Monitoring and EvaluationMonitoring and Evaluation

Charles Katende PhD.Charles Katende PhD.

Director of Monitoring, Evaluation and ResearchDirector of Monitoring, Evaluation and ResearchJHPIEGO JHPIEGO (An affiliate of John Hopkins University)(An affiliate of John Hopkins University)

Session ObjectiveSession Objective

• To increase participants understanding of the concepts used in designing M&E Frameworks and Plans

• To build participants competence in designing Program M&E Plans

Expected ResultsExpected Results

• At the end of the sessions participants will know about Program frameworks, M&E frameworks and the difference between the two frameworks

• Participants will be able to identify and select appropriate indicators for a program.

• Participants will be able to produce a program monitoring and evaluation framework.

Introduction…Introduction…

• Write the health problem addressed by a major public health program in your country

• Write at up to three specific objectives of a public health program that addresses the above mentioned health problem.

• Write down two indicators the program mentioned above uses to monitor it progress or performance towards its objectives.

What is What is ProgramProgram Monitoring, Evaluation? Monitoring, Evaluation?

Monitoring is the routine process of data collection and measurement of progress toward program objectives.

Evaluation is the use of social research methods to systematically investigate a achievement of a program’s results

Key QuestionsKey Questions

• What is the purpose of carrying out M&E

• Who needs, uses M&E Information

• Who carries out M&E?

• How is M&E carried out?

• When should M&E be carried out?

What is the purpose….?What is the purpose….?

• Improve program implementation– Data on program progress and implementation– Improve program management and decision making

• Inform future programming

• Inform stakeholders – Accountability (donors, beneficiaries)– Advocacy

Who needs, uses M&E Information?Who needs, uses M&E Information?

To Improve program implementation…

To Inform and improve future programs

Inform stakeholders

• Managers

• Donors • Governments• Technocrats

• Donors• Governments• Communities • Beneficiaries

Who conducts M&E….?Who conducts M&E….?

Program implementer

Stakeholders

Beneficiary

Remember ..

M&E Technical skills

Participatory process

How to carry out M&E…? How to carry out M&E…? Key FeaturesKey Features

1. Program Framework: Analyze and systematically lay out program elements

2. Identify key elements to monitor and evaluate.

3. Determine and describe the measures to be used for monitoring and evaluation

4. Develop M&E Framework and action plans, including data collection and analysis, reporting and dissemination of findings.

Program FrameworkProgram Framework

What do you know about your program….?What do you know about your program….?

Program FrameworkProgram Framework

• Systematic lay out of the program elements and path showing what the program plans to:

do ……………..achieve!

Program FrameworkProgram Framework

• Based on a theoretical, empirical model, or general understanding

Public health Problem

Population, system level factors that cause the public health problem

Action/interventions that can change the factors and ultimately alleviate/eliminate the problem

Results FrameworkResults Framework

Improved Health Status

Improved (Sustained) Use of Key Health Services and Practices/BehaviorsStrategic Objective:

Intermediate Result: Increased quality of…

Increased availability/ access to…

Strategies (Sub IR):Strategies: Strategies:

Improved social / policy environment…

Strategies:

Impact:

Example: Result Framework for a Example: Result Framework for a Family Planning ProjectFamily Planning Project

                                    

GOAL: REDUCED FERTILITY

SO: Increased FP use and improved FP/RH practices

Increased knowledge of, improved attitudes toward, and acceptance of key services and behavior

Increased quality of FP counseling and services for

Increased availability/access to FP/RH

Strategies:

 Increase availability of educational materials at clinic and community level

• Community mobilization (using PRA and PDI) including men

• Implement mass media strategy

• Mobilize opinion leaders at national and local level

Design/ implement supportive supervision System

• Train service providers (in-service and preservice in FP counseling and management of side effects

• Remodel clinic to allow for privacy

• Design and implement quality improvement program

Strengthen logistics management

• Mobilize private sector providers

• Mobilize CHWs/CBDs• Encourage socially

marketed pills

                                    

Improved social and policy environment for FP

Advocate for community based distribution of pills

Promote addition of Depo injections to EPI outreach strategy

Pilot social marketing of pills

Basic Logic ModelBasic Logic Model

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VCT Program Implementation Logic ModelVCT Program Implementation Logic Model

Train nurses & lab techs in VCT

ACTIVITIES OUTPUTSIMMEDIATE OUTCOMES

INTERMEDIATEOUTCOMES

IMPACTSINPUTS

Risk behaviors decreased

HIV treatment increased

NursesLab techs

Provide pre-test counseling

Conduct HIV test

Provide post-test counseling to all clients tested

Refer pregnant HIV+ women to

PMTCT svcs

Govt. fundsGAP funds

Other donor funds

Counseling protocol

HIV test kits

Referral system for

prevention & Tx services

Refer HIV+ clients to Tx

services

Clients are counseled for

HIV testing

Clients are tested

Clients receive results and post-test counseling

Pregnant HIV+ women referred to PMTCT svcs

HIV+ clients referred to ARV, support & HBC

Quality of VCT increased

Access to VCT increased

Knowledge of HIV status increased

Knowledge about & access to prevention

resources increased

Access to HIV treatment resources increased

HIV transmission rates decreased

HIV prevalence decreased

HIV morbidity & mortality

decreased

Nurses & lab techs trained

PROJECT DESIGN FRAMEWORK LABELS

Labels Used By Various Organizations

Project Design Level USAID Others

Impact Impact Goal

Strategic Objectives Purpose

Intermediate Results (IR) Specific Objectives

Startegies (Sub-IR) Outputs Activities

Outputs Activity Clusters Activities Inputs

Level A: Improvement

in Health Status

Level B: Use of

Services

Level C: Demand for Services

Capacity to Deliver

Services Level D:

Interventions

Case 1: To decrease maternal mortality, a 10-year program plan to improve to train midwifes to Delivery and ANC services at health facilities, and to train and deploy CHWs to increase the community’s awareness about, and use of the improved services at the health facilities.

Case 2: To reduce high fertility, a 5-year program plans to work with the Government to change policies in order to allow and promote use of modern family planning methods, train family planning providers to provide better FP services, and to launch public campaigns that promote family planning methods.

Case 3: To reduce HIV infection among adolescents, a five-year program plans to implement income generation activities for the youth, provide and promote universal secondary education, and build adolescent-friendly reproductive health service delivery points.

ExerciseExercise

• Identify and state is the Public Health problem implied in the case study.

• What are population level factors will the program target to change in order to alleviate the public health problem

• Prepare a Program Framework for the scase study

Monitoring and Evaluations Monitoring and Evaluations FrameworkFramework

M&E QuestionsM&E Questions

• Monitoring questions– What is being done?– By whom?– Target population?– When?– How much?– How often?– Additional outputs?– Resources used? (Staff,

funds, materials, etc.)

M&E QuestionsM&E Questions

• Evaluation Questions?

– Is the content of the intervention or the activity being delivered as planned?

– Does the content of the intervention or the activity reflect the requisite standards?

– Have the intervention achieved the expected results?

What do we need to answer these questions…?What do we need to answer these questions…?

INDICATORS INDICATORS …to take measurements.…to take measurements.

Indicators: DefinitionIndicators: Definition• Markers that help to measure change by

showing progress towards meeting objectives

• Observable, measurable, and agreed upon as valid markers of a less well-defined concept or objective

• Indicators differ from objectives in that they address specific criteria that will be used to judge the success of the project or program.

See comment for examples

Type and Level of Each IndicatorType and Level of Each Indicator• Type

– Input/Process (Monitoring)

– Outcome / Impact (Evaluation)

• Level

– Global level

– Country level

– Program level

Exercise: Group workExercise: Group work

• Use your case study and identify at least two indicators for program monitoring and two indicators for program evaluation.

What Is a Good Indicator?What Is a Good Indicator?• Valid: Measures the effect it is supposed to measure

• Reliable: Gives same result if measured in the same way

• Precise: Is operationally defined so people are clear about what they are measuring

• Timely: Can be measured at an interval that is appropriate to the level of change expected

• Comparable: Can be compared across different target groups or project approaches

Criteria for Indicator SelectionCriteria for Indicator Selection

• Consistent with project design—measure the desired result

• Useful—contributes to project design, management, and evaluation

• Available

• Affordable

Standard IndicatorsStandard Indicators

Where possible, a project should select standard indicators.

• They have been tested for validity and reliability.

• They allow comparison between projects or sites.

• They tend to be available for SOs and some IRs.

How Many Indicators?How Many Indicators?• Choose at least one or two indicators per intermediate

result, as well as the SO for evaluation purposes.

• Choose one or two indicators per result for program monitoring.

• Choose indicators that may be able to “cover” more than one element.

• For management, think about basic activities that you need to monitor to judge if you are implementing activities as planned; include indicators that help you make decisions.

Exercise: Group workExercise: Group work

Refer to the indicators you selected..

• Were the good indicators ?

• Did you select a minimum number recommended given the type and size of your program?

M&E FrameworkM&E Framework

Sample M&E FrameworkSample M&E Framework

Result Indicator Definition Data source

Collection Method

Freq-uency

Respons-ible Party

Active Management of the Third Stage of labor increased

Proportion of trained clinicians performing AMTSL to standard

# of trained midwives performing all steps of AMTSL on all patients/

AMTSL observa-tion checklist

Clinical observation

Annual Zambia JHPIEGO staff

Preventing Post Partum Hemorrhage : Preventing Post Partum Hemorrhage : Increase Active Management of the Third Stage of LaborIncrease Active Management of the Third Stage of Labor

See comment for examples

M&E PlanM&E Plan• The plan is a managerial tool that specifies the schedule, resources,

responsibilities, for your M&E activities (data collection, data quality control, reporting, dissemination and use of data)

• Note: – The plan should specify the time points when evaluations will be carried

out, for example: Midterm, and End term.

– Outcome/Impact evaluation is reserved for large longer term programs that can make impact at public health status level.

– Your plan should include activities to monitor and evaluate the implementation, as planned, of the M&E plan.

Strategic Planning for M&E: Setting Realistic Expectations

Most Some Few *All

Monitoring and Evaluation Pipeline

Adaptation of Rehle/Rugg M&E Pipeline Model, FHI 2001

Input/Output Monitoring

Process Evaluation

Outcome Monitoring/ Evaluation

Impact Monitoring/ Evaluation

Levels of Monitoring & Evaluation Effort

Number of Projects

* Supplemented with impact indicators from surveillance data.

Source: CDC. Global AIDS program monitoring and evaluation (M&E) field guide

QuestionQuestion

If funding for your case study program was cut off and the program closed in two years. What changes would you make to you M&E Plan?

Sources of InformationSources of Information• http://www.cpc.unc.edu/measure

• http://www.unaids.org/DocOrder/OrderForm.aspx

• http://www.fhi.org/en/Publications/index.htm

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