexpenditure depending on the type of financial data and the reporting level - as indicatedin the table below. Receipts from donors are reported as schedules in the consolidatedfinancial reports for the period under review.
TABLE: FINANCIAL REPORTING FRAMEWORK - CONSOLIDATED FINANCIALREPORT
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Consolidated Balance Sheet " quarterly /annually 3 monthsafter period
Consolidated Revenue and ExpenditureStatement "
quarterly /annually
3 monthsafter period
Cash Flow Statement "quarterly /annually
3 monthsafter period
Consolidated Programme FinancialReports "
quarterly /annually
3 monthsafter period
10.4. FI NANCIAL AUDIT REPORTS
10.5. GHANA H EAL TH SERVI CE REPORT
An annual progress report indicating the extent to which goals and objective of the POWare being achieved should be prepared every year by Districts, Regions, Programmes,Divisions and National. The report will rely on the various reviews carried out in theservice. Half year reports should also be written by the various levels to track the
performance against set targets.
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11. GOALS AND OBJECTIVES OF THE MONITORING AND EVALUATION SYSTEMWITHIN THE GHANA HEALTH SERVICE
The overall goal of the Ghana Health Service M&E system is to support the Ghana HealthService to achieve the impact and outcomes articulated in the Health Sector MediumTerm Development Plan, as well as the programme works developed from it. This will bedone by collecting, analyzing and disseminating data to:
1. Enhance understanding the of the trends in the various service outcomes2. Monitor progress with implementation of planned activities and interventions.3. Assess the effectiveness of the health interventions at national and sub-national
levels.4. Monitor funds provided for service activities
1. Inflows2. Expenditure
3. Budget5. Identify gaps and emerging needs.6. Guide the selection and application of solutions to address identified gaps and
emerging needs.7. Ensure accountability to stakeholders including.
11.1. STRATEGIES TO ADDRESS M ONITORIN G AND EVAL UATI ON GAPS
Work force gap
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2. Leadership and Governance gap
a. Make M&E a priority in PoWb. Advocate to increase budget allocation to create a more robust M&E system bothinternally and externally
c. Establish two-way feedback mechanisms to identify gaps requiring revision,greater coordination and alignment of process indicators.
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12. M&E ACTIVITIES, TIMELINES AND BUDGET
TABLE 8: M&E Act ivi t ies and Timel ines
Description of Majoractivities
Key Deliverables Timeframe Comments2010 2011 2012 2013
1.RESOURCEMANAGEMENT GAPa. Improve DataManagementDevelopment andDeployment ofDHIMS2(Web based datacollection software)
DHIMS2 Developed and deployedwith URL made available to all datamanagers
X X
District and RegionalData Validation meetings
District Regional Data validationteams meetings held in all districtsand regions
X X X Organized Monthly Nationalteams will visit few regionalvalidation meetings
Print and distributeprimary data captureforms/registers to bothprivate and public healthfacilities in the Districts.
Registers and data capture toolsavailable at all facilities/districts inGhana both private and public
X X X
JointMonitoring(Managerial)Visits to Regions andDistrict
Joint monitoring visits held. X X X Will be done twice in a year
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Develop pre-servicetraining modules forhealth service datamanagement for health
training schools
Pre-service modules developed inuse in the health training institutions
X X X
2. LEADERSHIP ANDGOVERNANCE GAP1. Improve the useof Data for decisionmaking
Annual Regionalperformance reviews
District and Regional Annual reviewsheld
X X X
Senior ManagersMeetings
Senior Managers Meetings Held X X X
GHS Headquarters Annual review meeting
GHS Headquarters annual reviewmeeting held
X X X
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TABLE 9: BUDGET FOR THE MONITORING AND EVALUATION PLAN
2011 2012 2013
N u m
b e r
P r o g r a m m
e
D e s c r i p t i o
n
D e s c r i p
t i o n
o f
I t e m
o r a c t i v
i t y
D e
t a i l
D e s c r i p
t i o n s
C o s
t $
D e
t a i l
D e s c r i p
t i o n s
C o s
t $
D e
t a i l
D e s c r i p
t i o n s
C o s
t $
T o
t a l C o s t
$
A Improve Data Management -Development and Deploymentof DHIMS2 (Web based datacollection software)
DHIMS2 Developed anddeployed with URL madeavailable to all data
managers
Developmentof DHIMS2 andtraining
900,000 Training ofmanagers onDHIMS2
460,000 Improvementin DHIMS2software
80,0001,440,000-
District and Regional DataValidation meetings
District Regional Datavalidation teams meetingsheld in all districts andregions
OrganizedMonthly National teamswill visit fewregionalvalidationmeetings
120,000 OrganizedMonthly National teamswill visit fewregionalvalidationmeetings
120,000 OrganizedMonthly National teamswill visit fewregionalvalidationmeetings
120,000 360,000-
Print and distribute primary datacapture forms/registers to bothprivate and public healthfacilities in the Districts.
Registers and data capturetools available at allfacilities/districts in Ghanaboth private and public
Printing ofregisters anddata collectiontools(once ayear)
200,000 Printing ofregisters anddata collectiontools(once ayear)
250,000 Printing ofregisters anddata collectiontools(once ayear)
300,000 750,000-
Joint Monitoring(Managerial)Visits to Regions and District
Joint monitoring visits held. Will be donetwice in a year
100,000 Will be donetwice in a year
100,000 Will be donetwice in a year 100,000
300,000-
Technical Monitoring visits toRegions and Districts
Technical Monitoring visitsheld. Will be donetwice in a year
13,000 Will be donetwice in a year
13,000Will be done
twice in a year 13,000-
39,000
B Improve ICT infrastructure -
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Procure Office equipment (desktop, lap tops, printers scanners,accessories and internetmodems
ICT equipment procured forregions and CHIM (Servers,computers, printers andUSB modems.
Aim to equipall districts withICT equipment
350,000 Aim to provideservers for allRegions andstrengthenCHIM
1,000,000 New districtsequipped
75,000 1,425,000
Host and maintain Server forDHIMS2
Server for DHIMS hostedand accessible for dataentry, analysis andreporting.
Payment willbe annually
40,000 Payment willbe annually
40,000 Payment willbe annually
40,000 120,000
Workforce GapDevelop Human Capacity for M&E
Train National, Regional andDistrict Teams on Monitoringand Evaluation
National, Regional andDistrict Teams trained inMonitoring an evaluation
Will aim tobuild capacityover the fouryears of theHSMTDPimplementation
350,00 Will aim tobuild capacityover the fouryears of theHSMTDP
implementation
200,000
Will aim to buildcapacity overthe four yearsof the HSMTDPimplementation
100,00 650,000
Train National, Regional andDistrict Teams on Data Quality
Audit
National, Regional andDistrict Teams trained indata quality audit
Training ofRegionalTeams to traindistrict teams
350,000 Training ofRegionalTeams to traindistrict teams
350,000 Training ofnew districts
120,000 670,000
Train District and RegionalTeams on SOPs on datamanagement and DataUtilization.
Regional and DistrictTeams trained
SOPs will bedevelopedDistrict/regionalteams trained
Develop pre-service trainingmodules for health service datamanagement for health training
schools
Pre-service modulesdeveloped in use in thehealth training institutions
Moduleswill bedeveloped
15,000 Training oftutors ofschools
250,000 265,000
Leadership And Governance Gap-
Improve the use of Data for decision making-
Annual Regional performancereviews
District and Regional Annual reviews held
Held once ayear in all theRegions
800,000 Held once ayear in all theRegions
850,000 Held once ayear in all theRegions
900,0002,550,000
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Senior Managers MeetingsSenior Managers MeetingsHeld
Held fourtimes in theyear
50,000 50,000 60,000 160,000
GHS Headquarters Annualreview meeting
GHS Headquarters annualreview meeting held
Held once ayear
4,000 Held once ayear
4,000Held once a
year
5,00013,000
-Half Year Review performancereview meetings held at theRegional Level
Half year review meetingsheld
Held by allRegions oncea year
500,000 Held by allRegions oncea year
500,000 Held by allRegions once ayear
600,000 1,600,000
Improving Data Quality
Standard Operation ProcedureManual Development
Develop SOP datacollection
Technicalmeetings todevelop SOP,Stakeholderinteractions ondocument
62,000
Train staff in the use ofSOP
Regional TOTTraining onSOPs
10,000 Districttrainings onSOPS
120,000 130,000
Review SOP Documentannually
Review ofSOP
20,000 Review andreprinting 150,000 170,000
Data validation routinesSet up data validation teamat each level of datamanagement
Meeting withRegional DatavalidationTeams
13,000 Formation ofDistrict DatavalidationTeams
210,00 223,000
Develop work plan for datavalidation
Technicalmeetings todevelop datavalidation workplan
2,000 2,000
Hold data validationmeetings
Regional andNational Datavalidationmeetings heldquarterly
76,000 Regional andNational Datavalidationmeetings heldquarterly
80,000 Regional andNational Datavalidationmeetings heldquarterly
85,000 241,000
Data TransmissionProcure data transmissionequipments e.g., externalstorage device, back-up
Procuremodems for alldistricts
10,200 10,200
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system, modems, routers
Establish data transmissionmechanism e.g. Internetconnectivity for CHIM
Payment ofbills once a
year
3,000 Payment ofbills once a
year
3,000 Payment ofbills once ayear
3,000 9,000
GRAND TOTAL 3,968,0000 4,620,000 2,751,000 11,339,000
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APPENDIX 1.
INDICATORS TARGETS AND MILESTONES FOR MONITORING AND EVALUATION
INDICATOR2010
Baseline2011
Target2012
Target2013
TargetData
sourcesMeasurement Monitoring
FrequencyResponsibility
HO1 Bridgeequity gaps inaccess tohealth careand nutritionservices andensure
sustainablefinancingarrangementsthat protectthe poor No. offunctionalCHPS zones
840 840 900 RoutineDate-District/Regional Reports
Number ofCHPS zoneswith CHOsoffering homevisits andother services(Home visitentails ANC,PNC,Immunization,Growthmonitoring,Nutrition
Bi-annual Annual
DDHS/RDHS
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INDICATOR2010
Baseline2011
Target2012
Target2013
TargetData
sourcesMeasurement Monitoring
FrequencyResponsibility
in the
catchmentarea of all thefunctionalCHPS zones.
Denominator :
TotalPopulation ofthe District
Population todoctor ratio
11,500 10,500 9,700 9,500 HumanResource
andDevelopmen
t DivisionReports i
The ratio ofthe number ofpeople to onepublic sector
doctor
Numerator: Total
population
Denominator:
Number ofdoctors in thepublic sector
Annual RDHS/DirectorHuman Resourceand Development
Division
Population tomedicalassistants/phys 48,641 43,340 38,634 30,709
HumanResource
and
The ratio ofthe number ofpeople to one
Annual Director HumanRDHS/Resource
and Development
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INDICATOR2010
Baseline2011
Target2012
Target2013
TargetData
sourcesMeasurement Monitoring
FrequencyResponsibility
ician assistant
ratio
Developmen
t DivisionReports
public sector
medicalassistant/physi
cian assistant
Numerator: Total
population
Denominator:Number of
medical
assistants/physician
assistant inthe public
sector
Division
Population tonurse (allcategories)ratio
1:1,100 1:1,000 1:900 1:800 HumanResource
andDevelopmen
t DivisionReports
The ratio ofthe number ofpeople to onepublic sector
nurse (allcategories)
Numerator:Total
Population.
Denominator:
Annual RDHS/DirectorHuman Resourceand Development
Division
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INDICATOR2010
Baseline2011
Target2012
Target2013
TargetData
sourcesMeasurement Monitoring
FrequencyResponsibility
Total number
of nurses inthe Public
Sector
Population tomidwives ratio
8,336 7,431 6,625 5,800 HumanResource
andDevelopmen
t DivisionReports
The ratio ofthe number ofpeople to one
midwife
Numerator:Total
Population.
Denominator:Total number
of midwives
Annual RDHS/DirectorHuman Resourceand Development
Division
Percentage ofUnder fiveyears who areunder weightpresenting at
facility andOutreach
11.32 9.98 8.64 7.3 District andRegionalHealthServicesReports
Percentage ofchildren under5 who werefound to beunderweight(weight forage below -2Z score )facility andOutreachNumerator:Total numberof Childrenfound to be
Annual Regional Directorsof HealthServices/DDHS
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INDICATOR2010
Baseline2011
Target2012
Target2013
TargetData
sourcesMeasurement Monitoring
FrequencyResponsibility
underweight(